Quality and Efficiency Support Team (QuEST)Quality and Efficiency Support Team (QuEST)Directorate for Health Workforce and PerformanceDirectorate for Health Workforce and Performance

Efficient and Effective Community Mental Health Services

Toolkit

Workshop A

Aim of the Workshop

• The aim of the workshop is to present the Efficient and Effective Community Mental Health Services Toolkit and to provide you with an opportunity to discuss and consider how the toolkit will work for you and for your service.

Workshop Objectives

• To present an overview of the content of the toolkit and provide examples from each section

• To describe why it was developed and how services can work with the toolkit

• To briefly describe the tools and how they can be accessed and used

• To provide an opportunity for reflection and discussion on key points

The Toolkit

ContentsSection One - Background and Introduction Background Introduction to the toolkit

Section Two - Effective Practice Reliable implementation of evidence based care Effective team working

Section Three - Understanding and Managing your Capacity Introduction to capacity Optimising capacity – reducing DNA and CNA Optimising capacity – skill mix Optimising capacity – effective meetings Optimising capacity – removing non-value adding work Optimising capacity – reducing sickness rates

Section Four - Understanding and Managing your Demand Introduction to demand Managing demand – set clear eligibility criteria Managing demand – goal setting, case review and caseload management

Section Five – Undertaking a full DCAQ AnalysisThis section is still in development phase and as not yet been issued

Section Six – Tools

Section 1 – Background and Introduction to the Toolkit

• Quality and Efficiency Challenges– Mental Health Pathway Efficiency and

Productivity Report

• Why has the Toolkit been Developed– Range of resources already available– To provide support and guidance– Supports achievement of the three quality

ambitions outlined within the NHS Quality Strategy

– Supports services to deliver the ambitions outlined within the Mental Health Strategy

How to Work with the Toolkit

• Structure– Modular format– Why it is important– Understanding your current state– Ideas for improvement– Within each main section there are

subsections

How to Work with the Toolkit

• Support– Analytical support– Skilled facilitation and management of change– Basic background knowledge of how to use

and present data– How to process map– Test change using PDSA cycles

• Where to start– Anywhere although effective practice may be

where you may want to focus initially

Section 2 – Effective Practice

• Reliable Implementation of Evidence Based Care

• Effective Team Working

Effective team working

Why is this important? Research has shown that when decisions and actions made within a CMHT have the participation and involvement of all team members, including service users and carers, the care which is delivered is of a higher quality than those decisions and actions made by an individual or by one discipline.1 Understanding your current state Team questionnaires can be a really useful tool to assess your current team working and identify opportunities for improvement. Recent research funded by the National Institute for Health Research2 has led to the development of tool to assess the effectiveness of team working in Mental Health. A copy of this for information only (this is a copyrighted tool) is included in Section Six This tool is based on the Aston Team Performance Inventory (ATPI) and 20 item CMHT effectiveness scale. The ATPI can currently be completed online for a flat rate of £1203 and more information can be found at http://www.astonod.com/team-tools. The Aston Organisational Development Ltd is currently deciding whether to make CMHT version of the ATPI available to a wider audience. Please see Section Six for more information.

1 West M, Alimo-Metcalfe B, Dawson J, El Ansari W, Glasby J, Hardy G, et al. Effectiveness of Multi-Professional Team Working (MPTW) in Mental Health Care. Final report. NIHR Service Delivery and Organisation programme; 2012 2 As above 3 Price quoted at 8 October 2012

Examples of Ideas for Improving the Effectiveness of your Team

• Clarify purpose and function

• Provide good leadership

• Actively manage team composition and processes

• Promote inter-team working

• Ensure reflection and adaptation

• Hold effective meetings

Section 3 - Understanding and Managing your Capacity

• Introduction to What, Why and How to measure capacity and activity

• Section on using Job Plans to measure capacity and also how to measure capacity without job plans

• Understanding how time is actually spent – Activity

• Includes tools to support analysis• Ideas for making better use of your

capacity

Optimising Capacity

• Reducing DNA’s and CNA’s

• Skill Mix

• Effective Meetings

• Removing Non-value adding work including duplication of work

• Reducing Sickness Rates

Reducing DNA’s and CNA’s

Figure 2 - Example of run chart of % of first appointments where service user DNAsTeam Somewhere CMHT (May 09 - Nov 11)

0

10

20

30

40

50

60

May

-09

Jun-

09

Jul-0

9

Aug-0

9

Sep-0

9

Oct-09

Nov-0

9

Dec-0

9

Jan-

10

Feb-1

0

Mar

-10

Apr-1

0

May

-10

Jun-

10

Jul-1

0

Aug-1

0

Sep-1

0

Oct-10

Nov-1

0

Dec-1

0

Jan-

11

Feb-1

1

Mar

-11

Apr-1

1

May

-11

Jun-

11

Jul-1

1

Aug-1

1

Sep-1

1

Oct-11

Nov-1

1

Month/Year

% D

NA

%DNA Median

Introduction of Full Booking

System

Introduction of Text Reminder

Optimising your Skill Mix

Table 4: Comparison of costs for different grades of staff spending 5 hours on admin

AfC Banding

Annual cost of 5 hours per week

Annual savings from using 5 hours weekly of Band 3 admin rather than 5 hours of clinical time (£)

Annual savings from using 5 hours weekly of Band 4 admin rather than 5 hours of clinical time (£)

Annual savings from using 5 hours weekly of Band 5 admin rather than 5 hours of clinical time (£)

6 4741 1986 1534 870

7 5661 2907 2454 1790

8a 6895 4140 3687 3024 8b 8101 5347 4894 4230 8c 9622 6867 6414 5751 8d 11527 8773 8320 7656 9 13953 11199 10746 10082

NB These savings are not cash releasing unless resources are being moved from vacant posts.

Section 4 – Understanding and Managing your Demand

• Introduction to What, Why and How to measure Demand

• Table outlining the data you require to analyse your demand

• Ideas for influencing your demand

Managing Demand

• Set clear eligibility criteria

• Goal setting, case review and caseload management

Section 6 –Tools

• Generic Improvement Tools

• Mental Health Specific Tools

Contents

Generic Improvement Tools This is not a comprehensive list. We’ve included the ones you are most likely to use for this work but for a more comprehensive list of tools please visit the QI HUB website at http://www.qihub.scot.nhs.uk/default.aspx

The Model for Improvement (including PDSA) Process Mapping Value Stream Mapping Process Reliability Statistical Process Control Charts (SPC) Pareto Analysis The 5 Whys Cause and Effect Skill Mix Analysis Skills Matrix

Mental Health Specific Tools CAPA Scottish Recovery indicator 2 Aston Team Performance Indicator and CMHT Effectiveness Questionnaire Mental Health Activity Tracker Mental Health Capacity Calculator DCAQ Guide Booklets The DCAQ Tool Wiseman Workload Measure Guidance on Calculating New to Follow-up Ratios Mental Health Waste Spotters Guide Summary of Data needed for DCAQ Analysis

Table Discussion

Considering what you have just heard andby referencing the toolkit on each table can youdiscuss the following points;• What are your initial thoughts about content and

format?• How might you introduce and test the toolkit with

your teams/services?• What support do you think you might need to test

the toolkit in practice?– Locally– Nationally

• How might we measure the effectiveness of the toolkit?