Table 2.

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

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	“We cannot improve if you don’t know how you’re doing”