1 Service access models: a way forward Resource guide for community health services
2 Published by the Primary Health Branch Victorian Government Department of Human Services Melbourne, Victoria December 2006 Copyright State of Victoria 2006 This publication is copyright, no part may be reproduced by any process except in accordance with the provisions of the Copyright Act This resource was developed as part of the state-wide Service Coordination Industry Consultant initiative, funded by the Primary Health Branch, Department of Human Services. This document may also be downloaded from the Department of Human Services web site at: Authorised by the State Government of Victoria, 50 Lonsdale Street, Melbourne. Printed by Dogsbody Publishing and TMP
3 Acknowledgments This resource guide is an initiative of the Service Coordination Industry Consultant (Community Health), funded by the Victorian Department of Human Services Community and Women s Health Program. The guide is the culmination of several years innovative and dedicated work by many, in addition to more recent contributions. Key Community Health Service (CHS) managers and staff, Primary Care Partnership staff and consultants have made significant contributions to the design and establishment of quality service access models. The authors are indebted to all who assisted, both directly and indirectly, and particularly acknowledge the following for their generous, visionary input and guidance: Specific community health services and other organisations: Bairnsdale CHS Ballarat CHS Ballarat Health Services Banyule CHS Bass Coast CHS Bentleigh Bayside CHS Bundoora Extended Care Centre Cardinia-Casey CHS Caulfield CHS and Caulfield General Medical Centre Cobram District Health Service Dunmunkle Health Service East Grampians CH Eastern Access CH Gippsland Lakes CHS Grampians CHS Greater Dandenong CHS Inner East CHS Inner South CHS ISIS Primary Care Knox CHS La Trobe CHS Manningham CHS Monashlink Moreland CHS Nillumbik CHS North Yarra CHS Peninsula CHS Ranges CHS Southern Health Primary Care Yarra Valley CHS Whitehorse CHS Victoria s Primary Care Partnerships Juliet Frizzell, Effective Change Pty Ltd Ro Saxon, HDG Consulting Deb Warren, Community Services Consultant and Trainer Service Coordination Industry Consultant Steering Committee members: Meredith Kefford Samara Cox Kim Marr Heather Russell Jonathon Brown Philomena Sawyer Jim Killeen Carina Martin Ben Leigh Karen Oliver Carol Fountain Anna Fletcher Mary-Lou Proppe Helen Wade Bronwyn Fleming Lyn McKay Chair Manager, Community & Women s Health Program, Department of Human Services Community & Women s Health Program, Department of Human Services Primary Health Integration Unit, Primary Health Branch, Department of Human Services Home And Community Care and Assessment Unit, Aged Care Branch, Department of Human Services Eastern Metropolitan Region, Department of Human Services Hume Region, Department of Human Services Whitehorse CHS Ranges CHS Bass Coast CHS and La Trobe CHS Bellarine CHS Southern Health Barwon Health Banyule Nillumbik Primary Care Alliance Central Highlands PCP Service Coordination Industry Consultant Service Coordination Industry Consultant Project Worker Jonathan Pietsch and Inner East PCP for Lyn McKay s secondment Jim Killeen and Whitehorse CHS Board of Management and Management team Department of Human Services Community and Women s Health Program
4 Service Access Models: A Way Forward Resource Guide for Community Health Services 2 Contents Acknowledgments... 1 About this guide... 3 Part 1. Introduction Service Coordination Service access Service access terminology Context System context Consumer experience... 8 Part 2 Service access models Methodology for identifying the models Core components of the models Structure Function Resourcing Identified service access models The way forward...18 Part 3 Principles for model selection Factors driving change and influencing model selection Desirable Service Coordination outcomes Review of current system or models Supportive organisation features Model consideration...27 Part 4 Implementation Learning from experience Change leadership Determining the services and functions in scope Implementing change: keys for success Challenges Overview of a suggested change management process...37 Part 5 Evaluation Key evaluation considerations Types of evaluations Evaluation planning framework Evaluation planning keys Evaluation tools...44 Glossary Appendix 1 Service Coordination Product Map...52 Appendix 2 Additional policy context from a Service Coordination perspective...53 Appendix 3 Hypothetical structural designs...59 Appendix 4 Service access models comparative chart...61 Appendix 5 Staffing options comparative chart...66 Appendix 6 Suggested change management process...70
