CancerCare Manitoba
Partner Efforts





When you suspect cancer (or any other serious condition) in a patient you are seeing in your office, is your clinic getting the referrals and requisitions you initiate "Out the Door in 24" hours? How long does it take for the paperwork or EMR form to be started, completed and ultimately faxed or mailed from your clinic? Is the process within your office consistent from clinician to clinician, clerical staff to clerical staff, full time to part time workers? Office delays can be a major barrier to the timely booking of a diagnostic imaging test or consultation with a specialist.

The Rapid Improvement Lead team in partnership with the Primary Care Working Group of In Sixty have developed a number of tools and clinical practice support opportunities for clinicians to access in order to assess clinic flows of information, measure the time from the creation of referrals and requisitions to the time they are sent to their destination and make improvements to how information is gathered, handed off and ultimately sent. These tools can be used by clinicians and support staff in independent, fee-for-service practices, large interdisciplinary regional clinics, and everything in between.

Out the Door in 24 Quiz: take two minutes to do this quick, five-question, self-assessment tool. Answers are scored with recommendations based on those scores. You can have others in your clinic complete the quiz too - do your scores match? If not, it may be time to dig a little deeper into your clinic flow. Included are five super fast referral fixes and the OTD24 Measurement Sheet.

OTD Measurement Sheet: this is a simple, single page spreadsheet to log in the timing of various visits and tasks that occur in your clinic relative to requisitions and referrals. The sheet can be printed and completed in paper or kept electronically as a spreadsheet. The suggested timeframe can be a two-week sample, kept in real time, but could also be used retrospectively as an auditing tool. Look for inconsistencies and variations.

LEAN on cME Session: these events combine a review of clinic work flows with a small group, case-based, CFPC-accredited Cancer Diagnosis education session of your choice. These 1½ hour sessions can be done right in your clinic or can be organized for a group of clinicians in your community.

LEAN Kaizan for Primary Care Clinics: Using a methodology called a LEAN Kaizan, In Sixty's Rapid Improvement leads guide clinicians and staff through an internal audit of work flows to identify and correct those work routines that are impeding referral turn around times.

All Out the Door in 24 information can be found online at:

or contact the CancerQuestion Helpline for Health Care Providers to be sent information electronically or to book a session or LEAN Kaizan:
call: 204-226-2262
online form:

Past Partner Efforts

Partner efforts have included:
  • Further development of the regional and community cancer hub network of cancer centres in the province, building upon the Community Cancer Program network, through expanded services from diagnosis, prevention, psychosocial care, treatment and end of life care.
  • Rapid Improvement events at over 20 locations across the province, where frontline staff at each site advised system engineers on process improvements and efficiencies to improve health care service delivery.
  • Investment in special diagnostic equipment to help determine breast cancer treatment and speed up breast cancer testing.
  • Launch of a Cancer Helpline for all Manitobans with cancer to call for support.
  • Opening of Urgent Cancer Care, a CCMB based clinic for cancer patients needing assistance with disease symptoms or side effects of treatment.