The Department of Medicine and the Calgary Health Region wanted to increase access to medical specialists. To better understand how this could be done, I spoke to family doctors throughout the region to identify the key barriers to service. The problem: lack of communication.  “Consultations as they are done now — faxing a letter and never knowing whether the patient ever gets an appointment. There is poor communication; no confirmation that fax is received”  (Family care physician).    The recommendation: improve communication and redesign the referral process.  Together, primary care physicians, medical specialists, patients, and administrative staff attended ‘Medical Access to Service’– a large-scale (200+), grassroots conference where they actively engaged in designing a solution.