Sustaining change: the imperative for patient access strategies.

The paper by Trypuc, MacLeod and Hudson provides a timely and important overview of methods to sustain provincial wait time strategies. The emphasis on accountability for patient access to timely care throughout the healthcare system comes through strongly--as it should. These accountabilities are made "real" through purchase service agreements. Physician-hospital relationships are a fundamental aspect of this accountability. This commentary suggests the inclusion of two additional supporting tools in addition to those cited by the authors of the lead paper--quality monitoring and the use of industrial engineering techniques for queue management and patient flow analysis. Strong and persistent leadership of patient access strategies will ensure sustainable change.