Update Report March 2015

Transcription

1 Project Name Whanganui Rising to the Challenge Project Phase Delivery Project Sponsor Tracey Schiebli Project Status On Track Project Leader Warwick Gilchrist Description To provide a recovery focused, seamless journey for consumers and their families by developing improvement activities and pathways across three work-streams based on Whanganui Rising to the Challenge The Mental Health and Addiction Service Framework The project will apply emerging best practice concepts for large scale change 12 with a focus on building a Change Platform and Shared Values rather than establishing a programme of change. Small scale change projects undertaken by individual work streams will use a methodology for change based on a modified version of the Break Through Series (BTS) IHI 3 Collaborative Structure. Key Achievements October 2014 February 2015 Since the November 2014 the Whanganui Rising to the Challenge project has progressed to the delivery stage with the establishment of three working groups. Adult Mental Health and Addictions (Triage), Older People (The confused patient) Child and Youth (Behavioural conditions). Each working group is configured to meet the needs of the specific focus area being considered (appendix one list the current group membership). Group membership should be considered fluid and will change as the work progresses. Core membership is 8 12 people for each group. Each working group has met at least three times over the period with a focus on establishing success factors, projects aims, barriers and potential small scale change projects. Although each focus area is different - common themes have become apparent. Common Themes (success depends on ) : Co-ordination and Shared Understanding Informed and compassionate Staff An integrated service that is informed by "What Matters" to the people and their Whanau and communities When it doesn t matter where the care happens as long as it does happen - with people being strengthened and resourced Improved patient/whanau experience 1 Leading Large Scale Change: a practical guide (2011), NHS Institute The Breakthrough Series: IHI s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; (Available on

2 Update Report March 2015 Robust, consistent, transparent processes - excellent patient care Education The number of common and recurrent themes is consistent with services operating in a shared environment within the same community patient groups may differ but the basic goals, objectives and barriers are the same. The Whanganui Rising to the Challenge project will use common solutions to these issues either as part of the project or as part of aligned project deliverables. Documentation Each Workstream has developed a project on a page Driver Diagram a living document that includes the key elements of the work being undertaken. The Driver Diagram and supporting project charter form the basis of the agreed approach for each working group. An example Driver Diagram and Project Charter accompany this report and are available on the project shared drive. Communication and Networking In addition to the three workstreams the project is building working relationships with DHB operational management, NGO s, community groups and primary care leaders. This aspect of the project will be ongoing and involves all members of the working groups. Whanganui Rising the Challenge was featured in the December edition of the Whanganui DHB newsletter and further updates will be provided. A community update is also being planned as are updates to the information on the DHB website. Patient Satisfaction - Real Time Feedback Starting in March the Whanganui Rising to the Challenge project will be introducing the Marama Consumer and Family/Whanau Real Time Feedback tool (RTF) developed by the Office of the Health and Disability Commissioner. The tool will be used in establishing benchmark consumer and Whanau satisfaction with current service delivery across the three focus areas. Mārama collects feedback from consumers and their family / whānau and presents the results in real time. Whanganui DHB has purchased a licence and five wireless tablets to use in data collection and will be using the programme to collect feedback for the Whanganui Rising to the Challenge project in the first instance. The trial objective is to gather baseline consumer and whanau satisfaction feedback. This information will be used in assessing the impact of activities across the three Whanganui Rising to the Challenge workstreams. The first area to use the tool will be the Older Peoples Workstream. Workstream Outputs 1. Older People - Confused Adult Work-Stream Workstream Leads: Wendy Stanbrook-Mason and Dr Terry Johnson

3 Goal: Enabling excellence of care to the person/whanau in front of you by providing tools, knowledge and support to the person providing that care Aim: (That ) Confused patients are cared for in a calm comfortable environment supported by staff with appropriate training by: Testing a revised Model of Care for the Confused patient across WDHB inpatient settings (ED Discharge) Provide evidence using a range of measures to demonstrate improved outcomes Identified Projects Using the Model for Improvement (PDSA) (see appendix 2 & 3): Test the Counties Manukau developed Confusion Assessment Method (CAM) tool 4 to evaluate its usability in the WDHB context prior to any implementation roll out. PDSA 1 ATR, PDSA 2 ED, Commence February 13 th Finish March 31 st Review and develop education bundle for CAM tool Introduce HCA education programme for confused patients Link CAM Tool, Map of Medicine and ED Protocols Collect Patient Stories 2. Adult Mental Health and Addictions Workstream Workstream Leads: Alex Loggie and Frank Bristol Goal: where the primary point of contact for Adult Mental Health and Addiction patients is informed and responsive Triage A function to inform access to the right service at the right time Aim: To develop and test a responsive first point of contact model of care for Mental Health and Addictions services are provided by the right people in the right place at the right time by: Testing a revised triage* model with 50 patients. Providing evidence of improved patient satisfaction, Reduced specialist referrals and increased utilisation of NGO/primary care services Identified Projects Using the Model for Improvement (PDSA) (see appendix 2): Test the use of the Loomio 5 crowd sourcing tool to widen the discussion around Triage and what constitutes a responsive first point of contact (PDSA 1 complete 27 th February) Capture and develop patient stories Map current triage process Loomio is a New Zealand Devloped online discussion and collaboration forum.

