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Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

Marie-Pascale Pomey1*, Pierre-Gerlier Forest2, Claudia Sanmartin3, Carolyn DeCoster4, Nathalie Clavel1, Elaine Warren5, Madeleine Drew6 and Tom Noseworthy7

Author Affiliations

1 Department of Health Administration, Institut de Recherche en Santé Publique de l’Université de Montréal (IRSPUM), University of Montreal, 7101 Parc Avenue, Montreal, Quebec, H3N 1X7, Canada

2 Pierre Elliott Trudeau Foundation, 1514 Docteur-Penfield Avenue, Montreal, Quebec, H3G 1B9, Canada

3 Health Analysis Division, Statistics Canada, 150 Tunney’s Pasture Driveway, Ottawa, Ontario, K1A 0T6, Canada

4 Data Integration, Measurement & Reporting Service, Alberta Health Services, 10101 Southport Road SW, Calgary, Alberta, T2W 3N2, Canada

5 Surgical Services, Eastern Health, Health Sciences Centre, Prince Philip Drive, St. John’s, Newfoundland, A1B 3V6, Canada

6 Accreditation Canada, 1150 Cyrville Road, Ottawa, Ontario, K1J 7S9, Canada

7 Department of Community Health Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada

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Implementation Science 2013, 8:61  doi:10.1186/1748-5908-8-61

Published: 6 June 2013



Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level.


A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience.


Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers.


Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

Wait times; Management strategies; Scheduled care; Implementation and Sustainability factors