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ACT HEALTH
MENTAL HEALTH ACT
Capital Asset Development Plan
Your Health-Our Priority
New Adult Acute Mental Health Inpatient Unit Stage 3 Implementation of The Model of Care
Presentation to
Mental Health Community Coalition ACT Friday 25 February 2011
Adult Acute Mental Health Inpatient Unit $23.6m
• A new 40-bed unit is now being built at the Canberra Hospital allowing for expansion of the facility to 50 beds.
• This unit replaces the existing PSU facility.
• Construction commenced mid 2010.
• Estimated completion late 2011.
Steps for all CADP projects
• Feasibility Studies • Budget appropriation Stage 1 Preliminary Model of Care • Design Options• Value Management Studies• Design Briefs• Way ShowingStage 2 Model of Care Gap Analysis• Preliminary and Final sketch plansStage 3 Operationalising the Model of Care• Policy & procedures, change management & workforce
planning• Tender for works• Construction• Commissioning• Post occupancy evaluation.
Government Agenda for Change
Current PSU described as less than optimal.A range of factors contributed to the decision to replace PSU:
Coronial InquestsService reviews Adverse publicityFailing public confidence Human Rights ReviewSignificant structural limitations
MHACT: Planning the Agenda for Change
• Commissioning a new unit is special
• Plan by asking where is everyone else at ?
• Need to triangulate, what’s happening elsewhere at the international / national level.
• What is best practice and how would we know ?
• What’s going to make and keep us special and different to everyone else ?
Adopting a change management process to support the change management plan
MHACT has the benefit of dedicated CADP and Human Resource Management resources.
The application of a change management process is crucial to success.
The change management process is underpinned by the learning organisation principles and practices.
What has happened elsewhere?
• Reviews and inquiries have been undertaken both nationally and internationally into acute mental heath inpatient care.
• Result: Narratives concentrate on “what should be done ” not “how to do it”.
• Result: No comprehensive “how to” manual developed.
IN SUMMARY WHAT DO THESE REPORTS SAY?
Expressed Themes of Concern
Limited consumer, carer participation in decision making Limited information provided Diminished dignity Limited activities especially evening and weekends Staff levels inadequate Delayed discharge Task Focussed, Staff Station Centric Staff
Expressed Themes of Concern Cont’
Consumers particularly female not feeling safe Little one to one time Rule bound staff Little explanation about medication and side effects Meagre or absent “talk therapies” Physical health matters not followed up Poor post discharge follow up
Previous Efforts For Change
REACTIVE
PROACTIVE
THE AGENDA FOR CHANGE HELPS DETERMINE ITS DIRECTION & SPEED
AN AGENDA OF COMPLIANCE TO MEET LEGAL, PROFESSIONAL AND COMMUNITY STANDARDS (IF IT WORKED ALONE WE WOULDN’T BE HERE).............................REACTIVE
AN AGENDA OF CO-PRODUCTION TO MAXIMISE THE POTENTIAL OF INDIVIDUALS THROUGH THE EFFECTIVE AND EFFICIENT USE OF RESOURCES AND AVAILABLE SOCIAL AND SUPPORT SYSTEMS (THIS IS THE NEW WAVE OF CHANGE FOR SOCIAL POLICY MAKING AND SERVICE DELIVERY) ……………………PROACTIVE
SO HOW DO WE GO ABOUT APPROACHING CHANGE?
FIRSTLY WE NEED TO KNOW A BIT MORE ABOUT WHAT WE
ARE CURRENTLY DOING AND WHY BEFORE WE CHANGE
ANYTHING JUST YET
MHACT Threshold Issues for Change
• Unpicking and unpacking ourselves from our selves (what are we doing and why are we doing it that way?)
• Not everything about the current PSU is “bad”.
• Ensuring staff, consumers and cares make a direct contribution to the decision making process for change ?
MAPPING CONNECTIONSWhat we know
(facts)
What we think we know(supposition)
What we don’t know we don’t know (ignorance)
What we know we don’t know (the opportunity to learn)
Mapping Connections What can we learn?
• That clear processes are required to “co-define” what is required in order to deliver services in a values based practice environment.
• There is a need to effectively manage and avoid “home spun” views about what’s right and what will improve things.
• That having “access to contemporary knowledge” about good/best evidence practice is a must do?
• Finding ways to “adopt, implement and evaluate” these practices is even better.
