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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
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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