The Question:
Post a reaction to a fellow student about their implementation plan. This post must include constructive comments about their plan. For example, they might note how they plan to conduct in-service training. Help them move upwards in the “hierarchy of effectiveness.
the student Post:
”
Dear All,
I would start with revisiting the previous two weeks posts;
Problem Statement:
Currently estimated waiting time for adult patients referred for outpatient psychiatric assessment showed 3-month. This carries a significant quality hazard as delayed access is associated with increased risk of mental health distress and burdens.
AIM statement:
The waiting time for referred adult outpatients to psychiatric service will be one month by end of Dec 2017 without overloading mental health professionals.
Proposed change interventions:
First I would set criteria to choose the most appropriate quality interventions:
1. Effectively strong
2. Sustainable and amenable for the Plan Do Study Act (PDSA) cycle
3. A product of rood cause analysis, brainstorming, literature review, best practices or/and pragmatic selection
4. involve lowest efforts and highest impact
Second, If you look at the whole process steps from the moment a referring professional think about initiating a consult to the moment of seeing and discharging a patient by the psychiatrist, you would find ample opportunities to make the process more efficient, less time-consuming, saving resources and shortening the waiting time. Below are examples of such improvement interventions we can make to the flow of patients and then decreasing the waiting time:
accepting only appropriate referrals that meet the departmental and institutional strategic objectives.
Proper time management of the scheduled bookings of the clinics
Proper staff resource re-allocation and management in the OPD service.
optimizing the role of primary and inter-specialty shared care.
utilization and training of staff who could do initial triaging and filtering the appropriate referrals.
discharge after first assessment back to referring professional with clear plan and recommendations.
Keeping follow up arrangements only for patients in most need for ongoing psychiatric care.
opening floating or temporary clinics only when demand arise.
Anticipated barriers
Several barriers are expected to occur:
· Individual barriers like some staff who resist to change or experiences anxiety aroud making a change.
· Systemic barriers like resisting a change to the flow of referrals from the referring professional to psychiatry OPD and how this process is managed.
· Leadership barriers like some managers who are close-minded to modify existing time and staff resources allocations within the department of psychiatry.
· Cultural barriers like wide-spread sense of hopelessness or on the other hand sense of “we ae the best”.
Addressing the barriers:
Barriers are our opportunities to identify, analyze and eventually remove by implementing certain techniques. John Kotter’s 8-point model is an example in this regard;
1. CREATE A SENSE OF URGENCY
Via clear problem statement, a strong message needs to be transmitted thru the widest possible networks of all involved in this process that a change needs to be visualized ASAP.
2. BUILD A GUIDING COALITION
creating a collaborative team within the department and shared institutional entities who co-ally to achieve the shared target.
3. FORM A STRATEGIC VISION AND INITIATIVES
in alliance with stakeholders and the leadership, a clear vision needs to be established and how the mission is achieved thru such quality improvement initiatives.
4. ENLIST A VOLUNTEER ARMY
involve out-of-the-box people who share same love and passion to make a change.
5. ENABLE ACTION BY REMOVING BARRIERS
remove processes and structures that foster obstacles and hinder improvements.
6. GENERATE SHORT-TERM WINS
short-term data showing less waiting time a month after kick-in is an example.
7. SUSTAIN ACCELERATION
hunt those improvement potential areas that thrive and at least sustain over time; make a growing story.
8. INSTITUTE CHANGE
Wide-spread of the change and its implications should be institutionalized beyond the physical boundaries. Work gently on the institutional cultural beliefs and assumptions for the best interests of your improvement initiatives.
References:
· Professors Baum’s lecture notes.
· 8-STEP PROCESS, Kotter international.
· Langley et al, The Improvement Guide, second edition.”
Assignment instructions:
Response posts: Posts do not have to be of any particular length, nor are citations necessary. Make sure to read the instructions each week as the requirements vary from week to week. You can use any resources that you wish however the post must be your own work.
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