Reasons Why

• Referral process critical issue• Need for engagement, connecting the system• Community building: innovation, adaptation,

learning• Locally grown solution, moving to action• Going slow to go fast• Model supports successful change

Conference Model & System Change

• Overlapping initiatives• DOM Innovation Initiatives• Department of Family Medicine quality initiatives• PCN service development• Chronic Disease Management• Information Management • AH&W Access to Service Projects

• The Issue• connected ‘parts’, point of integration• Seemed too big to solve: diffuse, many owners and

customers

Purpose

Broadly engage people in the health system to collectively re-design the referral process

between primary care and medical specialists so that it supports communication and improves

patient care

Leadership Journey

• Objections • “Why can’t we just get 20 smart people in a room”• Broad engagement = high risk• Too much time to commit

• Support• ‘Big Bang’ theory• Leadership representation from those

impacted/sponsoring• Go where there was energy, and take care of the

project work

Development Cycle

• Concept introduction, conference calls with Dick• Leadership retreat (1 day): model, purpose, boundaries,

risks etc.• Design team simulation & high level plan (3 days)• Conference Design (x2)• Conference Planning (x2)• Conference (x2)• Implementation

Involve the Whole System to Understand the System

Vision & Current State Conference

Design Conference

Road Show

Ongoing Implementation

& Evaluation

Road Show

SIMPLE COMMITMENTS

Planning, Communication, Data Collection

October November December January February March

1.

2.

3.

Paradox of Time

• Going slow to go fast• Upfront investment in leadership sense

making and commitment• Engagement of design team• Conference experience (tend to focus here)

• Implementation (need to focus here)• Nimble response to funding opportunity

(committee structure in place)• System knowledge = less ‘selling’ of need &

solution

Results• $4.2M Access Grant: implement the change• All 10 divisions in medicine have created central intake systems.  This allows pooling of referrals for

example in endocrine (1 of the 10 divisions - there used to be 16 separate intake points (1 per specialists) now there is one point of intake. This reduces wait times anywhere from 10- 40% depending on the specialty and patient urgency.

• We reduced the number of forms in medicine - and produced referral and triage guidelines to make the rules more explicit (that is the piece I showed you when you were here)

•  We are running access and efficiency collaboratives to reduce wait times and improve patient flow in both primary and specialty care.  We currently have 17 teams working on this.

• we are also piloting a new service model for patients with chronic complex needs• Translating into a broader system redesign opportunity across medicine, surgery, neuroscience, cancer

• People First Award• We reduced the number of forms in medicine - and produced referral and triage guidelines to make the

rules more•  .

People First Award