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Table 2 Stakeholder perspectives and responses to policy direction discussion questions (breakout discussion groups)

From: The use of a policy dialogue to facilitate evidence-informed policy development for improved access to care: the case of the Winnipeg Central Intake Service (WCIS)

Questions

Policy Direction #1: Measurement and monitoring according to a provincial framework

Policy Direction #2: Central intake as preferred model for delivery of services

Policy Direction #3: Central intake programs should be provincial

Policy Direction #4: Central intake structure, processes, performance should be public

Policy Direction #5: Patients should maintain the choice of who they see

Do you agree in principle with the policy direction?

- Yes

- Yes, but not universally; single-entry models (SEMs) may not be well suited to all clinical services

- Yes

- Yes

- Yes

Should it be pursued?

- Yes. Seen as “foundational” to the other policy directions

- Yes, where well suited

- Yes, but it must be acknowledged that it may not be suited to all clinical areas

- Yes, but careful thought must be given as to what should be reported and how well it could be understood

- Yes

Benefits

- Measurement, monitoring and accountability framework

- Would lead to benchmarks with actionable data and reporting

- Would establish transparency, standards to which processes could adhere, regardless of jurisdiction

- SEMs are well suited to choice-sensitive elective procedures, especially those with high volumes, long waits and variabilities

- Central intake creates a platform for starting to have clinical service agreements between primary and secondary care

- Potential for improved quality of care, governance and oversight

- Can facilitate improved access, sharing of resources

- Enables a provincial mechanism for quality assurance in all areas where care is being delivered

- Better information, reporting and decision-making

- Patients/members of public have right to know information

- Increased transparency could lead to improved accountability and encourage continual improvement

- Assurance to patients that processes are in place to ensure adherence to standards of quality of care

- A patient-centred approach

- Patient confidence

- More patient control

- Helps establish/maintain relationships between providers

Concerns

- May lead to unknown opportunity costs, unintended consequences, gaming

- Will not be effective unless participation is 100%

- Results of monitoring will be highly context dependent

- Cannot and should not be applied universally

- Potential depersonalisation, reduced accountability and reduced appropriateness of referrals

- May be challenging to gain consensus on a provincial quality metric that can be collected and used across regions

- Rural patients may be at a disadvantage

- Rural providers – fear of loss of patients to larger centres

- Management/coordination

- Data may not be valued or understood

- Too much information can be overwhelming and/or misunderstood

- Implications of the reporting could lead to gaming or skewed expectations from public

- Referring physicians may not know all of the options available

- General public does not fully understand how care is provided/referrals are directed

- Patients can sometimes have unrealistic expectations

- Acceptance will never be universal

Additional considerations of proposing this policy direction

- Must be a coherent effort, and not completed in isolation; apply to all

- There will need to be a standardised approach – consensus and agreement around which indicators should be measured

- Measurement and monitoring should be established on a provincial basis, not only regionally

- Standardisation of processes, quality measures, referral criteria, feedback mechanism

- Data-driven process (to help measure demand/patient volume); data could facilitate non-threatening dialogue

- Patients able to retain choice

- Incremental implementation

- Must have clear purpose/processes/provincial standards for quality – ensures transparency and flow of resources across regions

- There should be a focus on equity for all

- Patients must be able to retain choice

- Central intake does not mean central provision

- How will resources be distributed to meet demand – by volume? Per capita?

- Involvement of all stakeholders will be important for shared buy-in and use

- Incorporation of patient-reported outcome measures

- Patients should be able to retain choice

- Smaller selection of measures may be more meaningful

- Standards, processes, purpose of this data and implications should be clearly communicated to relevant stakeholders

- Information sharing will be required so that patients and referring physicians can be informed and help patients make the best decision

- With measuring and monitoring in place, confidence can be increased in providers across the system so that patients can feel more confident

- Feedback mechanisms will be needed for continual improvement

- Quality of care should not differ for patients who see the next-available vs. specific surgeon

- Patients will need to understand that their choice may involve a longer wait

How can we ameliorate these concerns and implement this policy direction?

- Begin with small, defined first steps and expand over time as capacity develops more fully

- Where promising, the scope for SEMs should be well studied to ensure the context/environment is conducive to success

- Care could be elevated to a system level, where all providers working together for the best care possible

- Strong infrastructure needed

- Consideration should be paid to ensure that any care pathway is not burdensome to patients

- Incremental implementation

- Aggregate reporting may be best

- As patients and providers are well informed and get used to the system, trust of the system and processes will increase

Additional comments

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