Nobody Likes a Healthcare Mystery

Jeff Doleweerd • July 2, 2017

Mysteries are fun to watch in the movies, but mysteries are rarely fun in real life.


  • It’s 4:00pm and your cable guy was supposed to show “sometime between 8am – 5pm”…
  • You ordered food at a restaurant 30 minutes ago and haven’t seen the waiter since…
  • You sent in an application months ago and were supposed to hear back by now…


Often the mystery while waiting is worse than the waiting time itself. It makes us anxious and angry. Our imaginations fill in the blanks with all kinds of worst-case scenarios (I’m going to have to wait at home again tomorrow for the cable guy … I’m going to get home really late after our meal, I’ll be tired at work tomorrow … I’m not good enough to get accepted to that program or ANY program).


In health care, mystery while waiting is routine:


  • You have been sitting in the ER for 3 hours due to a burn on your arm, and told there’s no way to know how much longer you will have to wait…
  • Your family doctor sent a referral to a cancer specialist 2 weeks ago because of concerning lab results…


The worst case scenarios get amplified when it’s related to our health. (I’m going to have a burn scar for life on my arm … I have cancer, and it’s getting worse while I wait. That referral must have gotten lost…).


Patients should not be burdened with this kind of stress-inducing mystery.


Are your patients experiencing mystery in your processes? What type of mystery? 


1) Shrouded in obscurity – The patient knows next to nothing about who they will see next and when.

2) Some clues are provided – The patient is provided an “educated best guess” about who they will see next and when, but will have to wait for more details.

3) Mystery solved – The patient knows exactly who they will see next, and when.


We have observed a lot of health care processes, and unfortunately 1) Shrouded in obscurity is the norm – even when 2) or 3) are viable options.


Moving from 1) Shrouded in obscurity to 2) Some clues are provided, is easy. Simply tell the patient what you know (e.g., How long did the last person like you wait? How many people are on your wait list? How many people do you see a week/day/hour? What determines how fast you will go through the line? etc.). Health providers often leave wait information shrouded in mystery because they don’t have the exactly correct information or they have information that the client might not like. However, something is better than nothing, even if the information is not exact or not what the patient wants to hear. Give a reasonable, conservative range based on experience and facts when you can’t be exact (1-2 hours, 2-3 weeks, etc.). If something highly unusual happens and you expect to go past the upper range, proactively let your patients know.


Moving from 2) Some clues are provided to 3) Mystery solved requires a strong process built on the quality improvement principles such as value flow and pull. An example would be a referral process where you directly book the first appointment for a patient with the referred service, providing the name of the person providing the appointment, the date, time, and location.



Solve your patients mysteries whenever possible, and they will have a much less anxious health journey.

Crown made of silhouetted people holding hands, yellow background, radiant lines.
By Jeff Doleweerd June 27, 2024
A truly effective central intake hub is not merely a team of staff manually routing referrals behind a veil of complexity; it is an integrated system that dynamically combines public accessibility, algorithmic precision, real-time capacity management, and seamless communication to ensure patients receive timely and appropriate care.
Three people collaborating around a laptop, one holding a mug. Light teal background.
By Jeff Doleweerd May 14, 2024
Access to community healthcare is paramount for individuals across various stages of life — from seniors desiring to age gracefully in their own homes, to new parents seeking care for their infants and individuals in need of mental health and addiction support. Traditionally, when we mention referrals, the image of a physician sending a document to a specialist comes to mind. However, the landscape of healthcare referrals is evolving, and it's time to redefine our approach. Gone are the days when referral management systems solely relied on healthcare professionals. Take Caredove, for example. What was once considered a referral management system has transformed significantly to a multichannel access management platform. Surprisingly, 43% of referral activity now stems from direct public sign-ups. This shift is monumental, with a staggering 70-fold increase in public service requests compared to pre-pandemic levels in 2019. Clinician referrals will be the minority of service requests activity in our platform by the end of 2024. Why this paradigm shift? During the pandemic, communities learned the importance of direct access to essential services. The notion of gatekeeping community services in any manner like specialist services became obsolete. The crisis strengthened the muscles of direct access, emphasizing the significance of preventive health through social and other services that keep people out of hospitals and other care facilities. Moreover, primary care is under immense strain, with 15% of Canadians lacking consistent access to ongoing primary care. In such a scenario, burdening already stretched healthcare professionals with more referral duties is not sustainable. Accessing services directly not only expedites the process but also empowers individuals to take charge of their own health journey. It signifies readiness for change and recovery, without the artificial requirement of seeing a physician solely for a referral. Primary care remains crucial, and it's imperative to equip them with resources available at their fingertips, enabling them to navigate the healthcare landscape autonomously. After all, patients trust their primary care providers, and we should harness this trust. We also need to foster a culture of self-advocacy and consumer empowerment as part of a broader solution. Community agencies are champions of a healthcare system where individuals are empowered to take control of their health, supported by a network of trusted professionals. In an era of putting patients before paperwork, it is time to embrace direct access and take every bit of unnecessary administrative burden off family doctors and nurse practitioners, in the process.
Two people communicating using string phones, standing on separate rooftops over a gap.
May 10, 2024
In the landscape of mental health support, a new trend is emerging: rapid access low-barrier walk-in counseling. This innovative approach is reshaping how individuals access mental health services, providing immediate support without the traditional hurdles of scheduling. At Caredove, we're witnessing the transformative power of collaboration among organizations delivering these services. Let's delve into why this trend is not just groundbreaking but essential. Immediate Suppo rt : Imagine being able to get the help you need right when you need it, without waiting weeks for an appointment. That's the promise of rapid access low-barrier walk-in counseling. It ensures that no one falls through the cracks during times of crisis. Reduced Stigma : By offering low-barrier access, we're sending a powerful message: seeking therapy for mental health concerns is not only acceptable but encouraged. This approach helps break down the stigma surrounding mental health, making support readily available and easily accessible. Increased Accessibility : Not everyone has the means to access traditional counseling services. Some regions have been able to eliminate cost barriers, thereby ensuring that everyone, regardless of financial situation, can access the support they need to thrive. Community Building : Low-barrier walk-in counseling centers can become community hubs, fostering a sense of belonging and support. Preventative Approach : By addressing mental health concerns early and proactively, these services can prevent more serious issues from developing later on. Empowerment : Rapid access low-barrier counseling empowers individuals to take charge of their mental health. By providing immediate support and resources, we're giving people the tools they need to overcome challenges and live fulfilling lives. Cost Savings : While offering these services may seem like a costly investment, it can actually save money in the long run. By addressing issues early, we can reduce the need for more expensive interventions down the line. No physician burden : Rapid access counseling requires no physician referral so does not tap the resources of overextended primary care, or present barriers for unattached patients. Progressive Approach : Embracing rapid access low-barrier walk-in counseling reflects a progressive mindset in healthcare. It's about prioritizing the well-being of all in the community. Stepped Care approach : Rapid access can operate in a stepped care model. During the session, if more specialized services are identified as necessary, individuals can be seamlessly referred to these services by their therapist. Rapid access low-barrier walk-in counseling represents a seismic shift in how we approach mental health support. By embracing collaboration, we can amplify its impact, ensuring that everyone has access to the help they need, when they need it. Together, we're not just changing lives; we're changing the conversation around mental health..
Show More