Whanganui Rising to the Challenge Seamless Experience

Project Name Whanganui Rising to the Challenge Seamless Experience Project Phase Delivery Project Sponsor Tracey Schiebli Project Status On Track Project Leader Warwick Gilchrist Date 25/01/2016 Description To provide a recovery focused, seamless experience 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 2014. The project is applying emerging best practice concepts for large scale change with a focus on building a Change Platform and Shared Values rather than establishing a single focus programme of change. Small scale change projects undertaken by individual work streams will use a methodology for change based on the Model for Improvement (MFI). Key Achievements Website updated with news and updates on Co-design and Older peoples workstream. Issues and Risks Critical Delays Next Period Plans Action Items for Sponsor Strengthened workstream focus on co-design and service mapping to support work done to date. MHATT and SuPP included in mapping. Rising to the challenge integrated in to mental health service model development. Training programme and schedule being developed for delirium and confused patients includes screening and interventions. AOD for older peoples stakeholder group meeting held direction refined, further work required C&Y workstream combined behavioural referral meeting test underway (due for completion January 29 2016. Shared working and common planning across teams is being progressed. Partners in care projects across personnel health, mental health and AoD services (6 projects underway) entering capture phase with stories, surveys and mapping taking place. Fitness for Surgery initiative being supported Meaningful community participation and engagement in child and youth work around behavioural focus has been difficult. Child and Youth workstream the paediatric team and the Child Development team participation in the behavioural referral meeting has been minimal. The initial test of four meetings over four weeks has not been able to be completed. Access to Information and tools (Website information, Apps, social media, tools, smart phones) identified across all work streams as a risk Communication with the community and community partnership in the change process is now critical. Community level roles and engagement meaningful actions for community providers Priority setting and workstream re-group and alignment with key planning direction. Communications for community stakeholders. Alignment with emerging strategic direction Advise on planning direction for next phase of the work-programme

Workstream Activities September January 2015 Older People - Confused Adult Work Stream Wendy Stanbrook-Mason and Dr Terry Johnson Service 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 Project 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 Community) Identified Projects - Using the Model for Improvement: Progress Next Steps 1 a) Test the Counties Manukau developed Confusion ABANDONED PDSA successful in identifying issues NHS Scotland will support our use of Assessment Method (CAM) tool 1 to evaluate its usability in their resources and training package Alternative tool identified NHS Scotland 4 AT the WDHB context prior to any implementation roll out. PDSA 1 ATR, PDSA 2 ED, Commence February 13 th assessment Tool is being investigated for use. Finish March 31 st b) Review and develop education bundle for CAM tool 2 Review and test 4 AT assessment tool 3 Tool can be used across all hospital settings including ED and Mental Health. Literature review complete Clinical lead support in place Training to be backed with publicity material and resources. Potential Application for Rest home use PDSA under development to test of 4 AT in Medical ward and ATR Training Package provided, resources provided by NHS Scotland. Workbook updated with new and revised content Care with Dignity signage and model of care branding approved Training programme and scheduling underway. Training to be delivered from February 2016 onwards. Priority groups are RMO s, RN, Allied Health and new staff commencing in Hospital. On-line e-training modules for clinical staff to be tested. WIPE session to be undertaken (scheduled) Training programme to be tested On-site visit from regional CEO s Test training and support options for Rest Home and community providers. 1 http://koawatea.co.nz/wp-content/uploads/2014/01/20600-20000days-delirium_hronline.pdf 2 http://www.knowledge.scot.nhs.uk/improvingcareforolderpeople/resources.aspx 3 http://www.the4at.com/

3 Introduce HCA education programme for confused patients 20150819 PDSA 1 Education PDSA com HCA package developed and tested training delivered. Workbook being edited and amended based on initial feedback Workbook updated with new and revised content Extend training to all HCA s scheduled for November - Workbook updated with new and revised content Expanded HCA training days to be run commencing November to include medical HCA, EN s and bureau staff. Care with dignity badges to be presented to all staff completing the training 4 Collect Patient and Staff Stories Staff stories collected patient feedback from Marama summarised Co-design project underway for physical layout of rooms - ongoing 5 Re-configure close observation room on Medical Ward Initial idea identified room allocated and initial facilities request made Concept design and co-design with user group Approval to scope project obtained 6 Co-design Partners in care project - ED Team identified project will focus either on Dementia Friendly or Yellow Space Questionnaires developed, project underway. Co-design team working in ED/Yellow space area

Adult Mental Health and Addictions Workstream Alex Loggie and Frank Bristol Service Goal: where the primary point of contact for Adult Mental Health and Addiction patients is informed and responsive *Triage a clinical, or other assessment, that seeks to inform access to the right services or support at the right time. Project 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 Progress Next Steps Test the use of the Loomio 4 crowd sourcing tool to widen the discussion around Triage and what constitutes a responsive first point of contact (PDSA 1 complete 27 th February) Loomio has been a useful addition to the project and is the platform being used to share information Definition of Triage agreed a clinical, or other assessment, that seeks to inform access to the right services or support at the right time. Loomio is now the standard communication pathway for the workstream The online discussion forum Loomio has been used by the adult work stream to support discussion and decision making processes and it`s use has been extended to the Releasing Time to Care (RTTC) project work. Ongoing use. Capture and develop patient stories Part of co-design projects commenced in October 2015 Map current triage process Referral pathway/form agreed - Initial process testing underway. Map of medicine initial draft complete Process being reviewed as part of PDSA 1 Ongoing planning and development meetings with RHN and workstream members Integrate pathway map, map of medicine and advance form Continue to develop costing and plan for development Include service directory model as part of pathway and as a decision support (awaiting advice from developers) 4 Loomio is a New Zealand Developed online discussion and collaboration forum. www.loomio.org

