Chapter 1: The patient experience

In its first four months, the Council heard from over 340 patients, and a recurring theme from their stories is what it feels like to wait for health care services in environments that don’t support rest or healing. Many patients described uncomfortably low levels of privacy in emergency departments, and feeling a complete lack of dignity when telling their personal stories and sharing their medical history with a health care provider in a hallway, where everyone could hear. For some people, even something that should be simple – like helping patients get to the washroom on time – was challenging under the current conditions.

Navigation & access to health care

The Council heard that patients and their families find it difficult to navigate the health care system. For some, it’s a matter of not being able to find timely health care, due to long wait-times or inconvenient service hours. For others, it can be difficult to know where to go for the right kind of care. For example, Ontarians often go to the emergency department with mental health or addictions issues that could have been dealt with more quickly, and oftentimes more appropriately, in primary care or community mental health and addictions agencies. By not knowing how to access community services or waiting too long for a community service because there are not enough of those services, many people reach a crisis point that leads them to the emergency department.

"Patients in Ontario are spending an average of 16 hours in the emergency department before being admitted to the hospital, which is the longest that wait has been in 6 years."

Health Quality Ontario, Measuring Up 2018

Either way, it means people are ending up in emergency departments, waiting hours for care that sometimes could have been more appropriately provided in a different care setting, or avoided entirely by proactive and preventative measures. These challenges with navigation and timely access contribute to the problem of hallway health care because the way patients move in and out of hospitals has a significant impact on the efficiency of the entire health care system.

Going to the emergency department for health care that could be provided somewhere else happens frequently in Ontario, sometimes because it’s the only health care setting that is open 24/7. According to the 2018 Health Care Experience Survey, 41% of Ontarians who went to the emergency department, and 93% who went to a walk-in clinic received care for a condition that could have been treated by their primary care provider.footnote 2 Even though 94% of Ontarians have a family doctor or nurse practitioner,footnote 3

While the health care system has evolved over the last 15-20 years, the emergency department still remains one of the only health care settings open and available whenever people get sick and need care. Additional focus on preventative measures, and effective engagement with primary care providers could help reduce the inflow of patients to emergency departments and hospitals, and contribute to reducing the problem of hallway health care.

Wait times & quality care

In general, visits to emergency departments across the province increased by about 11% over the last six years, to 5.9 million in 2017/18.footnote 4 This increase in volume of visits to the emergency department is just one contributing factor to the back-log across the system, since not all visits to the emergency department lead to hospitals admitting patients.

The current recommended target in Ontario – what the province expects from its hospitals – is if a patient is to be admitted, to get the patient to an inpatient room and bed within 8 hours of being seen in the emergency department.footnote 5 However, in November 2018, only 34% of patients admitted to hospital are admitted to an inpatient bed from the emergency department within that 8 hour target.footnote 6 footnote 7

"Half of parents who sought help for mental health services for their child said they faced challenges in getting the services they needed, primarily due to wait times."

– Children’s Mental Health Ontario (November 2017)

Furthermore, patients in Ontario who require admission to an inpatient bed are spending an average of 16 hours in the emergency department before a bed becomes available, which is the longest that wait has been in six years.footnote 8 .


Waiting too long for health care isn’t just a problem in hospitals; wait times are also longer than they should be in other parts of the health care system. For example, the median wait time for long-term care home placement in Ontario in fiscal year 2017/18 was 146 days, and the median wait time for home care was around six days for patients waiting at home.footnote 9.footnote 10

When Ontarians can access services and supports, the data generally tells a positive story. For example, survey results for home and community care show high levels of client satisfaction: 92% of respondents rated their overall experience as excellent, very good or good;footnote 11 however, long wait-times in some parts of the system are a clear signal that the system isn’t running as smoothly as it could. Furthermore, the location of health care services also matters. For example, families describe how complicated it can be to navigate pediatric health care services, and improving access to high quality services closer to home would help families and patients.  

In addition to expecting health services to be available to Ontarians within a reasonable time-frame, the province also expects high-quality care to be provided in every care setting. One way to improve access to care is to ensure people don’t experience avoidable complications while receiving treatment. For example, evidence shows that patients who get certain infections while in hospital have a length of stay that is two weeks longer than it otherwise would have been.footnote 12 These infections, which can be very costly to treat, may be avoided by following best practices in care.

We intuitively know that a delay in accessing health care – whether it’s waiting for a bed to open up in the right care setting, for a diagnostic test, or for a referral to a specialist, means the road to recovery is longer and possibly rougher than it needs to be.

Spotlight: mental health and addictions and hallway health care

The Council is concerned that patients are unable to access mental health and addiction services when they are needed most. For example:

  • Approximately 1 in 3 adults who went to the emergency department for mental health and addictions care had not previously accessed physician-based care for their mental illness.footnote 13
  • There was a 72% increase in emergency department visits and a 79% increase in in-patient admissions for children and youth with mental health issues over the last 11 years.footnote 14

Access to health care at the appropriate place and time is crucial for patients with mental health and addictions issues. Most mental health and addictions issues are more appropriately treated in the community; however, long wait times for community treatment means sometimes patients’ conditions worsen as they sit in the queue, giving them no other option but to seek care through the emergency department, and return home to continue to wait for services. The re-admission rates for mental health and addictions issues is significantly higher than many other health issues.footnote 15