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A Three-Stage Approach to Addressing Ontario’s Critical Surgical and Procedural Wait Times: Ontario Medical Association


Even before the COVID-19 pandemic, Ontario was struggling to ensure patients received timely access to health care. Challenges were particularly acute in areas related to surgery and interventional procedures, where many Ontarians waited far beyond clinical guidelines to access care. The COVID-19 pandemic exacerbated this problem, as hospitals scaled back operating rooms and diagnostic suites to non-urgent procedures, causing wait lists to grow, leading many patients to avoid the health system altogether, and contributing to many missing patients who never entered the care system. Physicians are now reporting that patients are presenting with a range of health conditions (including cardiac disease, cancer, etc.) at a more advanced stage of illness.

Knowing the compounding challenges faced within Ontario’s surgical and procedural delivery system, the Ontario Medical Association (OMA) engaged Santis Health to support the development of a policy proposal for the Ministry of Health, providing innovative recommendations on how to appropriately address current and future surgical and procedural needs in Ontario.

What Santis Did

To develop a strong case for change, Santis conducted multi-jurisdictional policy research and engaged with expert key informants in Ontario and across Canada, including clinical leaders, health system executives, leading policy makers and civil servants. Santis reviewed current access to scheduled care, analyzed how COVID-19 negatively impacted access, and developed a new model for service delivery to expand access and improve health system productivity.

Overall, Santis’ engagement with OMA involved:

  • A comprehensive environmental scan examining the Canadian and Ontario landscape.
  • A broad range of semi-structured interviews with clinical experts, health systems leaders and Ontario civil servants and policy makers.
  • Engagement with OMA physician leaders through customized surveys and focus group sessions.
  • The development of the OMA Policy Paper aligned with OMA’s post-pandemic health system recovery work which identified addressing the care backlog as a key pillar to the province’s health system COVID-19 recovery.
  • Support to launch and promote the Policy Paper throughout the spring of 2022.


Santis and OMA co-developed an innovative new approach to caring for patients who require surgery and procedures as showcased in the “Integrated Ambulatory Centres: A Three-Stage Approach to Addressing Ontario’s Critical Surgical and Procedural Wait Times,” released on February 16, 2022 through the Ask Ontario’s Doctors Media Briefing.

The report recommends Ontario to move beyond the current outdated Independent Health Facilities (IHF) regulatory regimen to introduce a new model of care called Integrated Ambulatory Centres (IACs). At its core, the model recommends a significant shift to outpatient service delivery which have shown to have efficiency gains of 20 to 30%, while closely integrating with the existing acute care system. The creation of new IACs could expand timely access to a range of surgical and diagnostic procedures while improving health system productivity and efficiency. The paper includes a clear implementation blueprint to support a stable multi-year transition to a more distributed ambulatory delivery system. The systematic approach recommends first maximizing all available system capacity and then expanding capacity through a growing network of ambulatory centres that work in close partnership with local hospitals and other health service providers.

The media briefing and news release were both shared on social media, resulting in 219 media mentions, making it the most successful briefing since the launch of OMA’s Prescription for Ontario Plan in October 2021. The recommendations were covered in CBC News, CBC Toronto, CBC radio, Global News, CTV News, CTV Northern Ontario, QP Briefing, Queen’s Park Today and The Canadian Press which was published by 50 news outlets. Dr. Adam Kassam, President of the OMA, also discussed the recommendations on 900 CMHL Hamilton and on a panel with Dr. Mary-Ann Aarts on CP24 Tonight Live.

Building on the release of the report in February 2022 and the momentum it generated, Santis, the OMA and other system leaders came together in the Future of Ontario’s Surgical and Procedural Service Delivery System” webinar in April 2022, for an in-depth discussion on key report findings and next steps.

“Santis’ extensive network, expertise, and political acumen were essential to the successful conclusion of our project. The team was responsive and fabulous to work with. The project was completed on time and more than exceeded our expectations.

James Wright, CM MD MPH FRCSC FRCS (Ed), Executive Vice President, Economics, Policy & Research, Ontario Medical Association