5 Service Access Models: A Way Forward Resource Guide for Community Health Services 3 About this guide Integrated service access models support efficient, effective and consistent consumer access to services. They also reflect individual organisation characteristics and local circumstances, and further embed community health within the service system. This resource guide has been developed to assist Community Health Service (CHS) managers to review, select, implement and evaluate service access models. It outlines the importance of service access models in supporting Service Coordination and provides a summary of the context. It identifies various service access models and describes and compares benefits and challenges associated with each. Factors influencing the selection of a service access model and the desirable outcomes an effective service access system can support are articulated. It includes implementation and change management strategies, as well as evaluation methodologies. The accompanying Service access models: Toolkit consists of sample documents, tools and templates to facilitate change management, and support the review, selection and evaluation of organisation service access systems. If you are new to service access models or wish to review the associated context, please start at Part 1. If you wish to consider various service access models and their core components, please go to Part 2. If you wish to review current service access practice or select a service access model, please go to Part 3. If you wish to implement a service access system, please go to Part 4. If you with to evaluate a service access model, please go to Part 5. If you wish to consider or use sample tools, policies or templates, please refer to the Toolkit in the accompanying CD. This resource guide complements broader Service Coordination resources. These include the Victorian Service Coordination Practice Manual (including the Good Practice Guide for Practitioners and Continuous Improvement Framework), local PPPS (Practices, Process, Protocols and Systems) manuals, the Service Coordination Tool Templates 2006 SCTT) 2006, and the Service Coordination Tool Templates (SCTT) 2006 Guidelines. See Appendix 1 for a range of resources to assist learning about Service Coordination practice and implementation. This guide can be applied beyond community health to other program areas such as HARP Chronic Disease Management, sub-acute and acute, dental, disability, mental health and drug and alcohol services. Use by any organisation type is welcomed.
6 Part 1 Part 1 Introduction Introduction
7 Service Access Models: A Way Forward Resource Guide for Community Health Services 4 1. Introduction 1.1 Service Coordination Service Coordination places consumers at the centre of service delivery to ensure that they have access to the services they need, opportunities for early intervention and health promotion, and improved health and care outcomes. The fundamental principles that underpin Service Coordination are: a focus on consumers partnerships and collaboration the social model of health competent staff a duty of care protection of consumer information engagement of other sectors consistency in practice standards promotion of an understanding of health as encompassing physical, social and emotional wellbeing. 1 All Community Health Services (CHSs) are expected to embrace the Service Coordination philosophy of consumer care. The process to achieve Service Coordination is as important as the outcome and needs to be incremental, flexible and responsive to local circumstances. Service Coordination models that reflect local circumstances, consumer and community characteristics and service availability have been developed by Primary Care Partnerships (PCPs) and implemented within individual organisations. These models build on existing good practice to develop broader sustainable and systematic practice across Victoria. The Victorian Service Coordination Practice Manual and Continuous Improvement Framework 2 aims to bring together common key features to provide a consistent statewide set of agreed organisational practices, processes and standards. Victoria s Service Coordination model is shown in Diagram 1.1. It depicts the components (or elements) of Service Coordination as identified in the Better Access to Services (BATS) framework 3 and the resources that have been developed to support their implementation. Some elements are more likely to happen in sequence, such as initial contact usually precedes initial needs identification. Others such as exiting service provision, information provision and feedback may happen at any time during the interaction with the consumer, depending on their need. Similarly, how the elements are delivered may differ across settings. For example, in some organisations initial needs identification is carried out by a different person (such as a Service Access or Intake or worker) at a different time to assessment (for example, physiotherapist). In other organisations the same person undertakes initial needs identification and assessment at the same time. The delineation between these 1 Department of Human Services 2001, Better Access to Services: a policy and operational framework. Aged, Community and Mental Health Division, Victorian Government Department of Human Services, Melbourne 2 To be released late Department of Human Services 2001, op. cit.
