Two years ago, the Suffolk Mental Health Partnership Trust focused on a project to drive quality and performance based on a lean improvement framework. The resulting patient care quality has been ‘remarkable’.
Suffolk Mental Health Partnership Trust operates over 60 sites across Suffolk and in 2009 decided to drive the quality and performance with a focused project.
Following 12 months of lean work with Alturos, the trust has now released up to 37 per cent more clinical care time with service users, achieved cost reductions and the implementation of new systems for transfer have improved quality and speed of response.
Like many large healthcare organisations, SMHPT looked for improvement opportunities. The key issues identified at the time included:
- Bureaucracy and administrative over load;
- Complex, multiple entry points for service-users;
- Multiple services with numerous delivery points;
- Competing demands on staff and management time;
- Erosion of patient care time;
- Duplication and overlap in work among various teams;
- Overall performance reduction;
- Quality of care needed to be improved;
- Speed of service delivery needed to increase;
- Requirement for cost savings;
- Fulfilling national NHS improvement agendas such as QIPP
- New services, and innovations in existing services, were required.
As a progressive trust, SMHPT set about the redesign of its systems and pathways and selected lean as its improvement framework. The result of this is that the trust is now on its way to becoming one of the most efficient mental health trusts in the region.
Bill Franklin, the associate director for services and business development within the mental health and social care directorate for SMHPT, said: “We have seen a remarkable increase in the quality of patient care as result of our lean work.”
In discussion with Alturos the trust looked at the entire organisation in terms of numbers of staff and decided to start its lean journey by focusing on two patient pathways – the psychoses pathway and the dementia pathway.
This involved all the staff delivering care to those pathways, as well as the stakeholders, carers and service-users involved in the process. Rani Sidhu, who works for the community support mental health team for the Suffolk Mental Health Partnership Trust, became one of the change agents for the lean process, while Christine Curry, a family carer and well-regarded regional business woman, was also invited to be involved.
The trust focused in on two key pathways for its initial lean programme: the psychoses pathway and the dementia pathway. The majority of people with psychosis are aged 14 to 35.The dementia pathway principally looks after service-users aged over 65.
While the overlap between the members of staff was quite small, the teams had different ways of doing things within the two pathways, all of which needed to be examined separately in terms of the lean process.
Unsurprisingly, a key discovery was the imbalance of workload between teams created by the demands of existing processes. Furthermore, one of the many issues that emerged from the initial four day lean training was the unnecessary level of overlap and duplication between the teams.
A time consuming element was also the hand-over time between teams and journey planning. By implementing new process designs one community team, that ran a ‘pilot’ programme, has created more time in service-user care, different types of care and all at less cost. This has been achieved through simple re-designs in team handovers, reducing the time involved by 50 percent.
Journey planning and reduction of unnecessary or duplicated administration has increased the quality of performance and has had a significant positive financial impact too. More strategic projects are emerging such as review and potential for re-design of administration processes for maintaining service-user records.
The other community teams also cover the entire Suffolk region, so by necessity this also involves a lot of travelling. Through a complete re-design of processes of how teams visit patients a significant amount of staff time was saved. In some cases this has released up to 37 per cent more clinical care time with services users. Now a more circular travel route plus car sharing systems have been put in place.
Six months on significant and targeted cost reductions have been created, better quality of service has been achieved and opportunities for new services: the effect of which has been far reaching.
The quality of care provided to patients was also examined. It was clearly identified in the current pathway that the client journey was not straightforward. There were often delays for service-users from referral stage to receiving the treatment that they needed. Also the complexity of service-user needs was mirrored in the way the service-user was transferred between the specialist teams. It was quickly recognised that complexity in needs should not mean complexity of process. New systems for transfer have now being implemented. Again this creates benefits in terms of quality, speed of response and focused cost reduction.
Staff and culture
The overriding outcome has been a significant change in the staff in terms of attitude, work satisfaction and willingness to rise to the challenge of change.
Rani Sidhu, of the community support mental health team for the Suffolk Mental Health Partnership Trust, said: “The changes over the past year have been significant. Staff are much more positive. There is a very upbeat change of culture within the team. We have a much clearer pathway from the moment the client comes in to when they leave the department. Much more importantly, the quality of care that we provide has improved a lot.”
In spite of the current challenges on the NHS, this trust is finding the time, staff motivation and energy to take the Lean framework into other areas of the trust in both front-line clinical activity, administrative and other support areas. With support of senior managers and directors such as Bill Franklin and Sandra Cowie, the staff is developing their own internal team of “Change Agents”. This cohort is then taking lean deeper into the trust. This is initially through awareness programmes and then onto specific lean projects.
The key results and strategic and operational gains so far are:
- Travel time and costs reduced significantly;
- QIPP agenda elements achieved or in-train; with a clear framework for further projects
- Administration processes streamlined with associated cost reductions;
- Staff capacity for carer increased, in some cases, by 37 per cent
- Quality of care increased;
- Morale and culture remarkably improved;
- New services created.
Mr Franklin notes: “My overall advice to other mental health trusts is to seek external advice on lean, tune yourself in, get appropriate help and start your journey - all the while recognising that it is not a short term quick fix. It is a continuous, never ending journey.”
Patient carer and regional businesswomen, Ms Curry, concludes; “From a service-user point of view, the level of patient care has improved remarkably. Staff has been freed up to do the job they are trained to do and what initially attracting them into the profession in the first place.”