BEAT It! every patient every time

Enhanced Mental Health Consumer

Journey in Wyong Emergency Department

Anne Louise Elsom CNC

Ben Roberts NUM

Project background

Case for Change

• 2014 NEAT (ETP) Target 80% up to 81% 2015

2013 result 47%

Project Goal and Objectives

Strategic Direction

Caring for the Coast every patient every time

Project Goal

To improve mental health consumers experience at Wyong ED by reducing wait times and treatment delays.

Project Objectives

• By June 2015 mental health consumers presenting to ED will be admitted, discharged or transferred within 4 hours, thereby improving Mental Health NEAT from 47% in 2013 to 81%

Methodology Solution

DesignProject Initiation &

Start-up

Diagnostics

Solution Design

Implementation

Planning Implementation

Checkpoints

• Post Implementation Evaluation

• Review & Redesign of Unsuccessful Initiatives

• Continuous Cycle of Redesign –Sustainability

• Sharing of Knowledge

• Writing For Publication

• Implement Quick Wins

• Implement all Solutions

• Trouble Shooting

• Coaching & Support

• Monitoring and Reporting

• Implementation Plans for Quick Wins

• Business Cases

• Implementation Teams

• Change Readiness Assessment

• Sponsorship Roles & Responsibilities

• Project, Stakeholder, Communication & Change Management Plans

• Performance Management

• KPI Def inition & Measurement Plan

•Piloting Initiatives

• Literature Search for Best Practice Solutions

• Facilitated Problem Solving & Brainstorming

• Solutions Identif ication

• Cost/Benef it Analysis of Solutions

• Prioritisation of Solutions

• Detailed Solution Statements

• Develop Quick Wins

• Process Mapping

•Diagnostic Tools & Techniques

• Staf f Interviews

• Patient Interviews

• Patient Tag Alongs

• Data Collection & Analysis

• Baseline KPI’s

• Issues Identif ication

• Issues Prioritisation

• Root Cause Analysis

• Building the Case For Change

• Project Management

• Project Objectives & Measuring Benef its

• Project Scoping

• Governance & Reporting

• Roles & Responsibilities

• Project Deliverables & Scheduling

• Project Costs

• Risk Management

• Change Management

• Stakeholder Management

• Communications Management

Pu

rpo

se

Centre for Healthcare Redesign - Methodology

Implementation

Planning

Evaluation

Sustainability

Knowledge

Sharing

To identify ways to improve the process, share lessons and drive sustainability

To design and prioritise solutions to issues and build stakeholder support

To collect and assess critical data about processes, patients and staff. Identify key issues to be resolved and build the case for change

To develop the project scope and set up project, change, communication and stakeholder management plans

To implement solutions and confirm that benefits are being delivered

To develop a comprehensive plan for implementing solutions and measuring benefits

Diagnostics

Project + Change + Stakeholder + Communication Management

Project Initiation &

Start-up

Diagnostics

Solution Design

Implementation

Planning Implementation

Checkpoints

• Post Implementation Evaluation

• Review & Redesign of Unsuccessful Initiatives

• Continuous Cycle of Redesign –Sustainability

• Sharing of Knowledge

• Writing For Publication

• Implement Quick Wins

• Implement all Solutions

• Trouble Shooting

• Coaching & Support

• Monitoring and Reporting

• Implementation Plans for Quick Wins

• Business Cases

• Implementation Teams

• Change Readiness Assessment

• Sponsorship Roles & Responsibilities

• Project, Stakeholder, Communication & Change Management Plans

• Performance Management

• KPI Def inition & Measurement Plan

•Piloting Initiatives

• Literature Search for Best Practice Solutions

• Facilitated Problem Solving & Brainstorming

• Solutions Identif ication

• Cost/Benef it Analysis of Solutions

• Prioritisation of Solutions

• Detailed Solution Statements

• Develop Quick Wins

• Process Mapping

•Diagnostic Tools & Techniques

• Staf f Interviews

• Patient Interviews

• Patient Tag Alongs

• Data Collection & Analysis

• Baseline KPI’s

• Issues Identif ication

• Issues Prioritisation

• Root Cause Analysis

• Building the Case For Change

• Project Management

• Project Objectives & Measuring Benef its

• Project Scoping

• Governance & Reporting

• Roles & Responsibilities

• Project Deliverables & Scheduling

• Project Costs

• Risk Management

• Change Management

• Stakeholder Management

• Communications Management

Pu

rpo

se

Centre for Healthcare Redesign - Methodology

Implementation

Planning

Evaluation

Sustainability

Knowledge

Sharing

To identify ways to improve the process, share lessons and drive sustainability

To design and prioritise solutions to issues and build stakeholder support

To collect and assess critical data about processes, patients and staff. Identify key issues to be resolved and build the case for change

To develop the project scope and set up project, change, communication and stakeholder management plans

To implement solutions and confirm that benefits are being delivered

To develop a comprehensive plan for implementing solutions and measuring benefits

Diagnostics

Project + Change + Stakeholder + Communication Management

Diagnostics

• Utilise existing data

• Staff interviews (n=30)

• Process Mapping (n=5)

• Suggestions Box

• Focus Groups (n=2)