8 Service Access Models: A Way Forward Resource Guide for Community Health Services 5 approaches is critical to the issues explored in this resource guide and will be discussed further in Part 3. Diagram 1.1 Service Coordination elements and supporting resources For more detail about Service Coordination, please refer to Appendix 1 and the Victorian Service Coordination Practice Manual. 1.2 Service access Service access models (often known as intake systems) support Service Coordination within CHSs. An integrated system supported by systematic processes and consistent practice can significantly contribute to positive consumer, organisational and wider service system impacts. Since the release of the Better Access to Services (BATS) framework, most CHSs have embraced Service Coordination and incrementally implemented it for all or core programs using the Service Coordination Tool Templates (SCTTs). While effort has focused on introducing the SCTTs and aspects of local practices, processes, protocols and systems (PPPS), organisations need to regularly review, and possibly redevelop, systems to ensure that consumers receive consistent support to navigate their way through the service system and obtain timely and appropriate access to services. The term service access models describes approaches that provide systematic, consumer needs identification and access to services, not limited to intake into a single organisation s services As stand-alone, community-managed CHSs and those integrated within rural and metropolitan health services are all required to embed Service Coordination into core business, there are gains to be made if acute and subacute departments adopt Service Coordination principles and processes in line with the community health sector. 1.3 Service access terminology Language influences the understanding and application of Service Coordination concepts. There is much confusion regarding service access language 4 e.g. duty work, intake, Service Coordination, information, intake and referral and intake access are used by various CHSs to describe initial contact and initial needs identification activities. Analysis of organisation experience reveals that these terms actually represent an inconsistent array of functions or tasks. Analysis of organisation experience reveals that these terms actually represent an inconsistent array of functionality or tasks 4 Analysis of the Impacts of Service Coordination on Service Capacity in the Primary Health Care Sector, Final Report (2004). KPMG for Victorian Department of Human Services.
9 Service Access Models: A Way Forward Resource Guide for Community Health Services 6 For an overview of service access functions, see Table 2.2 Service access model functions. For further discussion, see Part 3 for Role and scope of model. In this document the following terms are used: service access models describes approaches that provide systematic consumer needs identification and access to services, including but not limited to intake into a single organisation s services service access system refers to the organisational structures and arrangements that support operation of a service access model service access work - refers to the associated functions or activities that are undertaken to support consumer needs identification and access to services. Intake - refers to the discrete component of service access work that relates specifically to acceptance by an organisation of a request for service and arranging of service provision within that organisation. It is not used to refer to broad variety of front-end Service Coordination activities Common service access language is still developing. Organisations are invited to explore how well service access reflects the role and functions that such systems can provide. The sector may also consider whether global application of the term service access helps strengthen the profile of the service access role and associated functions - internally, externally and across the Victorian community. Definitions of other common terms can be found in the Glossary. Traditional terms to represent a variety of functions and varied interpretations of BATS language continue to highlight the complexity and communication challenges 1.4 Context Policy Current policy at the state, federal and international level highlights the importance of Service Coordination. Quality Service Coordination within community health supports consumer care, pathways between services and within the wider service system, and streamlined organisation systems (see Diagram 1.2). Agencies adopting comprehensive, effective Service Access systems highlight that supporting consumer navigation through the health system is a primary function The Better Access to Services Strategy is: the core driver of reforms in the primary care sector, aiming to achieve a cohesive and coordinated system that promotes seamless and integrated service responses for consumers. This commitment is affirmed in other key health industry policies, including the Community Health Services - creating a healthier Victoria policy, Hospital Demand Management Strategy, Improving the care of older people policy, New directions for mental health services and, most recently, Care in your community a planning framework for integrated ambulatory health care. The vision and intent of several other Government initiatives provide a specific rationale for endeavours to establish a more streamlined and coordinated service access model for consumers, as part of a comprehensive approach to improving Service Coordination 5. 5 Outer East Health and Community Support Alliance 2006, Developing a common 1300 telephone number service access system in the Outer East draft scoping paper, unpublished.
