How can an organization bring together diverse parties with different incentives to design a better system?

Healthcare for about 500,000 people in Canterbury, New Zealand, the South Island’s largest and most populous region, seemed gridlocked:

Patients consistently had very long wait periods in the emergency departments, as hospitals there were chronically over capacity. This was a result of many factors, one of which was that many patients came to the hospital for treatment of minor conditions, such as the removal of skin lesions and treatment for heavy menstrual bleeding.

Waiting times for procedures at hospitals had become not only a problem but also a political embarrassment. The issue came to a head in 2006, when the central government introduced regulations to sanction hospitals if they failed to provide treatment to approved patients within six months of their referral. The local district health board responded by arbitrarily removing from its waiting list about 5,000 patients with the longest waits. The local health board justified the removal to the press by saying that if patients could wait for more than six months, they must not need the surgery.

Suddenly, the primary care general practitioners (GPs) found their referrals to hospitals being sent back to them without any clear explanation.

Angry providers and patients flooded the press with stories, retold in the news with gruesome headlines. The coverage generated a sense of shock and dismay in the Canterbury health system.

On top of this fiasco, recent studies had projected the need for another 500 hospital beds, 20 percent more GPs and nurses, and another 2,000 residential care beds for Canterbury by 2020, which was financially infeasible.

And even if the money from the government could be found, attracting the additional 8,000 healthcare professionals needed for the new facilities would be next to impossible.

Something had to be done. The CEO and senior staff, who included the hospital and area physicians and community health groups, were asked to develop a vision for how the health system should look in 2020, and how it should be changed. They were given a wallet-sized card signed by the CEO giving them “permission” to change the system.