• Literature review

Engaging Consumers & Carers

• Patient & Carer Experience Trackers (n=26)

• Consumer & Carer Stories (n=4)

• Complaints & Compliments (n=12)

• Consumer Consultants

“No one told me how long I would have to wait”

“I felt uncomfortable with sick kids next to me ”

“There was a long wait in the waiting room”

Summary of Key Issues

> 200 Psych Reg

Availability & Workload

Length & Depth of MH Assessment

PECC Model of Care

Delays for Physical

Assessment

Inconsistent FirstNet

Processes

Presentation Times &

Workload

Delays in Admission

The PAST patient journey

Solution Design Techniques

• 6 x Brain storming sessions

• Literature Review

• Review of previous Mental Health NEAT projects

• Suggestions Box

• Solution Statements

• Solutions Prioritisation Tools & Voting

0 5 10 15 20 25

ED Nursing

ED Medical

MH Nursing

MH Medical

Managment

Solutions Prioritisation Stakeholders Engaged

CIN Screen & Workup

MH Triage

MH Ax

Document & Refer

Pt Arrives

Triage

Admit, T/F, D/C

FirstNet Sign Off

Patient Leaves

Admit or T/F

Document, & Arrange

Bed

Med, MH or

D/C

Medical Investigations

Admit or D/C

Depart Ready Sign

Off

Patient Leaves

D/C

Admit

D/C

Admit

5MIN 20MIN 45MIN 60MIN 90MIN 2HR 3HR

MH Standard MH

Med

D/C

The NEW Patient Journey

Summary of Key Solutions

FirstNet Referral & Discharge

FirstNet Monitor &

ePJB

Nurse Treat Only

Streamlined Assessment &

Documentation

Dedicated ED Staff

Specialist

CIN Pathways

CL & PECC Coverage

Combined Education

Assessment Clinic

Physical Review

Video-conference

assessment

Staggered Shift Times

Implementation Sequencing

Solution / Initiative Area

Qu

ick

Win

s

3

MH

Pro

ced

ure

s &

Wo

rklo

ad

1

Ph

ysic

al A

sses

smen

t

2

Ad

mit

ted

NEA

T 4

Jun July Aug April May Sept Jan Feb

2015

Mar

Review & Revise

Implementation

Establish Work Parties

Solution 2: Dedicated ED staff specialist

Solution 1.3: VC between sites

Solution 3.1: FirstNet Referral & Discharge process

Solution 1.1: Streamline MH Assessment & Documentation procedures

Solution 3.2: Firstnet Communication SOP

Solution 4: Electronic Patient Journey Board

Solution 1.2: ESoP for ED MHT Nurses

Development

Scope

Develop Pathway

Consult IM&T

Develop SOP Roll Out

Implement

Validation

Educate

Consult Implement

Evaluate & Monitor

Evaluate

Evaluation

Trial

Develop SOP Roll Out Evaluation

Solution 1.4: ED MHT staggered shift times

Solution 1.5: CL/ACT/PECC coverage to ED

Solution 1.6: Assessment Clinic

Solution 2.2: MH CIN Pathways

Solution 2.3: Physical R/V & Ax Pathway

Solution 2.4: Structured ED MH Education

Consult

Consult Develop SOP Evaluate

Consult Develop Pilot Implement Evaluate

Consult CL Revise Implement Evaluate Consult ACT Await ACT R/V

Educate Implement

Consult Revise Educate Implement Evaluate

Review Draft Educate Implement Evaluate

Review Consult Revise Implement Evaluate

Review Consult Schedule Conduct Evaluate

Order Install

Oct

Evaluate

Consult

Progress to Date

Results to Date

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

National ED Access Target 81% MH ED Wyong

Data Target

Results to Date

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

Mental Health Non-Admitted ETP Target 80%

Process Measure 1 - MH Non-Admitted ETP Data

Process Measure 1 - MH Non-Admitted ETP Target

90%

Results to Date

0

1

2

3

4

5

6

7

Num

be

r o

f p

atie

nts

Did Not Waits

Data

Target

Next Steps

Weekly reports to team

Ongoing Implementation

- Staggered shift times

- Clinical Initiative Nurse Pathways

- Video Conference assessments

- Assessment Clinics

Whole of Health Program

Consumer & Carer Survey

Australian Nursing & Midwifery Conference

Achieving Performance Targets through Patient Flow Conference

Lessons learnt

• Maintain consumer experience as focus

• Collaboration and ownership by stakeholders

• Cascading sponsorship to translate and reinforce the importance of

changes

• Regular, clear and concise communication

• Robust and accurate data to support and monitor performance

Acknowledgements

• Tim Free Director of Clinical Operations

• Project Steering Committee

– Charles Thompson, Dr David Lienert, Mario Fantini, David Duerden, Dr

Simon Battersby, Mark Constable, Dr Kate Porges, Jamie Gills

• Project & Implementation Teams

– Jamie Gills, Oliver Higgins, Lisa Thornton, David Foster, Laura Christie,

Nicole Hargreaves, Mary-Louise Leslie, Cassandra Byrnes

• Our Consumers & Carers

• Mental Health & Emergency Department clinicians

• NSW Health Whole of Health Program

• Lynne Blanchette ISLHD

Beat the Mental Health NEAT

Thank you