Belfast Company Big Motive works with Health and Social Care Northern Ireland and the Health Service Executive in Ireland to support the design of solutions for some of our biggest health care challenges.
Director, Rebecca Walsh, talks us through a recent project and how it has made a huge difference to services.
“Children and young people in CHO8 (Midlands Louth Meath Community Healthcare Organisation) access assessment and intervention for a range of developmental, therapeutic and mental health needs through Primary Care, Children’s Disability Network Teams and Child and Adolescent Mental Health Services. Families, clinicians and administrative staff identified several long standing challenges within the referral process. These included unclear pathways, duplication of referrals, long waiting times and services working in siloes, all of which contributed to delays and additional work for staff.
“Big Motive supports healthcare projects across the HSE and HSC. This project has been particularly valuable because the team has been able to measure early benefits within a short project timeline, allowing visibility of improvements beginning to take shape for both clinicians and families.
“The opportunity for this work emerged from a discovery process carried out by CHO8, Big Motive & HSE Spark in 2024. Families, HSE staff and managers participated in interviews, research sessions and discussions that identified priority areas for improvement. One of the strongest themes was the need for clearer referral pathways, improved communication and more coordinated working between care groups. Supported by the HSE Spark and Big Motive, CHO8 established a multidisciplinary project group to redesign the referral process using a human centred design approach.
The redesign work began with a deep dive into existing referral practices. This included interviews with service users and staff, desktop research and a review of local, regional and national processes. Findings highlighted that families needed clearer information and more transparency around decision making. Staff identified issues such as inconsistent referral information, limited visibility across care groups and repeated work caused by referrals being reviewed separately by different services. Opportunities for improvement focused on clearer routing, shared clinical decision making and establishing a single point of access.
Based on these insights, the project team co designed and refined a prototype referral pathway. The key element was the creation of a Central Review Team consisting of one senior clinician from Primary Care and one from CDNT. This team jointly reviewed all referrals submitted via the National Access Policy referral form. If it was clear which team was best placed to meet the child’s needs, referrals were forwarded directly to that service.
If further information was required, referrals were directed to an Integrated Team Information Gathering meeting.
The prototype was tested in Longford over a four week period. All multidisciplinary referrals received by Longford Primary Care or CDNT during this time were processed through the prototype pathway. Feedback was collected through staff surveys, service user surveys and interviews.
Staff reported benefits including reduced duplication of work, improved efficiency and more timely decision making. Many highlighted improved collaboration and clearer shared understanding across care groups. The data in the final report shows significant reductions in referral processing time for both Primary Care and CDNT staff. Service users who participated in Integrated Team Information Gathering meetings expressed high levels of satisfaction with the clarity of the process, the timeliness of communication and the information they received. Feedback from users who progressed through the Central Review Team pathway highlighted improvements compared with past referral experiences, while also identifying opportunities for clearer communication about next steps.
The prototype also helped identify areas for refinement prior to wider rollout. These included ensuring full engagement across all care groups, providing additional support for staff participating in Integrated Team Information Gathering meetings and strengthening communication for families following Central Review Team decisions.
Although this project focuses on one part of Children’s Services, it offers learning relevant to wider health system challenges. Many pressures within the health system arise from complexity. When pathways are unclear or referrals are reviewed multiple times across different teams, delays occur and staff workloads increase. By simplifying referral decision making and improving coordination across care groups, this work demonstrates how clarity and collaboration can begin to address these pressures. Improvements in communication and decision making at the point of entry can also contribute to reducing duplication, managing waiting times and supporting a more efficient system overall.
This project highlights the value of collaboration and the importance of involving families, clinicians, managers and administrative staff in shaping solutions. By designing and testing a shared referral pathway in a real world setting, CHO8 has demonstrated strong potential to improve clarity, consistency and coordination across Children’s Services.”