Introduce real time feedback for patient satisfaction Map of Medicine develop referral pathway Mental Health Pathway V2 13.05.20 Develop revised electronic referral form for use by primary care and NGO referrers MH&AOD_Referral_0 6_15.docx Approach developed and agreed with CMHT training package being developed Real time feedback in use at Balance as part of peer support Software is unstable in use vendor asked to rectify PDSA cycle 1 Draft Map of Medicine developed and circulated for comment further development required. Stage 2 deferred awaiting redraft of referral form etc. PDSA cycle 1 Underway Trail with Aramoho, Gonville and Te Waipuna - including 30 extended GP consultations and direct referral to Peer support consults. Working party reviewed electronic referral form options awaiting phase 2 PDSA to revise. Planned for introduction in CMH in February. Further development required additional service directory aspect to be included. Data report and full progress report to be developed by 15 February 2016. Business case and timeline for Advanced Form to be confirmed with project sponsor by February 15 2016 There have been a total of 21 primary care extended consultations in both Gonville Health and Aramoho. Of these 21 consults 4 have been referred on to CMH and Addictions services. It is verbally reported that during the period April 2014 April 2015 there was a significant reduction in CMH and Addictions services declined referrals and did not attends (dna`s) compared with the previous year. Please note that data confirming this is still being collated. Feedback is that a MS Word based form is not meeting GP needs an alternative approach is required Start redesign and develop scope for Advanced form Additional services and options should be included (counselling etc)

Compile feedback from PDSA 1 to date Trial direct access peer support consultation Review and expand current service information PDSA cycle 1 underway with direct referral from primary care for 50 patients Balance peer support NGO has completed 19 Peer support consultations none of which have required referring on to CMH and Addictions services. GP s are not making referrals or using form asking clients to self-present. Marama is being used as are ORS and SRS questionnaires. Collect data standardised screening tool score, session rating scale, Marama real time feedback Continue meetings with GP s and remind them about using the referral form for this test phase. Revise target number of consults for PDSA 1 Compile data repot Training bundle to be developed to support revised referral form and Map of Medicine Summary report compiled (Attached) Progress to date: TOTAL Known Referrals: 20 (one was a couple). Letter from GP: 1 Formal Referral Form through post: 6 Phone call from GP: 1? Referal from Counsellor: 1 **Self referral: 12 (see attached report) report for triage.docx Ongoing - Develop Service descriptions for training bundle So that referring practitioners/organisations Know what is expected of them They will be clear about the sorts of interventions and tools required That they will easily be able to access advice and consultation Know what services do and what response times are

Child and Youth Workstream - The Seamless Journey Children and Youth with Behavioural Difficulties Dr David Montgomery and Dr Gargi Bandyopadhyay Service Goal: To provide a service that nurtures children and young people - where their needs are met effectively the first time a need is identified. Project Aim: To improve access to, and engagement with, services for children and youth with behavioural difficulties. Identified Projects Progress Next Steps Develop and test Intake coordination process for CAMHS and PAEDs. Trial joint clinics (CAMHS/PAEDS) for behaviour related referrals Review HEADs group - can we use this group differently? Expanded to include Child Development Team CAMHS Pathway.docx CDT.docx Paeds MAP.docx Agreement from Workstream to develop a joint approach for these children and young people. Visit to Taranaki CAMHS to observe process. Neutral location for behavioural assessments identified Identified direct referral barrier to Paediatric (Dr to Dr only) - Paediatrics to accept referrals from CAMHS clinicians Initial planning meeting to agree scope of change project. CAMHS, Paediatrics & Child Development Team Pathways developed for CAMHS, PAEDS, Child Development Team Co-design project underway Test joint referral meeting Data Summary produced Review joint referral meeting Data Summary for Child and youth Wo Build staff capacity for change education, support options CAMHS staff workshop held. Releasing time to care to be introduced. Co-design workshop to be included WRTTC to continue to work closely with releasing time to care to ensure ongoing improvement culture change SuPP discussions underway Co design project focused on youth underway Co-design project for CAMHS/Paeds under discussion Co-design capture analysis to inform model of care development

Expanded methods and measure workshop to include CAMHS local data council and Releasing Time to Care Capture phase of co-design work Review current referral guidelines and information for referrers CAMHS Referral Form Manual 23.02.15 PDSA 1 Referral form revised revised version in use Work with primary care to develop electronic form initial draft awaiting outcome of CMHT discussions Intake documentation and reception practice reviewed and changed. Informed consent now taken by clinicians Model of care and pathway development underway. Mapping of current state complete (see separate report) Model of care development underway with SuPP to establish service mandate, linkages and points of shared care. Pathway developed Pathway Model of care development to inform service descriptions for training bundle So that referring practitioners & organisations Know what is expected of them They will be clear about the sorts of interventions and tools required That they will easily be able to access advice and consultation Know what services do and what response times are Generic CAMHS Pathway to Partnersh Update WDHB webpage information None To be updated with revised referral information Collect patient stories journey mapping Patient stories collected see previous updates Co-design project to include patient stories Establish Social Media presence trial Facebook and twitter options None DHB policy barrier Develop &Test Txt to remind for clinics appointments (CAMHS?Paeds?PHN) None dependent on PAS changes Awaiting roll out of Oracare. Networking and joint working with NGO and other providers Jigsaw have offered to help co-ordinate a regular provider hui. No progress to date discuss option at next workstream meeting in February