title: Sustainability: orthopaedic surgery wait time management strategies.
abstract: OBJECTIVE
  The purpose of this paper is to examine Canadian organizational and systemic factors that made it possible to keep wait times within federally established limits for at least 18 months.
  
  
  METHODS
  The research design is a multiple cases study. The paper selected three cases: Case 1 - staff were able to maintain compliance with requirements for more than 18 months; Case 2 - staff were able to meet requirements for 18 months, but unable to sustain this level; Case 3 - staff were never able to meet the requirements. For each case the authors interviewed persons involved in the strategies and collected documents. The paper analysed systemic and organizational-level factors; including governance and leadership, culture, resources, methods and tools.
  
  
  RESULTS
  Findings indicate that the hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit.
  
  
  CONCLUSIONS
  The authors' research highlights an important gradient between three cases regarding the factors that sustain waiting times. The paper show that the hospital factory model seems attractive in a super-specialized surgery context. However, patients are selected for simple surgeries, without complications, and so this cannot be considered a unique model.
authors.affiliation: Collaboration for Innovation and Improvement, Canadian Foundation for Healthcare Improvement, Ottawa, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Amar
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Pomey
authors.forename: Claudia
authors.initials: C
authors.lastname: SanMartin
authors.forename: Carolyn
authors.initials: C
authors.lastname: De Coster
authors.forename: Tom
authors.initials: T
authors.lastname: Noseworthy
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000706:statistics & numerical data; D019645:Arthroplasty, Replacement, Knee / Q000706:statistics & numerical data; D002170:Canada; D006297:Health Services Accessibility; D006739:Hospital Administration; D006801:Humans; D007407:Interviews as Topic; D017146:Models, Organizational; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D009937:Organizational Objectives; D009985:Orthopedics; D015397:Program Evaluation / Q000379:methods*; D014850:Waiting Lists
keywords: Canada; Management; Strategies; Sustainable services; Waiting time