Significant early positive cultural changes have been made in the Ontario healthcare system to address the province's Wait Time Strategy. Improving efficiency in parallel with the introduction of accountability agreements will provide early successes. However, there are fundamental system weaknesses that must be addressed in the long term to sustain the program. These include a wait list information system that addresses all patients waiting for care, additional healthcare providers with wider scopes of practice, improving hospital capacity, accountability agreements with agreed-upon performance indicators, new payment systems for physicians and a fundamental change in referral and care processes. Innovative approaches such as gain-sharing should be considered. Though resources are scarce, there is a need for significant early additional investments to achieve long-term success.

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