4 Introduce real time feedback for patient satisfaction Trial extended telephone consultation and advice Review and expand current service information 3. Child and Youth Workstream - The Seamless Journey Children and Youth with Behavioural Difficulties Workstream Leads: Dr David Montgomery and Dr Gargi Bandyopadhyay Goal: To provide a service that nurtures children and young people - where their needs are met effectively the first time a need is identified. Aim: To improve access to, and engagement with, services for children and youth with behavioral difficulties by: Trialing Improved information availability and channels (website and social media, txt to remind) Develop and trial a seamless assessment process using an MDT across CAMHS and Paediatrics Developing an evidence base to support ongoing change Identified Projects Using the Model for Improvement (PDSA) (see appendix 2): Develop and test Intake coordination process for CAMHS and PAEDs Review HEDs group - can we use this group differently? Trial joint clinics (CAMHS/PAEDS) Build staff capacity for change education, support options Review current referral guidelines and information for referrers PDSA 1 ready for testing 27 February Update WDHB webpage information Collect patient stories map their journey Establish Social Media presence trial facebook and twitter options Develop &Test Txt to remind for clinic appointments (CAMHS?Paeds?PHN)

5 Appendix 1. Whanganui Rising to the Challenge Workstream members February 2015 Older People Workstream: Dr Terry Johnson and Wendy Stanbrook-Mason Core Group Organisation Olive Redfern Walking in Another's Shoes educator, WDHB Karen Goymour Case Manager, Assessment Treatment & Rehabilitation, WDHB Jan Gregson Geriatrician, Assessment Treatment & Rehabilitation, WDHB Colleen Hill Clinical Nurse Manager Medical Ward Carla O Keeffe Clinical Nurse Manager carla.o'keeffe@wdhb.org.nz Emergency Department Mihi Backhouse Service Coordinator, WDHB Mihi.Backhouse@wdhb.org.nz Wider (Consult) Group Karen Smiley Merle Ormsby Clinical Coordinator, Community Mental Health/Alcohol & Other Drugs, WDHB Te Puawai Aarahi, Maori Health, WDHB Karen.Smiley@wdhb.org.nz Merle.Ormsby@wdhb.orgn.z Fiona Corbin WRHN Pharmacist fiona@wrpho.org.nz Fiona Reweti Te Oranganui Iwi Health freweti@teoranganui.co.nz Authority (TOIHA) Melina Cropp Te Oranganui Iwi Health mcropp@teoranganui.co.nz Authority and HBS Jenny Spence Alzheimers Alzheimers.wang-coordinator@xtra.co.nz Sue Trevethick Service Manager, Registered Nurse, Whanganui Community Living Trust (NGO) suet.wclt@xtra.co.nz Nanci Quigley Supporting Families Nancie@sfwang.co.nz Bonnie Sue Te Puke Karanga Hauora bonnie.sue@ngatirangihealth.org.nz Sharon Crombie Jennie Fowler Manager, Hinengaro Hauora, Te Oranganui Iwi Health Authority Strategic Advisor Aged Care, WDHB sharon.crombie@teoranganui.co.nz Jennie.Fowler@wdhb.org.nz

6 Child & Youth Workstream: Drs David Montgomery and Gargi Bandyopadhyay Core Group Organisation Janice Bowers CAMHS Julie Jackson Public Health Nursing Chrystal Hamlin Service Leader, Pathways Barbara Branford Family Advisor, Supporting Families (NGO) Jon Buchan Portfolio Mgr Maternity, Child & Youth, WDHB Kim Fry Director of Allied Health, WDHB Tim Metcalfe Jigsaw Peter London Peer support worker, Balance Whanganui (NGO) Marama Cameron ASD Co-ordinator CAMHS Wider (Consult) Group Jo Smith IDEA Services Wendy Kopura Crippled Children's Society Rae McLean Iwi Ngati Rangi Com Health Centre Debbie Rimene Registered Nurse, Te Oranganui Iwi Health Authority (TOIHA) Grace Taiaroa Manager, Ngati Apa Iwi Hine Potaka Maori Problem Gambling Health Promotion, Nga Tai O Te Awa Fiona Wakeling SF Wanganui Fiona@sfwang.co.nz

