Auckland algorithm improves equity of waitlists

NEWS - eHealthNews.nz editor Rebecca McBeth

An equity adjuster-waitlist tool is live across all surgical services at Te Whatu Ora Te Toka Tumai Auckland and is due to roll-out at Waitematā and Counties Manukau.

The adjuster aims to reduce inequity in the system by using an algorithm to prioritise patients who have been waiting a long time for surgery according to five areas; clinical priority, time spent on the waitlist, geographic location (isolated areas), ethnicity (specifically Māori or Pacific people) and deprivation level.

Dawson Ward, acting director adult surgical, says three years ago Te Toka Tumai set up navigation teams for Pacific and Māori patients to facilitate looking at the surgical waitlist and this identified some equity issues around access to care.

A steering group was created to build an equity adjuster, which included data and analytics staff, the Māori health team, Pacific health team, and surgical services leadership.

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Together they developed an algorithm covering five areas with different weightings, to adjust where someone sits on the waitlist. It was piloted in the urology surgical service at Auckland Hospital and had a positive impact on equity.

As of February this year, the adjuster is live across all surgical services in Te Toka Tumai, including at Starship Children’s Hospital, and is now being rolled out for first specialist appointments.

“We have demonstrated by the use of data that this is the right thing to do and is getting the results we want, so there is a lot of enthusiasm to roll it out further,” Ward explains.

He says implementing the adjuster is done in close collaboration with clinical services, who make the ultimate decision about the waitlist.

Greg Williams, interim chief digital officer, says by the time patients get on to a hospital waiting list, they have already faced a variety of hurdles, which make the system inequitable.

“By the time patients engage with our part of the system, there is already a number of entrenched inequities which have led to that point, so this calculation is trying to undo some of the upstream inequity,” he says.

“If we apply a first come first served approach, then you carry forward whatever inequities are already at play.

Williams says there is a huge trust element involved in the project and if there are blockades to a patient getting treatment, Māori or Pacific navigators can work with them to overcome these.

“This tool helps us to realise who those patients are who need that extra bit of help,” he says.

“If the people who can potentially benefit from our services don't trust our services, then we will not have the impact we are looking for, so nagivation teams are central as they help build trust that the system is reflective of their needs.”

Williams says the Covid-19 pandemic had a negative impact on equity globally so it is hugely beneficial to have the equity adjuster in place to help address the problem.

Following intense media interest in the tool Prime Minister Chris Hipkins has asked Health Minister Ayesha Verrall  to take a look at the equity adjuster "to make sure that there is a reassurance that we are not replacing one form of discrimination with another."

This story was updated on June 21, 2023

Picture 1: Greg Williams, interim chief digital officer, Te Whatu Ora Te Toka Tumai Auckland
Picture 2: Dawson Ward, acting director adult surgical, Te Whatu Ora Te Toka Tumai Auckland

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