The innovative aspect of the project is that it harnesses existing resources to automate seemingly meaningless administrative tasks. No additional resources, besides the motivation to bring about change, were required in the implementation and development of this project.
However, it resulted in a tenfold increase in the number of patients accessing the services.

The people who implemnted the project had no technical experience in coding or automation, but all skills required for the implementation of the project were learnt on Youtube.

The innovation creates real-time information as to referral pattern9s) and the nature of services required, this results in a responsive healthcare management that allocate staff and perform targeted training

The innovation was piloted in April of 2022 and by October of that year it had become established - on the basis of its success in linking patiets to community health workers in the clients area of residence it was rolled out to a second second sub-district in the Cape Metropolitan area, by April of 2023 the intervention had organically grown and was in use across health facilities in the entire Cape Metropole.
Use of the tool has remained consistent with increasing numbers of referrals from a growing group of clinicians.

The clinicians key contribution was addressing the administrative barriers experienced by their staff.
CBS coordinators were critical in acknowledging and supporting a move from paper based referrals would increase legibility but also accuracy of applications,
The NPO were key as the primary stakeholder who would apply the service, they were key in assuring the community health workers had the adequate training and support to disseminate the service, to assist the CHW in providing the feedback

Clinicians in healthcare facilities across the cape metropole were primary users - they experienced ease of access to the form and could readily complete from the patient bedside
The key stakeholders were the CBS coordinators who would disseminate the forms to NPOs, benefitted from legible forms and thus patients could readily be connected to NPOs and CHWs.The key beneficiaries were the patients, who would be able to receive health care in their own home. The referral assured continuity of care

In the 22 months following commencement of the intervention there have been 8800 digital referrals in the immediate drainage area of the facility which represents a tenfold increase from the baseline number of paper-based referrals. A total of 23 thousand referrals have been sent from health care facilities in the Cape Metropole, this equates to 1 referral for every 200 residents of the city. 1 fifth of referrals are for patients suffering with tuberculosis who have failed to access or are requiring support in continuing their treatment. Health care managers can access a real-time dashboard of utilisation and how they can further support their staff, whilst NPOs can see services requested and develop targeted training for their CHWs

In essence, this system reduces administrative load by task shifting to an automated process. The strength is that it leverages a single Office 365 account is also a potential Achilles heel in the sense that any disruptions to the account poses significant threats to the entire process and redundancy must be inbuilt into the system to avoid this.
Though developed by an individual needs to be well documented; communicated and other individuals must have a firm grasp of the system in order to make changes.
The system is dependent on accurate email routing, any inaccuracies in recipient addresses or lapsing of email access occur the system would be rendered non-functional, the use of generic shared inboxes avoids this challenge.

The key condition to the success of this intervention was the ability to harness already existing resources in the form of tools available through a Office 365 License, this would reduce administrative challenges and create the capacity to directly the significant human resource that existed within the organization.
Though seemingly overwhelming, the technical skills to create the initial automation is readily gained from readily accessible resources, most notably youtube.com which has real-time step-by-step tutorials to assist in gaining the skills.
The motivation to bring about change and assure that health care is equitably accessed are key drivers to address the challenges faces

As the tool leverages existing products in the office 365 suite and that it only requires a single user license, the innovation which focusses on moving organisations from paper-based to digital processes is readily scalable. A single Office 365 license was used to scale this innovation to provide the service to approximately 5 million people with referrals from 80 health facilities in the Cape Metropole – in the coming months it will be implemented to all health facilities in the Western Cape.
The code running the process in non-proprietary and templated so might readily be implemented in other provinces – there are only 2 dependencies 1) an Office 365 license
2) a email address of a willing recipient to act

The key learning from this experience was that not only patients experience barriers in accessing health care, but there are significant administrative barriers that prevent clinicians from its provision. If one can identify the barriers, readily available tools can address these.
The success of the innovation was the conversion of an opaque process (where and how and to whom does one complete a referral) to simply scanning a quick response code.
Clinician’s vis a vie any civil servant have to derive meaning from the work that they do. If task outcomes are not immediately evident they are suboptimally performed – in this case there was a fourfold increase in the number of referrals when clinicians started to receive feedback of the visits