2. 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

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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

9. 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.

10. People First Award