Transcript Efficient and Effective Community Mental Health Services

Quality and Efficiency Support Team (QuEST)
Directorate for Health Workforce and Performance
Efficient and Effective
Community Mental Health Services
Toolkit
Workshop A
Aim of the Workshop
• The aim of the workshop is to present the
Efficient and Effective Community
Mental Health Services Toolkit and to
provide you with an opportunity to discuss
and consider how the toolkit will work for
you and for your service.
Workshop Objectives
• To present an overview of the content of
the toolkit and provide examples from
each section
• To describe why it was developed and how
services can work with the toolkit
• To briefly describe the tools and how they
can be accessed and used
• To provide an opportunity for reflection and
discussion on key points
The Toolkit
Contents
Section One - Background and Introduction


Background
Introduction to the toolkit
Section Two - Effective Practice


Reliable implementation of evidence based care
Effective team working
Section Three - Understanding and Managing your Capacity






Introduction to capacity
Optimising capacity – reducing DNA and CNA
Optimising capacity – skill mix
Optimising capacity – effective meetings
Optimising capacity – removing non-value adding work
Optimising capacity – reducing sickness rates
Section Four - Understanding and Managing your Demand



Introduction to demand
Managing demand – set clear eligibility criteria
Managing demand – goal setting, case review and caseload management
Section Five – Undertaking a full DCAQ Analysis
This section is still in development phase and as not yet been issued
Section Six – Tools
Section 1 – Background and Introduction
to the Toolkit
• Quality and Efficiency Challenges
– Mental Health Pathway Efficiency and
Productivity Report
• Why has the Toolkit been Developed
– Range of resources already available
– To provide support and guidance
– Supports achievement of the three quality
ambitions outlined within the NHS Quality
Strategy
– Supports services to deliver the ambitions
outlined within the Mental Health Strategy
How to Work with the Toolkit
• Structure
– Modular format
– Why it is important
– Understanding your current state
– Ideas for improvement
– Within each main section there are
subsections
How to Work with the Toolkit
• Support
– Analytical support
– Skilled facilitation and management of change
– Basic background knowledge of how to use
and present data
– How to process map
– Test change using PDSA cycles
• Where to start
– Anywhere although effective practice may be
where you may want to focus initially
Section 2 – Effective Practice
• Reliable Implementation of Evidence
Based Care
• Effective Team Working
Effective team working
Why is this important?
Research has shown that when decisions and actions made within a CMHT have the participation and involvement of all team members,
including service users and carers, the care which is delivered is of a higher quality than those decisions and actions made by an individual or
by one discipline. 1
Understanding your current state
Team questionnaires can be a really useful tool to assess your current team working and identify opportunities for improvement. Recent
research funded by the National Institute for Health Research 2 has led to the development of tool to assess the effectiveness of team working
in Mental Health. A copy of this for information only (this is a copyrighted tool) is included in Section Six
This tool is based on the Aston Team Performance Inventory (ATPI) and 20 item CMHT effectiveness scale. The ATPI can currently be
completed online for a flat rate of £1203 and more information can be found at http://www.astonod.com/team-tools. The Aston
Organisational Development Ltd is currently deciding whether to make CMHT version of the ATPI available to a wider audience. Please see
Section Six for more information.
1
West M, Alimo-Metcalfe B, Dawson J, El Ansari W, Glasby J, Hardy G, et al. Effectiveness of Multi-Professional Team Working (MPTW) in Mental
Health Care. Final report. NIHR Service Delivery and Organisation programme; 2012
2
As above
3
Price quoted at 8 October 2012
Examples of Ideas for Improving the
Effectiveness of your Team
• Clarify purpose and function
• Provide good leadership
• Actively manage team composition and
processes
• Promote inter-team working
• Ensure reflection and adaptation
• Hold effective meetings
Section 3 - Understanding and Managing
your Capacity
• Introduction to What, Why and How to
measure capacity and activity
• Section on using Job Plans to measure
capacity and also how to measure
capacity without job plans
• Understanding how time is actually spent
– Activity
• Includes tools to support analysis
• Ideas for making better use of your
capacity
Optimising Capacity
•
•
•
•
Reducing DNA’s and CNA’s
Skill Mix
Effective Meetings
Removing Non-value adding work
including duplication of work
• Reducing Sickness Rates
Reducing DNA’s and CNA’s
Figure 2 - Example of run chart of % of first appointments where service user DNAs
Team Somewhere CMHT (May 09 - Nov 11)
60
50
Introduction of
Full Booking
System
%DNA
Median
Introduction of
Text Reminder
30
20
10
ay
-0
Ju 9
n0
Ju 9
l-0
Au 9
gSe 09
p0
O 9
ct
N 09
ov
D 09
ec
-0
Ja 9
nFe 10
bM 10
ar
-1
Ap 0
rM 10
ay
-1
Ju 0
n1
Ju 0
l-1
Au 0
gSe 10
p1
O 0
ct
N 10
ov
D 10
ec
-1
Ja 0
nFe 11
bM 11
ar
-1
Ap 1
rM 11
ay
-1
Ju 1
n1
Ju 1
lAu 11
gSe 11
p1
O 1
ct
N 11
ov
-1
1
0
M
% DNA
40
Month/Year
Optimising your Skill Mix
Table 4: Comparison of costs for different grades of staff spending 5 hours on admin
Annual cost of 5
hours per week
Annual savings from using 5 hours weekly
of Band 3 admin rather than 5 hours of
clinical time (£)
Annual savings from using 5 hours weekly
of Band 4 admin rather than 5 hours of
clinical time (£)
Annual savings from using 5 hours weekly
of Band 5 admin rather than 5 hours of
clinical time (£)
6
4741
1986
1534
870
7
5661
2907
2454
1790
3687
4894
6414
8320
10746
3024
4230
5751
7656
10082
AfC
Banding
8a
6895
4140
8b
8101
5347
8c
9622
6867
8d
11527
8773
9
13953
11199
NB These savings are not cash releasing unless resources are being moved from vacant posts.
Section 4 – Understanding and Managing
your Demand
• Introduction to What, Why and How to
measure Demand
• Table outlining the data you require to
analyse your demand
• Ideas for influencing your demand
Managing Demand
• Set clear eligibility criteria
• Goal setting, case review and caseload
management
Section 6 –Tools
• Generic Improvement Tools
• Mental Health Specific Tools
Contents
Generic Improvement Tools
This is not a comprehensive list. We’ve included the ones you are most likely to use for this work but for a more comprehensive list of tools
please visit the QI HUB website at http://www.qihub.scot.nhs.uk/default.aspx










The Model for Improvement (including PDSA)
Process Mapping
Value Stream Mapping
Process Reliability
Statistical Process Control Charts (SPC)
Pareto Analysis
The 5 Whys
Cause and Effect
Skill Mix Analysis
Skills Matrix
Mental Health Specific Tools











CAPA
Scottish Recovery indicator 2
Aston Team Performance Indicator and CMHT Effectiveness Questionnaire
Mental Health Activity Tracker
Mental Health Capacity Calculator
DCAQ Guide Booklets
The DCAQ Tool
Wiseman Workload Measure
Guidance on Calculating New to Follow-up Ratios
Mental Health Waste Spotters Guide
Summary of Data needed for DCAQ Analysis
Table Discussion
Considering what you have just heard and
by referencing the toolkit on each table can you
discuss the following points;
• What are your initial thoughts about content and
format?
• How might you introduce and test the toolkit with
your teams/services?
• What support do you think you might need to test
the toolkit in practice?
– Locally
– Nationally
• How might we measure the effectiveness of the
toolkit?