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NHS Improving QualityService Improvement Tools

Overview for Mental Health teams

1. Welcome & Introduction2. Housekeeping3. Achieving Excellence in Mental Health4. The NHS Change Model5. Benefits of Delivering High Quality Care6. Process Mapping7. Demand and Capacity8. Measurement for Improvement9. Clients/Patients, Carers and Public Involvement10. Engagement, Getting Started and Sustainability11. Case Studies Coming Online12. Questions & Answers13. Other Resources and e-Learning14. What’s Next

AGENDA

NHS Improving QualityService Improvement Tools

Overview for Mental Health Teams

Jeri Hawkins Elaine Kemp

www.nhsiq.nhs.uk/

Welcome and Introduction

Anita Hayes Programme Delivery Lead End of Life Care, Mental Health and Dementia

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Achieving Excellence in Mental Health

The NHS Change Model

Today –

• Process mapping • Demand and Capacity• Measurement for improvement • Patient and public involvement• Engagement and ‘getting started’ and

sustainability

Where is NHS working now?- Crisis support- Cardiovascular physical Health Checks

Process Mapping

Process map of the pathway for an in-patient to receive CBT for psychosis.

Bayney R APT 2005;11:305-314

©2005 by The Royal College of Psychiatrists

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DEMAND AND CAPACITY

Demand – How much work we are asked to do - referrals

Backlog – Work we have been as yet unable to do – waiting lists

Capacity – The amount of work we should be able to do – beds

Waste – The amount of capacity lost – cancellations, DNA’s

Activity – What we actually delivered

Demand, capacity, activity and backlog need to be measured in the same units for the same period of time

Don’t compare unless they are measured in the same unit of time It is important to compare on a single graph and the same measures

must be used for each

• When you: - have a completed process map, identified the long delays and understand the variation - need to focus improvement on flow and prove a variance between demand and capacity

Examples:• Reducing the time from receipt of referral to first assessment

appointment for CMHT• Improving the transition time between liaison psychiatry assessment

in the ED and provision of appropriate further services, eg inpatient specialist bed

When to look at demand and capacity

A Few benefits of looking at demand and capacity

• Flow can be improved by reducing the variation in capacity and ensuring that the capacity meets the variations in demand, particularly where there is a constraint (bottleneck) in the process

• Balancing demand and capacity can help reduce errors by ensuring staff are not working in an environment where there is a constant backlog

• Most delays and inefficiencies in the healthcare system are not the result of excess demand or the shortage of resources. The key issue is a mismatch between when capacity is available and when demand presents to a service.

Demand and Capacity Top Tips

• Always compare like with like – e.g. time as a unit of measure• Start simple and use existing data where possible• If no data exists complete a snap shot audit• Be aware of the impact on other services of efforts to deal with

backlogs (surges of work) and focus on the whole journey• Even in a well designed process flow will be affected by capacity and

demand• Make sure clinical and administrative processes are aligned

“You can’t fatten a cow by weighing it” (Palestinian proverb)

Improvement is not about measurement, but……..

How do we know if a change is an improvement?

“If you can’t measure it, you can’t improve it”

Measurement for improvement16

Measurement throughout the project cycle

Project Identification

Getting a baseline

Did project make a

difference

Will project sustain

Evaluating worth of the

project

A PDS

A PDS

A PDS

A PDS

A PDS

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7 Repeat steps 4-6

7 Steps to measurement

1 Decide Aim

2 Choose Measures

3 Define Measures

4 Collect Data

5 Analyse & Present

6 Review Measures

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The improvement process

Wai

ting

Tim

e

0

200

150

100

50

250

Performance Report

Week

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20

Act Plan

DoStudy

Special causes present -

unpredictable

Process predictable

(within control limits)

Process improvement

To identify whether we are meeting service requirements: How do we know that we are providing the services/products that our service users and carers require?

To help us understand our processes: To confirm what we know or reveal what we don't know: Do we know where the problems are?

To ensure decisions are based on fact, not emotion: Are our decisions based on well-documented facts and figures or on intuition and gut feelings?

To show where improvement needs to be made: Where can we do better? How can we improve?

To show if improvements actually happened: Do we have a clear picture?

To reveal problems that bias, emotion, and longevity cover up: If we have been doing our job for a long time without measurements, we might assume incorrectly that things are going well. (They may or may not be, but, without measurements, there is no way to tell.)

To identify whether others are meeting our requirements: Do people giving us a service know if our requirements are being met?

20Some Benefits of Measurement

1. All your gut should tell you is when to eat2. Measurement is not the goal; improvement is3. Remember that variation exists 4. Define what you are collecting clearly5. It is better to measure a few simple things well than

to develop many complex metrics and measure them badly

6. A few key measures plotted over time is all you really need to know if there has been an improvement

7. Only interpret data using statistically significant measures

8. Statistical Process Control was designed to be used with PDSA cycles - use it for all stages of your project

Measurement Top Tips

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Clients/Patients, Carers and Public Involvement

http://www.nhsiq.nhs.uk/improvement-programmes/experience-of-care.aspx

The secret of getting ahead is getting started. The secret of getting started is breaking your complex overwhelming tasks into small manageable tasks, and then starting on the first one.

Mark Twain

Engagement, getting started and sustainability

The work before the work….

• Stakeholder profiling

• Engagement and working with groups

The work before the work….

• How to manage the project

• Sustainability

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Case Studies coming online….

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Next case study ….

Webinar: Wednesday 23rd July, 10am

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• Any Questions?

If you have a question, either type it into the chat box or raise you hand and we will unmute your line so you can ask us directly.

Other resources and e-Learning

http://mentalhealthpartnerships.com/Mental Health Innovation Hub

http://www.yhpho.org.uk/default.aspx?RID=191242Mental Health Dementia and Neurology Intelligence Network

http://www.jcpmh.info/Joint Commissioning Panel for Mental Health. Co-chaired by RC Psych/RC GP.

http://www.wardipedia.org/Ideas, examples, information and research about therapeutic inpatient mental health care

http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement.aspxRoyal College of Psychiatrists College Centre for Quality Improvement (Note: Access to resources may require membership or subscriptions)

http://www.piramhids.com/home.aspxPositive and innovative resources: A Mental Health Interactive Database (Scotland)

http://www.icptoolkit.org/home.aspxIntegrated Care Pathways for Mental Health (Scotland)

What Next?

• We are going to run a poll (insert explanation) to find out if you have any service improvement training needs

• We would also like to hear if you have good examples of service improvement

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Thank you

A link to this webinar will be sent out to you shortly along with a link to the slides which will be made available through our website