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The Royal College of Psychiatrists Improving the lives of people with mental illness

Spotlight on Quality Improvement

Spotlight on quality

Quality Improvement: a case study

Last month we told you that Amar Shah had become the college’s first Quality Improvement lead. Amar would love to hear your stories of quality improvement in your workplace.

Each month from now, we’ll include a QI case study.

The first one focuses on Durham and Darlington Child and Adolescent Mental Health Services Senior Management Team, which is part of Tees Esk and Wear Valleys NHS Trust.

 

Long waiting times, high caseloads

In February 2016, the service was facing particular issues with children waiting to access services.

There were 923 children waiting and 212 had waited over 9 weeks.

To compound the issue there was poor staff retention & recruitment with 35 vacancies, staff sickness was at 10.1%.

Staff caseloads were high; there was limited transparency on the performance of the service.

 

How QI methods helped

The introduction of daily lean management has provided a system for baselining demand and daily monitoring.

Daily huddles and visual control boards were introduced to provide transparency and visibility within the service.

This process enabled the leadership team to identify issues, agree actions and ensure accountability. For example, a particular issue with the ASD pathway was identified and a formal improvement event was commissioned.

A number of interventions, including

  • daily clinical huddles

  • caseload management and

  • activity planning

were introduced into each community team.

This has supported the improved flow of patients, the ability to flex capacity in line with demand to ensure patients are seen promptly and an improved levelling of work across all team members.

 

Boosting recruitment and other innovations

A recruitment fair was held to recruit new members of staff to a number of vacancies.

A single point of access service was introduced through the use of a formal quality improvement event. There is now one single point of access to the service.

All of the improvements and interventions have been developed into standard work and leaders undertake Gemba walks to ensure that standard work is being followed.

In November 2016, there was a significant reduction in waiting times with a total of 122 waiters (only 10 over 4 weeks and none over 9 weeks). Staff sickness was 4.6%, there were no vacancies and there was an improvement in the staff Friends and Family Test.

A combination of Gemba walks and the DLM process has enabled the service to understand their value stream and identify opportunities to remove waste from the system.  A number of improvement events with Durham & Darlington CAMHS were held during 2016 using the trusts QIS methodology. 

Upon identification of the events, the leaders observed the process to understand the issues and potential areas for improvement.  Improvement teams consisting of a Sponsor (Director of Operations) and Process Owner (HOS and Service Manager) and Workshop Lead (Certified Leader in the Trusts QIS) were identified to lead the pre-event, the event and post event activities. 

A key role of the Sponsor is to identify the targets for improvement.  12 weeks prior to the events, the Workshop lead and their team lead completes a series of deep dive observations to provide a baseline for metrics. 

The metrics were developed into a Target Progress Report which provided the system for measurement post event.


Amar would like to hear your QI success stories to help spread best practice. Please email him at amarshah@nhs.net and we will publish a success story in the eNewsletter each month.

 

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