Towards a Better Fit [poster] - Ministry of Health

Method

Methods

1:1 Patient Interviews

Staff Surveys

Focus Groups: Nurse and NUMs

Root Cause Analysis

1:1 Staff Interviews

Consultation with below stakeholders

Patient Voice Surveys

Process Mapping

Systems Data 

Capture & Manual 

Manipulation

Literature Review

AcknowledgementsThe Project team would like to acknowledge the support of:

JH&FMHN staff:

Julie Babineau, Julie Carter, Rajiv Anand, Damien Eggleton, Kelley Yates, Catherine Hancock, IngYu, Yuting Lu, Jessica Harris, Amy Laxton, Dean Cobbe

ABF Taskforce: 

Natalie Bryant

ACI Team

Other Forensic Mental Health providers:

Forensicare (VIC) and The Park (QLD)

ConclusionThis project has focused on improving the collection compliance, quality and clinicalutilisation of mental health outcome measures in The Forensic Hospital in preparationfor the introduction of the Australian Mental Health Care Classification (AMHCC). TheAHMCC is a comprehensive classification system that will allow accurate data to becollected on all mental health services in Australia, to address service gaps and improveservice delivery.

The project team found that the following strategies are the most important inachieving their goal and objectives:

• Lifting the profile of patient outcome measures and increasing patient engagement.

• Development of a clear reporting framework.

• Facilitating evidence‐based practice using Activity Based Management principles.

• Networking with IHPA and the ABF Taskforce and interstate Forensic Mental Health providers, (Forensicare and The Park).

Since the development of this project, the NSW MoH has initiated the AHMCC Readiness Project. Some of the strategies above are being utilised in the run out of this Readiness Project to all LHDs/ Networks.

Case for Change Diagnostics

Results

TOWARDS A BETTER FITDefining a Forensic Mental Health Patient. Health Network

GoalTo ensure Forensic Hospital inpatient data clearly reflects the complexity and needs of this patient group in preparation for the implementation of the  Australian Mental Health Care Classification (AMHCC)

Objectives 1. To improve the compliance with the collection of the National Outcome and 

Casemix Classification patient outcome measures from 78% to 90% by June 2017.2. To improve the quality of the HoNOS ratings by reducing the percentage of 

overall scores of >4 from 55% to 70% by June 20173. To increase the self‐reported clinical utilisation of outcome measures by clinical 

staff from 38% to 50% by June 2017

Sustaining changeProject team has:

• Developed a reporting framework that increases individual clinician accountability through the provision of patient level reporting

• Increased the profile of collection of outcome measures by highlighting Network compliance that is reported quarterly 

• Participated in the NSW Ministry of Health led AMHCC Readiness Project that will use outcome measures for classification and costing of mental health services

• Through liaison with other Forensic MH Services, identified how outcome measures can be incorporated into patient care (individual management plans and multi‐disciplinary reviews). A working group will be set up to examine and implement the findings.

• Commenced consultation with IHPA to review the appropriateness of current AMHCC measures for classification and costing of forensic mental health services.

ContactName: Dale OwensTitle: MH‐OAT and Quality Coordinator, JH&FMHNPhone: 02 9700 3049Email: dale.owens@justicehealth.nsw.gov.au

Name: Puneet DattaTitle: Corporate Operations Manager, Forensic Hospital, JH&FMHNPhone: 02 9700 3578Email: puneet.datta@justicehealth.nsw.gov.au

Name: Yuri Guevara SerranoTitle: Business Manager Hospitals & Corporate, JH&FMHNPhone: 02 9700 3028Email: yuri.guevaraserrano@justicehealth.nsw.gov.au

“What do I have to do to prove that I am ready to move on…I can’t stand the uncertainty” 

– Patient X

JH&FMHN is required to prepare for the implementation of the Australian Mental Health Care Classification by July 2017. 

1 in 6 patients have a HoNOS rating of 0. This means that they have no identified clinical needs, however they remain in a maximum security forensic hospital.  Questionable data?

DUNDRUM

Planning & Implementing Solutions 

Improve:• Data reporting to clinicians

• Clinical utility• Education• Documentation

Integrate:• Trial measures• ABM governance• Feedback to ABF Taskforce

Identify:• Literature review• Consultation with other FMH services

• Working groups

Clinicians:

• “It is a time consuming process and the data goes into a black hole” ‐ Clinician

• 66% of staff surveyed: Outcome measures collected are clinically relevant to working with forensic mental health inpatients.

• Only 36% of staff surveyed reported that they utilise the outcome measures in patient care. 

Patients:

Data:

78

50

66

0

10

20

30

40

50

60

70

80

90

HoNOS Kessler-10 LSP-16

20%

80%

High complexity

Medium complexity

HoNOS Complexity:2015 ratings (using AMHCC) found that only 20% of patients would be classified as ‘high complexity’. This would impact on funding.

48%

37%

15%

1

2

3

Number of Diagnoses:48% of patients had only 1 diagnosis recorded. This is high for a patient cohort in which co‐morbidity is the norm.

Compliance %: Review of the data in 2015 found that 22% non‐compliance rate with collection of HoNOS, which is the measure that IHPA has chosen to include in the AMHCC and will be used to classify and fund mental health services.

Process Mapping:

Feedback

Knowledge

MeasuresResource

s

My experience would have been better if…

‘ …I was moved more quickly through the system’

‘ …I knew when I was going to be released’

Consultation:

Objective 2:QUALITY

Objective 1:COMPLIANCE

Additional Benefits:Objective 3:SELF REPORTING

Process Mapping (Ideal):

Forensicare (VIC) and The Park (QLD) have embedded outcome measures such as HoNOS in patient care plans to varying success

Prompt to collect data Data collected Audit to check 

compliance 

Prompt to collect data Data collected Audit to check 

compliance Reporting to units (quality)

Integration into management 

plan

92%Current

78%Baseline

52%Current

55%Baseline

TBCJuly 2017

38%Baseline

Decreasing HoNOS scores of 0 (implies patient has no clinical issues identified)

Improved patient participation in completion of Kessler 10 

(survey completed by patients that measures levels of psychological distress)

Increased completion of LSP (current level of psycho‐social functioning)

Consultation with IHPA was undertaken to discuss the appropriateness of current AMHCC measures for forensic mental health patients.

15%Baseline

11%Current

50%Baseline

62%Current

66%Baseline

74%Current