Clinical audit as a basis for improvements in mental health services

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Baldric Bishop
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1 Clinical audit as a basis for improvements in mental health services A qualitative study Monica Stolt Pedersen, PhD-fellow 1,2 Supervisors: Anne Landheim 1,3 and Lars Lien 1,3, 4 Bergen, February 3 rd Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders (NROP), Innlandet Hospital Trust, Ottestad, Norway 2 Faculty of Medicine, University of Oslo, Norway 3 Norwegian Centre for Addiction Research, University of Oslo, Norway 4 Hedmark University College, Campus Elverum, Norway

2 AIM To describe and explore an implementation process from the use of an audit to change in practice with a spesific focus on the use of audit

3 NATIONAL GUIDELINE ON DUAL DIAGNOSIS National guideline for assessment, treatment and social rehabilitation of persons with concurrent substance use disorders and mental disorders (March 2012) 93 recommendations Chapter on Implementation Aims at a several target groups National audit conducted in 2009

4 RESEARCH QUESTION 1. How do district psychiatric centers use a clinical audit to make strategic choices on improvement areas and implementation tools? Are there any key factors? 2. How do clinicians/staff in district psychiatric centers experience to work with clinical audit as a basis for own change in practice? 3. How do management in district psychiatric centers experience to work with clinical audit as basis for change in practice? 4. Does the implementation process lead to change in practice?

5 WHAT DO/DON T WE KNOW? Much research on implementation actions (audit and feedback, training, reminders, learning materials, opinion leaders etc.) Most individual actions have low impact on changes in practice. Several initiatives simultaneously have somewhat better effect Audit and feedback can be useful intervention to improve health professionals compliance with desired practice Less research on «what happens in clinical mental health practice» and «how are audit and feedback acted upon in practice at a district psychiatric centre»

6 CLINICAL AUDIT Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through systematic review of care against explicit criteria and the implementation of change. Aspects of the structure, process and outcomes of care are selected and systematically evaluated against explicit criteria. Where indicated, changes are implemented at an individual, team, or service level and further monitoring is used to confirm improvement in healthcare delivery Principles of Best Practice in Clinical Audit Measures may be done in various ways

MODEL FOR CLINICAL AUDIT Local clinical audit: handbook for physicians, 2010. http://www.hqip.org.uk/assets/guidance/local-clinical-audit-handbook-forphysicians-august-2010-final.pdf 1.

7 MODEL FOR CLINICAL AUDIT Local clinical audit: handbook for physicians, Identify a topic that it is important to audit. 2. Establish the authoritative standards against which to audit. 3. Develop audit criteria that will measure performance against the agreed standard. 4. Collect and analyse data and report results. 5. Reflect on results and agree and improvement plan. 6. Implement the improvement plan. 7. Repeat the data collection to measure improvement

Convenience sample Consisting of 4 units: - outpatient

8 POPULATION - SAMPLE One District Psychiatric Centre in South-Eastern Regional Health Authority in Norway Convenience sample Consisting of 4 units: - outpatient clinic - outpatient emergency team - ward 1 - ward 2 Multiple case study

9 PROCESS SUPERVISOR Leadership meetings management involvement decisions Completion of local audits (questionnaires) Reviewing results pr. unit Education on how to carry out a structured improvement process

10 DATA COLLECTION Clinical audit, electronic questionnaire. N= 54 (staff and clinicians. No administrative personell, min. 50% position) Observation: 7 groups (3-23 participants per group. Clinicians and staff from the units, chosen by head of units. A total of 54 individuals) 11 group meetings 4 ledership meetings. Final decision on shared strategy for the whole District Psychiatric Centre

11 OBSERVATION Low degree of participation Sound recording of meetings Notes of reflections notice of convocation, minutes, improvement forms, audit results

12 SO BACK TO THE RESEARCH QUESTION 1. How do district psychiatric centers use a clinical audit to make strategic choices on improvement areas and implementation tools? Are there any key factors?

THEMATIC ANALYSIS Essentially independent of theory and epistemology, yet flexible and can provide rich, detailed and complex account of data Phase 1: Phase 2: Phase 3: Familiarizing with data and

13 THEMATIC ANALYSIS Essentially independent of theory and epistemology, yet flexible and can provide rich, detailed and complex account of data Phase 1: Phase 2: Phase 3: Familiarizing with data and transcription (verbatim) of all the group meetings (data set) Generating initial codes using NVivo (semantic) Searching for themes identifying, analysing and reporting patterns (themes) within data

15 THE ROAD AHEAD New clinical audit spring/summer 2015 Focus group interviews with the participants from the working groups Individual interviews with the head of the units

16 Questions? THANK YOU!

OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines

OPTUM By United Behavioral Health OPTUM GUIDELINE EVIDENCE BASE: Level of Care Guidelines Guideline Evaluation and Treatment Planning Discharge Planning Admission Criteria Continued Stay Criteria Discharge