Transcript There is NO magic bullet!

There is NO magic bullet!
(The TDHB journey to good collection compliance)
Graham Donlon
Outcomes & Clinical Information Projects Officer
Mental Health
Taranaki District Health Board
Taranaki – where is it?
Taranaki background:
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Taranaki is a rural, comparatively isolated area
Population 108,100 (June 2009 estimate)
Major Industries: Farming, Energy, Tourism
Winner of several ‘Most liveable’ city awards
Gorgeous parks, gardens and walkways
Taranaki is a rich in the arts + culture
Cosmopolitan café culture
Surf and ski
Fishing and hunting
Sports/fitness
Context:
At the time of writing, Taranaki District Health Board
has one of the best outcomes collection compliance
rates in New Zealand
However
• Compliance could always be better
• Good compliance does not equate with good quality
data!
We still have a long way to go...
TDHB community compliance
Taranaki inpatient compliance
TDHB Community compliance
Why this sudden climb in
collection compliance?
• The ‘Carrot’
Line managers nominated staff who were diligent in staying on top of their HoNOS
collection or those staff who supported others to do so - awarded ‘Star Performer’
certificates. Also, those who made a huge effort to get on top of overdue forms
were recognised
• The ‘Stick’
Memo circulated to all staff stating that overdue HoNOS tasks would be
performance managed
• Staff realisation
“It’s not going away, so I may as well get on with it!” (start collecting)
• Hard work
To be covered soon.
Other factors that influenced
compliance:
• Resourcing:
Outcomes coordinator position is 1FTE. Enables more ‘hands on’
support. ‘Go-to’ person both within and outside DHB
• High coordinator profile:
Coordinator is well-known to clinical staff, having worked in most teams
over two decades (“Polyfilla Man”). Open-door policy.
• Size:
TDHB is comparatively small - easier to effect change. Coordinator
knows all mental health staff
Another factor that
influenced compliance:
• Leadership, leadership, leadership!
Without a robust support framework, the Outcomes Coordinator
position would fail. This support came from:
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Service Manager
Governance Group
Implementation Team
Training Team
Clinical staff themselves
IT staff
Damaging factors
• Continual IT problems (AKA The 3D effect)
Delivery delays (system almost two years late), vendor absenteeism, bugs, wrong versions, etc.
• Absence of reports from system
Only reports – overdue, upcoming and graphical report of progress of single consumer over time
• Environment of change
Management restructuring, Acute Services review, proposed CAMHS review, PHO tendering > OUTCOME:
dispirited workforce
• Fear of changing practice
An IT-driven initiative not universally welcomed by staff (older workforce), resistance to changing practice,
i.e., not used to preparing for MDT reviews, power issues
• Outcome measures still sit outside routine clinical practice
HoNOS is well collected but only used in a few small teams. Not shared with consumers. Major challenge!
• Misconception about purpose of the HoNOS tools
“This is something we only collect for the Ministry of Health”
PRESENTATION SUMMARY
There really is no magic bullet,
good compliance is dependent
on many factors including:
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Adequate Resourcing (FTE)
Leadership & governance
Hard work
Coordinator profile
Size of the DHB
The use of the ‘carrot’ and ‘stick’
Any Questions?