UNDERTAKING A PRELIMINARY WORK STUDY
Current V’s Desired Reality
“Changing”
from where we are
to where we need to be
Challenges for Transformational Change
Initiating
Re-thinking and re-designing
Implementing and sustaining new systems
A process for change and change management
• Making the experience positive and uplifting.• Promoting a sense of pride.• Defining what success looks like ?• Adopting measures for success ?• Making a national contribution to the
literature about “how to” implement an acute inpatient model of care.
Ethical Practices
• Values based care. • What do we believe in (our philosophy).• Actions (the things we do in support of these
beliefs).• Identify them.• Make them visible. • Make them known.• Be accountable for them.• Ask consumers and carers to verify and
measure them.
MEETING COMMUNITY EXPECTATIONS
Of our service and ourselvesA complex and complicated task
Building a
Co-participation System involves
Staff, Consumers, Carers & the Community we serve
THRESHOLD ISSUE
The need for a
A TWO-WAY FEEDBACK SYSTEM
to make good on “co-defined” expectations
A TWO WAY FEEDBACK SYSTEM NEEDS TO BE
• ADJACENT • IMMEDIATE
• RESPONSIVE
IN MEETING EXPECTATIONS
Meeting Staff Expectations
• Services are adequately resourced • Staff are well led, valued and respected by their
own management • Training, professional and career development
are provided• Working conditions are supportive of
professional effort• The environment is safe
Meeting Staff Expectations
• Senior staff take an interest and support staff at the coal face
• Issues are responded to and managed effectively
• Regular opportunities occur for staff to communicate and be communicated with
• The workplace is free of bullying and harassment
Meeting Community Expectations
• Human kindness, sensitivity and compassion for vulnerable people
• Standards are met • The law is upheld• Governments are accountable • Services are resources, sustainable and
accessible• Staff are trained and available • High quality care is provided in a timely manner
Meeting Community Expectations Cont’
• There is a treatment and recovery plan• Consumers and carers are kept informed and involved in
decisions• Transparency applies to decision making by professional
staff • Consumers are helped supported and treated with respect • Physical facilities are supportive of treatment and recovery** Recovery is a key driver for the way services are delivered** Treatment is the best and most contemporary available
WHAT IS THE BASIS OF THE APPROACH TO IMPLEMENTATION?
CONSUMER/CARER/ STAFF SERVICE
CO-PARTICPATION FEEDBACK SYSTEM
VALUES
GOVERNANCE
STAFF CLINICAL/ ADMINISTRATIVE SERVICEDELIVERY SYSTEM
“EXPECTATION GENERATOR”CONSUMER/CARER/STAFF
[TREATMENT & RECOVERY PLAN]
“EXPECTATION EVALUATOR”CONSUMER/CARER/STAFF
[OUTCOME/ INDICATOR MEASURES]
THERAPEUTICPROGRAM
1. PURPOSE OF WARD
2. GOVERNANCE
3. LEGAL REQUIREMENTS
4. BEST EVIDENCE PRACTICE
5. CLINICAL PRACTICE GUIDELINES
6. SAFETY & RISK MANAGEMENT
1.
2.
3.
4.
5.
6.