10 Service Access Models: A Way Forward Resource Guide for Community Health Services 7 Appendix 2 explores policies from a Service Coordination perspective and provides links to key policy documents. Care in your community 6 outlines an approach to planning for the health care needs of local communities based on defined geographic areas. It emphasises the significance of well-developed Service Coordination practice and the importance of a planned approach to developing the systems and infrastructure necessary to improve service access and support the delivery of integrated health care to consumers. The following three of the four Care in your community policy principles point to the role that Service Coordination will increasingly play. Principle two: Together we do better Principle three: Technology to benefit people Principle four: A better health care experience The provision of health care will be based on partnerships among levels of government and public and private health care services. There will be a consistent, planned approach to developing the infrastructure for the delivery of integrated health care, including information and communications technology, standard tools and protocols. Care will be person and family centred, focusing on the needs of the whole person as these change over time Information about people and the services they receive will be consistently managed and coordinated across health care services to protect privacy and support integrated service delivery and continuity of care. Good Service Coordination practice provides the building blocks for strengthening community health practices and has informed recent program developments, including the demand management review and the Early Intervention in Chronic Disease in Community Health Services initiative, as well as the development of the Home and Community Care (HACC) Assessment Framework. 1.5 System context To embed Service Coordination, organisations need to review internal systems (addressing how clients move into and within their organisation) and external service systems (such as examining who are key referral partners and the effectiveness of referral pathways to and from those services). Many CHSs have reviewed internal structures, processes, policies and procedures that support how consumer needs are identified and responded to, and have introduced an improved service access system. These organisations regularly review their service access systems and Service Coordination practices as part of continuous improvement cycles, and many are now seeking support with evaluation methodologies. Others are either beginning or part way through an initial review of current practice and subsequent selection and implementation of a service access model. Organisations that have successfully implemented Service Coordination understand that using the tool templates is one part of Service Coordination, but examining and modifying current practice is equally important. In fact, full implementation of Service Coordination requires major revision of client intake processes, including eligibility and risk assessment criteria, an examination of referral mechanisms and a systematic approach to the management of waiting lists. 7 6 State Government of Victoria 2006, Care in your community, a planning framework for integrated ambulatory health care, Victorian Department of Human Services, Melbourne 7 State Government of Victoria 2004, Making it work improving access to services for clients in community health, Primary and Community Health Branch, Victorian Department of Human Services, Melbourne
11 Service Access Models: A Way Forward Resource Guide for Community Health Services 8 Implementing an integrated service access model provides an opportunity to think and act strategically Service Coordination has a wide sphere of influence beyond consumer navigation and access to services, as Diagram 1.2 depicts. How organisations embed Service Coordination also impacts on relationships with partner organisations, functional integration 8 and policy implementation. This creates opportunities to influence the service system as a whole by moving towards greater functional integration and improving consumer outcomes. Diagram 1.2: Service Coordination spheres of influence 1.6 Consumer experience The need to improve consumers experiences within the service system is a major driver for Service Coordination implementation. The 2005 evaluation of the PCP strategy 9 reports mid to high range consumer satisfaction levels with interactions with professionals, information sharing between organisations and receipt of service information and consumer information. The evaluation also indicated that where Service Coordination was implemented more thoroughly, consumers reported more positive experiences. However, qualitative information highlights that much remains to be done to support consumers to determine their precise needs and navigate the broad service system. According to a recent Outer East Health and Community Support Alliance report 10, a sample of consumers surveyed about their experiences with a variety of service access models revealed that: they generally find the service system complex, fragmented, confusing and frustrating to navigate. There continues to be multiple entry points that are not necessarily connected and which offer little consistency in terms of the way they respond. If consumers access the system at one point but need a different service, a successful outcome is more likely to be dependent on the person rather than guaranteed by the system. 