What Nature Taught Us About Health Care Networks [Infographic]

Jeff Doleweerd • November 18, 2016

Health networks battle with questions like, “should we put all patients through one wait list?” or “should we have one single phone number for patients to call?”. Otherwise put, should we centralize referrals for service, or decentralize? Stories frequently appear in the media, often after an effort to centralize referrals fails to bring the desired results. Centralized intake departments often “go under the knife” like in this Ottawa example or with Fraser Health’s centralized flu shot booking.



Can nature teach us a better way?


When birds flock in a V formation, it appears as though there is a “lead” bird controlling the direction and speed. In fact, none of the birds “lead”, but rather each bird interprets what to do based on the movements and sounds of other birds right near them. It is a coordinateddecentralized, decision making system. The result is a beautiful migration pattern with birds maintaining strong interactions to keep their formation. Insect behaviour is similarly decentralized, where decisions are distributed across the colony, rapidly and accurately.


Patient Transitions Today: Referral Chaos

Unfortunately, handling patient transitions between services isn’t like a flying V, it’s more like herding cats – chaotic, with little synchronization (even the MythBusters can’t herd cats).


Here is how transitions currently (don’t) work:

A diagram showing the process of getting a service.


When clinicians refer today, first they have to find the right service in a confusing ocean of information. Then they have to find the right form, fax it, and wait. Nobody knows when the patient will be served. Referrals get backlogged, phone tag begins, and some referrals never get completed. Confused patients adapt by seeking out alternatives, often resorting to costly hospital emergency department visits.

A diagram of a referral chaos with a question mark in the middle.


Referrals can feel chaotic and unorganized. A common solution is to centralize the transition process, but can the solution also incorporate the benefits of informed coordinated decentralized decision making?


Centralized Chaos?

“Centralizing intake” typically means that all referring clinicians in a region direct referrals of a specific type to one spot, using one form, or through one phone or fax number, with one central agency “triaging” the referral before it is routed to the final provider agency. The key benefit of this approach is that it makes life simpler for the referrer.

A diagram of a centralized referral chaos


The main problem with a central referral process is that the quality of the interaction between the referrer and the patient doesn’t fundamentally improve, as the patient still doesn’t clearly know the next step in their transition. 


In fact, there is often weaker interaction and less connection using the traditional centralized referral processes because there is less available information to convey to the patient. The referrer usually doesn’t even know what organization the referral will land at. The message to the patient becomes a variation of “someone will be in touch with you, sometime”.


Once the central referral department receives the referral, they often have to apply the same referral procedures that the original referrers once used. Centralized intake, without a fundamental process change, is still confusing for the patient (also, it can be quite costly).


Coordinated Transitions

Referring clinicians can improve the quality of interactions with patients when they book referrals for patients. A booked referral is where front line clinicians directly provide patients with appointment time options, and book them into a preferred time slot with the referred service. Patients clearly know the next step in their care.


Health system planners often feel that they need to decide between a costly centralization agenda or a decentralization agenda. With Caredove, this becomes a false dichotomy. Both models co-exist in a coordinated access model with booked referrals. Referrals to most services can be handled by directly booking the right service for the patient, or enabling patient to directly sign up. For situations where an intermediary would provide additional value (e.g., early assessment of patient needs for a service with a long waitlist), clinicians can refer to a centralized intake function which, itself, performs a booked referral to the required service.

A diagram of a book being referred to a receiver.

Caredove provides the information and tools necessary for a health system to behave like a coordinated flying V, with the benefit of a single control centre, using both decentralized and centralized approaches to improving patient transitions.


Contact Caredove to start a conversation about affordable e-referral today.

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By Jeff Doleweerd June 27, 2024
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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.
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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..
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