The co-design of an integrated Gastro Pathway- Can we improve the emotional well-being of patients
in the Gastroenterology pathway
Pre-Phase
Action-phase
Why
emotional
health and
gastro ?
Results
GPRoutine
GP-Out-Patient Gastro Process Map V1
RD& EConsultant
DRSSChoose & Book
MOPD
Updates spreadsheet with
outcomes
Gastro referral service
Consultant Grades referral
Colorectal Pathway
Gastro Secretary’s Office
Consultants Deskx11
Outpatient Folder
Endoscopy Folder
Other Tests
Gastro outpatient slots allocated
OPD
Patients
Occupational Health
Calprotectin Test
Hospital DOS
Prints referral lettersChecks details
Pending list
Connecting Pathway
Creates a Spreadsheet
Liver Pathway
Connecting Pathway
Secretary picks up letters
Gastro referral service
Pending list updated Micro system mapped CXC
Dr Calverts Clinic
OPD
Process Step Information
GP referrals sent via E-referrals ElectronicInformation Systems
/Data flow
Con to Con via white card/letters via sec to sec internal mail
DRSS triage? referral
Received in MOPD Printed added to
pending list ungraded
Paper received and pending list updated
Graded
Returns back to electronic process
Process now becomes paper
based
Slot allocated via E-referrals app booked letter generated on
PAS
Sent to patient via synertec with
questions
Data Flow – Electronic process
Data Flow- Paper process
KeyGastro OP Referral Process to Talking Health -V1
Issue
PDSA Screening Process
Talking Health 1
Health Psychology
2
Psychiatric liaison
3
Pt attends clinic -HCA asks patient to
complete questionaire
Pt hands questionnaire to
clinician
Clinician to review and score
questionnaire
Discuss outcome from questionnaire
with patient
Referral recommendation for
Talking Health
Email/send copy of letter to TH
Future state this can be sent via
appointment letter
PDSA information held on secure
research database
Give patient leaflet -if unsure may wish
to self refer
TH receive referral What happens when
in TH ?????
Health
Psychologist
Senior
leader
Gastro
Consultant
Dietitian
IBD Nurse
30% of people with a long-
term physical condition
also have a mental health
problem
Visualising the
pathway and creating
opportunities for
improvements
Understanding the
scale
IPS/GI Pathway Mind Map
Big Room
Comm’s Plan
Pre-Phase Data
Coaching Time
Research
What is happening in other Trusts
Our 3 Key Messages
Venue, time of first Big Room
Attendance list
Presenting the information
Progress reports
Promoting the FCA Framework & Method
Social Media
Face to Face
Movable display boards
High influence -High Interest
ED summit -existing work in other areas- H&N Debates
CAMS PAEDS
What is the problem and the aim
Observational audit/patient survey
Sharing with other pathway coaches
Intranet
To FCA Sheffield
RDE&DPT Faculty/Exec Sponsor
Process Map-Pathway value stream map
Twitter #DevonFCAWeekly catch up’s face to
face
Structure the Problem ?
Aligning with existing work streams
Why look at this area as oppose to anywhere else
ISP- Map & Measure GI O/P Clinic
Data capture with patients -Screening tool barometer
Primary
Secondary
Complaints
121 conversations with identified pathway leads
Pathway associated Diagnostics/investigations
Referrals
Pathway admissions Datix Incidents
Improve patient & staff experience
Reduced cost in investigation procedures, reduced waiting lists,
reduced F/U
Will inform pathway process map
How do we identify where Psychological
interventions would be beneficial?
Using the data to inform a starting point
for improvement efforts
Site visits- clinics, wards, GI MDT meeting
Site visits- clinics, wards
What are they?
Post GI MDT meetings Friday afternoons ?RDE Wonford E
template
National guidelines -other similar work -lessons learned
Learning from each other, sharing success
and failures
Define our communication
strategy for FCA and internally for pathway-
tailor accordingly to improve success
Pathway metrics essential to measuring
improvements both qualitative and
quantitative
Risk Creating a local
optimal and displacing issues elsewhere in the
system
Big Room-ground rules, active listening,
respect, coaches to coach not lead
What we think the problem is
+ What the data tells us
+ What the stakeholders
tell/show us
–
Any bias
=
A starting point for improvement
Lost leader What's the ROI for the time out from Job plan
Risk Not knowing what data we have and
how to use it
Risk Not creating a
consistent message
Risk Jumping to
solutions forcing a predetermined
agenda
Risk Comorbidity shift
to other areas- missed
opportunities
Patient voice/stories co-design principles
Specific Aims:
By designing an integrated service we will:
• Assess/Screen for co-existent psychological distress and
mental health disorders
• If mental health issues are identified, patients will be seen
by the right services in a timely manner
• Improve all HCPs knowledge and understanding of mental
health and how to access these services (education)
• Improve communication across organisations as well as
between primary and secondary care
• Improve patient experience
• Improve health outcomes and reduce unnecessary health
utilisation
Global aim:
To improve the identification and management of
mental well-being across the whole
gastroenterology pathway
Co-designing the best
pathways to access
services
Around 50% of medical gastro outpatients have no clear organic pathology and investigations
for medically unexplained symptoms cost between 20-50% more than for other patients.
‘I keep having the
same tests and
hearing the same
things, but I'm not
feeling any better’
What are
patients
telling us…
Gastro Screening Tool
Screening
for
Depression
& Anxiety/
Somatic
Symptom
burden
Screening Tool Data collection
160 patients screened in O/P
New Follow-up
47 patients screened positive for D&A
36%
Pos 28%
Pos
23 patients
referred for
CBT treatment
‘More confident in
approaching the
topic of MH’
Dietitian
‘Fantastic, being
genuinely
integrated with
Gastro Clinicians’
DAS Manager
‘I have been
encouraged to
speak and
suggested ways to
improve the
patient experience’
Patient
Feedback
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