{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:04:48Z","timestamp":1787065488572,"version":"build-2736575974"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T00:00:00Z","timestamp":1723075200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PJT-166108"],"award-info":[{"award-number":["PJT-166108"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Canadian health systems fare poorly in providing timely access to elective surgical care, which is crucial for quality, trust, and satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional analysis of surgical wait times for adults receiving non-urgent cataract surgery, knee arthroplasty, hip arthroplasty, gallbladder surgery, and non-cancer uterine surgery in Ontario, Canada, between 2013 and 2019. We obtained data from the Wait Times Information System (WTIS) database. Inter- and intra-hospital and surgeon variations in wait time were described graphically with caterpillar plots. We used non-nested 3-level hierarchical random effects models to estimate variation partition coefficients, quantifying the proportion of wait time variance attributable to surgeons and hospitals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 942,605 procedures at 107 healthcare facilities, conducted by 1,834 surgeons, were included in the analysis. We observed significant intra- and inter-provider variations in wait times across all five surgical procedures. Inter-facility median wait time varied between six-fold for gallbladder surgery and 15-fold for knee arthroplasty. Inter-surgeon variation was more pronounced, ranging from a 17-fold median wait time difference for cataract surgery to a 216-fold difference for non-cancer uterine surgery. The proportion of variation in wait times attributable to facilities ranged from 6.2% for gallbladder surgery to 23.0% for cataract surgery. In comparison, surgeon-related variation ranged from 16.0% for non-cancer uterine surgery to 28.0% for cataract surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>There is extreme variability in surgical wait times for five common, high-volume, non-urgent surgical procedures. Strategies to address surgical wait times must address the variation between service providers through better coordination of supply and demand. Approaches such as single-entry models could improve surgical system performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0307845","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T13:55:15Z","timestamp":1723125315000},"page":"e0307845","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["Surgeon- and hospital-level variation in wait times for scheduled non-urgent surgery in Ontario, Canada: A cross-sectional population-based study"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3085-9532","authenticated-orcid":true,"given":"Pieter","family":"de Jager","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dionne","family":"Aleman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Baxter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaim","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merve","family":"Bodur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Calzavara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8423-6747","authenticated-orcid":true,"given":"Michael","family":"Carter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Emerson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Gagliardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Irish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcy","family":"SaxeBraithwaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pardis","family":"Seyedi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Takata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suting","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudia","family":"Zanchetta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Urbach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,8,8]]},"reference":[{"key":"pone.0307845.ref001","doi-asserted-by":"crossref","first-page":"e316","DOI":"10.1016\/S2214-109X(15)70115-4","article-title":"Global access to surgical care: a modelling study","volume":"3","author":"BC Alkire","year":"2015","journal-title":"Lancet Glob Health"},{"key":"pone.0307845.ref002","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1177\/0840470419900646","article-title":"Elective surgery wait time reduction in Canada: A synthesis of provincial initiatives","volume":"33","author":"EAB Wennberg","year":"2020","journal-title":"Healthc Manage Forum"},{"key":"pone.0307845.ref003","first-page":"253","article-title":"Access and quality of health care in Canada: Insights from 1998 to the present.","author":"C Samuelson-Kiraly","year":"2020","journal-title":"Healthcare Management Forum. SAGE Publications Sage CA: Los Angeles, CA"},{"key":"pone.0307845.ref004","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1136\/qshc.2003.009001","article-title":"Public trust in health care: the system or the doctor?","volume":"13","author":"MW Calnan","year":"2004","journal-title":"BMJ Qual Saf"},{"key":"pone.0307845.ref005","article-title":"2021: Reflecting Poorly","author":"Mirror Mirror","year":"2021"},{"key":"pone.0307845.ref006","first-page":"E844","article-title":"Wait-time reporting systems for elective surgery in Canada: a content analysis of provincial and territorial initiatives","volume":"8","author":"RE Segall","year":"2020","journal-title":"Can Med Assoc Open Access J"},{"key":"pone.0307845.ref007","article-title":"Population estimates, quarterly.","author":"SC Government of Canada","year":"2018"},{"key":"pone.0307845.ref008","unstructured":"Ontario Health | Ontario Health. [cited 14 February 2024]. Available: https:\/\/www.ontariohealth.ca\/."},{"key":"pone.0307845.ref009","unstructured":"Wait Time Information System\u2014Introduction. [cited 8 January 2024]. Available: https:\/\/ext.cancercare.on.ca\/ext\/databook\/db2223\/WTIS\/WTIS-Introduction.htm."},{"key":"pone.0307845.ref010","unstructured":"Measuring Wait Times for Other Surgeries and Procedures\u2013Health Quality Ontario. [cited 17 April 2023]. Available: https:\/\/www.hqontario.ca\/System-Performance\/Measuring-System-Performance\/Measuring-Wait-Times-for-Other-Surgeries-and-Procedures."},{"key":"pone.0307845.ref011","unstructured":"Wait time metadata | CIHI. [cited 14 February 2024]. Available: https:\/\/www.cihi.ca\/en\/wait-time-metadata."},{"key":"pone.0307845.ref012","doi-asserted-by":"crossref","first-page":"e104","DOI":"10.1016\/j.jcjo.2022.10.014","article-title":"Regional trends in ophthalmic surgical wait times in Ontario","volume":"58","author":"T Felfeli","year":"2023","journal-title":"Canada. 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