8 A form of integration in which agencies and services continue to operate as independent entities but agree to agree to work in a cohesive and coordinated way to ensure that consumers experience a seamless and integrated response. 9 Australian Institute for Primary Care 2005, An evaluation of the Primary Care Partnership Strategy, La Trobe University, Victoria 10 Outer East Health and Community Support Alliance 2006, Developing a common 1300 telephone number service access system in the outer east, draft scoping paper,
12 Service Access Models: A Way Forward Resource Guide for Community Health Services 9 Consumer experience with the service system can differ, with some missing out on services altogether. The report revealed the following issues that a number of consumers face: They don t necessarily know or understand what their issues or needs actually are, and are seeking assistance to help sort through and make sense of their circumstances They don t know who or where to ring When they do begin the phone hunt for a responsive and appropriate service, they are often given a list of phone numbers for other organisations There is often a feeling that these lists are merely options to try, rather than being given with any real knowledge or conviction that they are the right or best option In many instances, they may have to wait several days just to receive a return call Agency after agency will tell them that they don t meet the eligibility criteria, that they are a low priority or that the waiting lists are extremely long or closed By this stage they often give up, or their situation escalates to the point of traumatic or even tragic consequences. Despite this, many consumers believe their service experience is better today than in the past, however this depends to some extent on luck or greater capacity to navigate the system. Those with greater knowledge of the system, or who happen to stumble on the right place to call in the early stages of their distress, often report a positive experience, characterised by timely and responsive service and appropriate support and assistance. Feedback suggests that this is most evident in organisations or sectors where the necessary skills, capacity and resources are available to support uptake of the Service Coordination principles and practices. Consumers have identified several features that depict good practice in service access and intake: Clearly identifiable entry points and processes Timely and responsive service Facilitated referrals and/or assistance with navigating and negotiating the service system Provision of short-term support or interim strategies to help contain issues whilst waiting for ongoing assessment or service delivery Practices that reduce the need to repeat stories, but which adhere to high standards regarding privacy, confidentiality and consent An example where this results in positive consumer outcomes is at Whitehorse CHS. The service access system provides a single point of entry for all allied health services and has led to significantly improved client satisfaction. In an evaluation conducted in 2004, Whitehorse CHS found that 100% of consumers reported being satisfied with the service access process i.e. needs identification, the provision of information and service navigation assistance. This included consumers not eligible for services at Whitehorse CHS. 11 Universal implementation of integrated service access models that incorporate these consumer-identified good practice features could significantly improve the consumer experience Given this information, universal implementation of systematic service access models that incorporate these consumer-identified good practice features could significantly improve the consumer experience. 11 For further details, see the Analysis of the Impacts of Service Coordination on Service Capacity in the Primary Health Care Sector, Final Report (2004). KPMG for Victorian Department of Human Services
13 Part 2 Service access models Part 2 Service access models