EXPECTATIONS FOR THE ADULT ACUTE INPATIENT MODEL OF CARE
CHANGEMANAGEMENT
PROGRAM
TWO WAYFEEDBACK
SYSTEM
STRUCTURE OUTCOMES
1. CARE PATHWAY CO-ORDINATION
2. CLINICAL LEADERSHIP & WORKFORCE
3. CLINICAL PRACTICE
4. ENGAGEMENT & THERAPY
5. RECOVERY & PERSONALISATION
6. QUALITY IMPROVEMENT
PROCESS
1. C
AR
E P
AT
HW
AY
C0-
OR
DIN
AT
ION
2. C
LIN
ICA
L L
EA
DE
RS
HIP
& W
OR
KF
OR
CE
3. C
LIN
ICA
L P
RA
CT
ICE
4. E
NG
AG
EM
EN
T &
TH
ER
AP
Y
5. R
EC
OV
ER
Y &
PE
RS
ON
AL
ISA
TIO
N
6. Q
UA
LIT
Y IM
PR
OV
EM
EN
T
1. PURPOSE OF WARD
2. GOVERNANCE
3. LEGAL REQUIREMENTS
4. BEST EVIDENCE PRACTICE
5 CLINICAL PRACTICE GUIDELINES
6.SAFETY & RISK MANAGEMENT
CHANGEMANAGEMENT
PROGRAM
EXPECTATIONS FOR THE ADULT ACUTE INPATIENT MODEL OF CARE Emphasis on Structure
TWO WAYFEEDBACK
SYSTEM
1. P
UR
PO
SE
OF
WA
RD
2. G
OV
ER
NA
NC
E
3. L
EG
AL
RE
QU
IRE
ME
NT
S
4. B
ES
T E
VID
EN
CE
PR
AC
TIC
E
5. C
LIN
ICA
L P
RA
CT
ICE
GU
IDE
LIN
ES
6.S
AF
ET
Y &
RIS
K M
AN
AG
EM
EN
T
1. CARE PATHWAY CO-ORDINATION
2. CLINICAL LEADERSHIP & WORKFORCE
3. CLINICAL PRACTICE
4. ENGAGEMENT & THERAPY
5.RECOVERY & PERSONALISATION
6. QUALITY IMPROVEMENT
CHANGEMANAGEMENT
PROGRAM
EXPECTATIONS FOR THE ADULT ACUTE INPATIENT MODEL OF CAREEmphasis on Process
TWO WAYFEEDBACK
SYSTEM
PURPOSE OF WARD GOVERNANCE & LEGISLATIVE REQUIREMENTS
1. PURPOSE OF WARD
- Co-definition- Aims and Objectives - Values- Philosophy- Professional ethical and moral tone
2. GOVERNANCE
- Collaborative Engagement Forum
2.LEGISLATIVE REQUIREMENTS
- Mental Health (Treatment & Care) Act 1994
QUALITY IMPROVEMENT, SAFETY &RISK MANAGEMENT CARE PATHWAY CO-ORDINATION
6. QUALITY IMPROVEMENT
- Policies & Procedures (SOP’s) - Activities- Indicators- Outcomes- Consumer Carer Family Feedback - Ward Atmosphere (WAS)- Research- Balanced Score Card - Accreditation
CLINICAL LEADERSHIP & WORKFORCEBEST EVIDENCE PRACTICE, CLINICAL PRACTICE GUIDELINES
3. CLINICAL LEADERSHIP & WORKFORCE
- Team work - New Ways of Working- Workforce- Learning and Development - Multidisciplinary roles & functions- Operations Director - Clinical Director - Team Leader- Clinical Staff- Non Clinical Staff- Volunteers
4. BEST EVIDENCE CLINICAL PRACTICE
- Reception - Admission- Comprehensive Assessment- Collaborative Care Planning- Treatment and Physical Care- Clinical Review- Ward Rounds- Handover- Documentation- Clinical Teaching and Supervision- Discharge Planning and After Care
ENGAGEMENT & THERAPYRECOVERY & PERSONALISATION
5.ENGAGEMENT & THERAPY
- Reception and Orientation - Collaboration and Communication- Carer and Family Connection- Ward Rules and Handbook- Tidal Interaction Model - Psychotherapeutic Program- Complimentary Therapies- Leisure and Activity Program - Health Education and Medication - Star Wards
HOW WILL IT
BE IMPLEMENTED?
Project Governance AAMHIU Stage 3 Model of Care Planning and
Implementation groups Planned / staged implementation through 2011.
Senior staff manage completion of “key pieces of work”.
Staff, consumers and carers are integral to implementation and will contribute as active participants in the process.
Reporting system on the basis of “done” or “not done”.
RISKS o Poor leadership and managemento Lack of commitment, priority and interest o Lack of resources and know how o Lack of time and insufficient lead timeo Relevance transfero Implementation plan not sufficiently dynamic in
engaging stakeholderso Lack of involvement of staff, consumers and carers o To mention a few !!
NEXT STEPS• Communicate understanding of the Stage 3 Implementation
objectives with stakeholders. • Identify and convene Model of Care Planning and
Implementation Groups.
• Develop working relationships and Stage 3 Implementation Governance processes.
• Implement Work Plan.
• Focus available Resources and Co-ordinate Effort through 2011.
• Monitor and evaluate results.
DISCUSSION !!
Contact us
Kevin Kidd- Director MH CADP and Principal Nurse- [email protected]
David JacksonHope- CADP Senior Project Officer- [email protected]
THANK YOU
TIL NEXT TIME : )