7 Adult Workstream: Alex Loggie and Frank Bristol Core Group Organisation Jo Stephen CMH/CAMHS Psych Julie Nitschke Clinical Director - WRHN julie.nitschke@wrpho.org.nz Anne Kauika Project Manager, Healthy Anne.Kauika@wdhb.org.nz Eating, Public Health, WDHB Mike Ward Trust Manager, Whanganui ward.wclt@xtra.co.nz Community Living Trust (WCLT) (NGO) Kori Hemi Balance jkhemi65@gmail.com Tony Frith Te Waipuna Medical Centre, tony.frith11@gmail.com Te Oranganui Iwi Health Authority (TOIHA) Wider (Consult) Group Shaz McFarland Clinical Nurse Manager, Sharon.McFarland@wdhb.org.nz Community Mental Health/Alcohol & Other Drugs, WDHB Grace Taiaroa Ngati Apa Iwi, Manager grace@ngatiapa.iwi.nz David Hughes Pathways (NGO) David.Hughes@pathways.co.nz Raewyn Hall PATHS coordinator Raewyn.Hall@wdhb.org.nz Ron Kinsey WDHB Cl Psychol Ronald.Kinsey@wdhb.org.nz Lachie Smith GP, Aramoho Health Centre Lachies@aramohohealth.co.nz Annie Chapman Balance annie@balancewhanganui.org.nz Comms Group Kim Fry Director of Allied Health, Kim.Fry@wdhb.org.nz WDHB Brian Tuck Mental Health Support B.Tuck@ucol.ac.nz Workers Certificate Lecturer, UCOL Helena Taniwha Administrator, Mental Illness mist@xtra.co.nz Survivors Trust (MIST) Peter de Roo WDHB Stn Hse CNM Peter.deRoo@wdhb.org.nz Chrissy Bretherton Supporting Families (NGO) chrissyb@sfwang.co.nz Janine van Blerk WDHB Cl Psychol Janine.vanBlerk@wdhb.org.nz

8 Appendix 2 The Model for Improvement 6 A structured trial of a process change. Plan - a specific planning phase; Do - a time to try the change and observe what happens; Study - an analysis of the results of the trial; and Act - devising next steps based on the analysis. 6 Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.

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10 Appendix 3 PDSA Outline Planned Start Date 16/2/15 Planned Finish Date 2/3/15 PDSA #: This PDSA Title: Owner: Objective for this PDSA Cycle: To test the CAM assessment tool to evaluate its usability in the WDHB context prior to any implementation roll out. This PDSA will be used to: Collect Data Develop a Change Test a Change Implement a Change Plan: Fill the sections below as part of planning Change Idea: Briefly Describe the change you plan to test: Test tool in current format Identify two staff in ED and Medical ward to use this form Test on patients over the age of 65 year Over a period of two weeks. Questions: What question(s) do we want to answer on this PDSA cycle? Is the current format what WDHB should retain Is the wording in the context of the WDHB Is this an effective tool at identifying delirium/confusion in admissions in ED and medical ward How many forms were used verses how many over 65 years old presented to ED and admitted Has this form provided insight into staff s own practice and knowledge Prediction: What do you think will happen? Prediction on Change: The tool will provide WDHB an official assessment tool for a delirium/dementia Over 65 years was the appropriate age to commence with Emergency department benefits from a tool to assess the status of these patients Prediction on Question wording may need to be adjusted to the WDHB context the format is appropriate for the WDHB context This tool provides staff the opportunity to reflect on how they assess a patient for delirium Data: What data will you need to test your prediction(s)? How will you collect it. Collected forms, will not be filed in patient notes at this time. Staff to complete a feedback form provided Use of Oracare data

11 Task to be completed for Test Who When Where and How Find two appropriate staff Carla & Colleen Week 9 Feb 15 ED and Medical. Identify staff with interest Provide the tool for testing Wendy Feb 15 Run copies and begin talk with comms Provide education to the testers Olive, Wendy, Carla, Colleen Input from the wider team also Do: Carry out the change or test; Collect data and begin analysis. What problems or unexpected events did you encounter? Feedback and observations from the participants? Study: Complete analysis of data; What do the data show? Was your predication confirmed? If not what did you learn? Compare the data to your predictions and summarize the learning Act: Decide the next step. Following this test, you will Adopt Adapt Abandon this change? What is your plan for the next cycle

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