14 Service Access Models: A Way Forward Resource Guide for Community Health Services Service access models 2.1 Methodology for identifying the models The classification and articulation of service access models in this guide has been informed by several processes and builds on the three Service Coordination models within the broader primary care sector, as identified in the Analysis of the impacts of Service Coordination on service capacity in the primary health care sector 12. The classification and description of models attempts to integrate learnings from experience to date and provide guidance for the future. These models have been clarified and refined in response to reviews of literature and implementation experience across the community health sector. A series of consultative interviews was conducted with several CHSs to identify their service access models and the methodology used to review, select and implement models. Further information was gathered from the broad knowledge base of many other organisations and PCPs. The diversity of service access models that operate within CHSs reflects variables in structural design, function and resourcing, as well as the complexity and range of funding lines and program mix that the sector supports. This diversity also represents the transitional nature of Service Coordination implementation, for example, some organisations focus on implementing agreed local or regional PPPS and implementing the SCTTs, while others have reviewed and redeveloped internal systems at different rates. Many organisations have prioritised reconfiguration of their service access systems to improve the consumer experience, help strengthen the organisation s strategic position and align with recent State Government and Commonwealth Government policy directions. Leading organisation experience of selecting and introducing integrated service access models has been an organic exercise that each organisation has undertaken in its own way, some with PCP and/or consultancy assistance and others without. This has occurred in the absence of any formal benchmarking, model development, implementation or evaluation guidance. Despite the absence of formal, technical review or evaluation, the models are based on this considerable practice wisdom accumulated over recent years The classification and description of models is intended to reflect the complexity of the environment without over-simplifying the options. It also attempts to integrate learnings from experience and provide guidance for the future. 2.2 Core components of the models A useful way to describe service access models is to consider their three core components structure, function and resourcing. These components are essential, inter-related elements that combine to form an individual service access model. While the components can be addressed in a variety of ways, each should be considered in relation to how they can best achieve the desired outcome in combination with the other two (see Diagram 2.1). 12 KPMG 2005, Analysis of the impacts of Service Coordination on service capacity in the primary health care sector, Final report, Victorian Department of Human Services, Melbourne.
15 Service Access Models: A Way Forward Resource Guide for Community Health Services 11 Diagram 2.1 Core components of service access models 2.3 Structure Structure is the core component of a service access model. It refers to the organisational arrangements and consistency of practices, processes and tools within the service access model. Importantly, structure provides a foundation upon which function and resourcing such as staffing arrangements can be built according to individual organisation requirements. While there are a myriad of structures for service access models, we identify and explore two major types for CHSs, with the primary model incorporating two variations: INTEGRATED SINGLE ACCESS SYSTEM A service access model with a single discrete access point, characterised by systematic and consistent practice for all programs/services. PARALLEL ACCESS SYSTEM A service access model with a combination of discrete access point(s) for most services/programs (organisation/site/ LGA/region based) and additional, discrete program/specialist/ service-specific access point(s). Characterised by integrating mechanisms that support systematic and (mostly) consistent practice for all programs/services. AND NON-INTEGRATED A service access approach with multiple access points, characterised by variable, inconsistent practice per practitioner, discipline, program or site. Coupled with a limited focus on facilitating intake into (or exclusion from) one particular organisation s services, this historically dominant model presents challenges in the current policy environment and direction for seamless consumer care. In addition to the models described here, examples of hypothetical structural designs and descriptors can be found in Appendix 3. While the descriptions used do not precisely match those above, they have been included to facilitate preliminary thinking about hypothetical options and to provide a brief commentary about benefits and disadvantages at a conceptual level.
