A redesign journey to improve patient access to acute Mental Health Services
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- Mariah Barton
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1 A redesign journey to improve patient access to acute Mental Health Services Create better experiences for people using health services Prepared by Louise McFadden and Gabrielle Mulcahy A redesign journey to improve patient access to acute Mental Health Services Greater Southern Area Health Service October 2007
2 Aim To improve the timeliness and quality of care provided to people with mental health issues who access Emergency Departments (ED) within the GSAHS. Mental Health access (also known as Emergency Admission Performance) Calculate the number of MH patients in ED for < 8hrs, divided by the total number of admissions to the collocated Mental Health inpatient unit. Target 80% 1
3 Nature and Extent of the Problem MH patients presenting to Emergency departments were at times having to wait longer than benchmark of 8 hours before admission or discharge Overall area performance 77%; 1 site 22% Early 2006: 1 st redesign project commenced: stakeholder interviews, data analysis, focus groups. Resulted in improved access. November 2006 patient access decreased at 2 sites. Delay in access was not acceptable from a patient satisfaction or safety perspective 2
4 Strategic importance Primary focus at both State and GSAHS levels State Health Plan: Strategic Direction 2 Create better experiences for people using health services" NSW Health Performance Agreement monitors access to acute mental health on a monthly basis by the State and GSAHS Chief Executive. NSW Health Mental Health Performance Report: monitored on a monthly basis locally and at State level. 3
5 Planning & Implementing solutions 1 st Redesign project (one site) identified need for: an Action oriented patient centred approach that allowed incremental change, and was monitored on a regular basis. Team formed: Local Mental Health Cluster Managers; Senior Nurse Managers (GSAHS Acute MH Inpatient Units); GSAHS Director Critical Care; MH Support Centre representatives; Mental Health Business Manager; Mental Health Governance and Service Redesign Manager 4
6 Planning & Implementing solutions (continued) Communications Weekly 30 minute teleconference (patient activity report) Weekly status report Monthly report to NSW Health Services Performance Improvement Branch Monthly Performance Indicator results Governance Management support Stakeholder involvement 5
7 Outcomes & Evaluation Improvement in problem solving culture from sites Steady improvement in all four State Performance Indicators: Average time in ED in hours. Average time in ED in hours. Patients with mental health issues waiting in ED for greater than 24 hrs. Emergency Admission Performance. 6
8 Average Time in ED (hrs) for Mental Health Non-admitted patients Total Ave Hrs in ED Total Year Month 7
9 Average Time in ED (hrs) for Mental Health Admitted Patients 5.00 Total Ave Hrs in ED Total Year Month 8
10 Mental Health Patients in ED >24 Hours 14 Total Waited more than 24 hrs Total Year Month 9
11 Emergency Admission Performance (EAP) Mental Health Patients 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% Total 40.0% 30.0% 20.0% 10.0% 0.0% Year Month 10
12 Sustaining Change Daily recording of patient activity continues. This ensures regular review of patient access and problem solving strategies in addressing variances. Continue weekly teleconferences with hot spots encouraging an action-oriented problem solving culture. Engagement of Director Critical Care to ensure an integrated and holistic approach. Monthly Report provided to the NSW Health Services Performance Improvement Branch encompasses a brief summary of progress against each of the redesign initiatives within mental health to assist in achieving improved access. 11
13 Lessons Learned System Governance Partnership Communication Sustainability 12
14 Future Scope Ongoing and sustainable core business New benchmarks Integrating new projects Continued participation in fortnightly teleconference with the NSW Health Service Performance Improvement Branch. The progress made by GSAHS in improving patient access has been acknowledged at this State level. 13
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