16 Service Access Models: A Way Forward Resource Guide for Community Health Services Function Service access systems can perform a range of functions on behalf of consumers, organisations, services and the wider service system. An integrated system provides the potential to centralise and systematize other activities such as the implementation of quality improvement activities, health promotion initiatives and distribution of emergency relief/material aid. Service access work essentially involves undertaking the IC and INI elements of Victoria s Service Coordination model. Service-specific or specialist assessment and care planning are separate functions, although they may occur on the same occasion or be undertaken by the same practitioner, and care planning may commence when a consumer first makes contact with the service access system. As noted, analysis of organisation experience to date reveals little consistency with the current system response to consumer and referrer requests, involving an array of functions or tasks undertaken in a myriad of combinations, at different points along the consumer journey, on an ad-hoc basis or not at all. As most of these functions have traditionally been undertaken as aspects of assessment or intake into one particular organisation or service, distinguishing them as components of, or associated with, INI continues to present a challenge to the sector. As organisation implementation of Service Coordination varies, INI can occur along with IC and/or service-specific, comprehensive or specialist assessment, or as a discrete activity. While service-specific access is highly desirable and necessary for consumers to receive services and meet internal organisation requirements, managers should consider how processes allow for broad screening/ini to occur in addition to and discrete from service-specific assessment. In organisations where discrete service access units are in place, the distinction between these Service Coordination elements is usually clearly defined. Service access systems can perform a diverse range of functions on behalf of consumers, organisation services and the wider service system However, where INI is built into the first assessment appointment it can be difficult to ensure that the consumer s broad needs are identified and explored holistically, because service-specific requirements may dominate. Organisations report that it is difficult to monitor or determine how effectively this combined process works, or if INI beyond the presenting problem does, in fact, consistently occur. While some core access functions are common to all CHSs, other functions that have long been undertaken by CHSs can now be incorporated into consistent service access work. Organisations should consider centralising these functions and determining the most appropriate point to provide them - within the consumer journey and to best suit internal structures, workflow and business processes. For a systematic service access system to operate effectively, functions must be clearly identified, described and documented within policies and guidelines. They must be understood by all staff and, most importantly, be consistently provided and monitored. This is explored in Part 4 and examples of policies and guidelines are provided in the accompanying Toolkit. The historically dominant approach to service access relies on reception staff and individual practitioners or disciplines to duplicate a complex set of activities to determine need, eligibility and access to their service only. This approach presents challenges in the current policy environment of aiming for seamless consumer care. Establishing an integrated service access model provides the service system with the means to respond more holistically to consumers, particularly those with complex or chronic needs. It also provides the opportunity to provide services early in a consumer s journey, beyond simply identifying a presenting need, eligibility screening and providing information. See Table 2.2: Service access model functions and further discussion in Part 4 Determining which services and functions are in scope.
17 Service Access Models: A Way Forward Resource Guide for Community Health Services Resourcing Financial Reallocation of organisation resources is usually required to successfully establish and maintain an integrated access model. While this can pose initial challenges, many organisations have effectively reallocated resources as part of the overall change management process. This process relies heavily on first identifying the percentage of service delivery time that is used (and wasted) duplicating service access functions across the organisation. This data can then be used to support reallocation of the equivalent value from services that will be supported by the new system. The allocated funding can then be used for staffing and infrastructure costs. While the reallocation process can have variable initial impacts on demand management and staff attitudes, once the model is functioning efficiently, the overall improved efficiencies, the increase in practitioner time for service delivery, and improved quality of service for the consumer are highly valued Infrastructure Infrastructure resources to support service access systems can include: office accommodation telephony, such as phone systems and headsets IT requirements, such as hardware and support administrative costs, for example, records management, information resources and postage Staffing Four staffing options can support service access models: dedicated rostered allocated activity individual role activity. Staffing by individual role activity has been the dominant approach; however, this can result in duplication, inconsistent practice, inefficient use of resources and nonuniform responses to consumer needs. Once the model is functioning efficiently, the overall improved efficiencies, the increase in practitioner time for service delivery, and improved quality of service for the consumer are highly valued Factors influencing selection of a staffing option may include staff preferences or availability of suitable staff; however, it is recommended that organisations consider this primarily from a strategic and operational perspective, following the selection of a suitable model. See Table 2.3 Overview of staffing options, and the Staffing options comparative chart in Appendix 5 to compare the features of each option. Staffing resources to support service access systems can include: project leader or ongoing service access coordinator role - equally important with both dedicated and rotating staffing options dedicated practitioner and/or administrative positions - if implementing dedicated staffing option training costs for example, program eligibility criteria & screening requirements, suicide intervention, e-referral supporting administrative roles backfill positions - if implementing dedicated staffing option. Most organisations report that the most suitable staffing option incorporates a mix of both practitioner and administrative positions.
18 Service Access Models: A Way Forward Resource Guide for Community Health Services Identified service access models While the identified service access models for community health of Integrated: Single Access System or Parallel Access System and Non-Integrated models are classified in terms of structural design, they are also defined by practice characteristics (See Table 2.1: Overview of service access models). Consistency in practice according to common guidelines is the core feature of integrated models. Each model can support a variety of functions and incorporate a range of staffing options, as described in Tables 2.2 and 2.3. Each model is also applicable irrespective of the number of organisation sites. While identifying variations to the models does not preclude further variations, organisations should aim to establish as simple yet robust a model as suits their operating environment and strategic position within the service system. The Non- Integrated model represents the historically dominant practitioner/discipline-specific model, which is unlikely to effectively meet present day demands. Comparisons of features associated with each model can be examined in the Service access models comparative chart in Appendix 4. As depicted in Diagram 2.2, the models can also be described as points along a continuum which culminates in achieving a truly integrated service access model. For example, many CHSs have adopted a form of the Integrated, Parallel Access system which does not yet incorporate common procedures, while others are using a combination of the Non-Integrated system and program/specialist/service-specific access points, while extending the scope incrementally and working towards using consistent practice. Often the biggest challenge of this transitional process is ensuring that integrating mechanisms which support systematic and consistent practice for all programs/services are built in. Often the biggest challenge of this transitional process is ensuring that integrating mechanisms which support systematic and consistent practice for all programs/services are built in. Diagram 2.2 Continuum toward an integrated service access model
19 Service Access Models: A Way Forward Resource Guide for Community Health Services 15 Table 2.1 Overview of service access models Model Access Description Example Integrated Single Access system A single discrete access point, characterised by systematic and consistent practice for all programs/services A service access unit consistently undertakes all core and some additional service access functions on behalf of all organisation services that are delivered across multiple sites (for example, allied health, counselling, Planned Activity Group, alcohol and drug and dental clinic), in accordance with agreed practices and procedures Parallel Access system A combination of discrete access point(s) for most services/programs (organisation/site/local government area/region based) and: additional, discrete program/specialist/servicespecific access point(s) characterised by integrating mechanisms that support systematic and (mostly) consistent practice for all programs/services A service access unit consistently undertakes all core and some additional service access functions on behalf of allied health, counselling and Planned Activity Group services, and: a medical access point provides broad INI as well as intake for the GP clinic supported by a common set of practices and procedures and appropriate mechanisms for providing integrated care across the organisation. Non - Integrated Multiple Access Points Multiple access points characterised by variable, inconsistent practice per practitioner/discipline/ program/site. Each practitioner responds to enquiries, screens, makes appointments and manages a waiting list in an individual or discipline-specific manner. Historically dominant model presents challenges in the current policy environment and direction for seamless consumer care
20 Service Access Models: A Way Forward Resource Guide for Community Health Services 16 Table 2.2 Service access model functions Functions Core Identifying presenting need Assisting with sorting through circumstances and exploring broader needs Eligibility screening Risk screening Determining priority Facilitating consumer navigation of the service system Providing service and/or consumer information Offering and providing assisted referrals 13 Identifying health promotion opportunities Providing short-term support or interim care strategies Undertaking intake procedures into organisation services Facilitating access to assessment and/or care planning Additional Appointment scheduling Undertaking demand and waiting list management Educating consumers regarding service system initiatives, for example: o Medicare Benefits Scheme Enhanced Primary Care or Mental Health Care initiatives - access to private allied health, psychological or psychiatric services o Nurse-On-Call etc Undertaking needle and syringe exchanges Providing material aid Facilitating care planning, for example: o o Other identifying suitable consumers and relevant service providers establishing initial meetings 13 Assisted referrals: When practitioners within the service system make a referral on behalf of a consumer. Primary Care Partnerships, Victorian Service Coordination Practice Manual (unpublished draft, Nov 2006). Effective Change, HDG Consulting