The Mental Health Advice and Assessment Team [MHAAT] is a small service that provides assessments and advice for service users with complex mental health problems.
Historically there had never been a link between the demand and capacity of the service. Following a restructure of the Trust in 2012, the service was given resources based on estimations as to what was required. The Executive team invited Meridian to conduct an analysis with the view that the new systems and processes would help them answer the question “how much resource do we need to deliver this service within its service targets?”
The team is split into two Borough teams, made up of 10.4 WTE plus two team leads, a Consultant Doctor and a Service Manager. The service is targeted at delivering an assessment for each service user within 5 or 10 days, depending on the urgency of the referral.
Meridian was invited to conduct an analysis of the service and specifically asked to look at the existing referral pathways, capacity and demand of the service and current management systems.
Meridian expended 11 resource days on an analysis of the MHAAT which commenced on Monday the 9th of September 2013 and finished on Monday the 16th of September 2013. The analysis identified the following;
- A one day delay existed between referrals arriving and being fully processed and triaged;
- Assessments being booked by sending a letter and no contact with the service user creating a high DNA rate;
- No clear link between the demand and capacity of the service when assigning work;
- No evidence of a robust management control system.
Meridian proposed to install a ‘live referral processing’ system, prompt two way service user contact in the booking process, link the assignment of work to the capacity of the service and to install a robust management control system.
This proposal was accepted and the project commenced on Tuesday the 17th of September 2013.
The MHAAT improvement project lasted for 10 weeks and addressed all of the points from the analysis.
With such a tight time scale, engaging with the MHAAT management team was key in delivering the program of change within the proposed 10 week period. Through a series of seven workshops and close one-to-one training, Meridian were able to complete all of the deliverables within the planned timescale.
Meridian quickly installed data capture mechanisms and measurement of the work entering the service via referrals. This data had never been collected before and was essential in linking the demand and capacity of the service.
Working with the MHAAT management team through the workshop sessions, they set and agreed a series of ‘internal service targets’ and ‘planning norms’ which would be used to measure the performance of the team on a day to day basis.
Installation of ‘Live Referral Processing’ took place in the first two weeks. ‘Live Referral Processing’ shifted the day which referrals were processed from the day after they arrived to, in some cases, a decision being taken and the referral being processed within a few hours, resulting in 1 day being clawed back in which assessments could be booked in the 5 / 10 day target. This new process was agreed and implemented through the initial workshops and quickly became standard practice for the service.
Installing a daily follow-up meeting enabled the MHAAT management team to keep track of their progress with the new process. Actions were 2 taken each day when variances were identified. This enabled the MHAAT to consistently process all referrals on the day of arrival by the end of week 3.
A new booking template, which enabled the MHAAT to plan a ring-fenced capacity for new assessments to meet the 10-day target was introduced in week 6 of the programme. This tool was developed closely with the MHAAT management team and administrators who were responsible for booking assessments. This allows the MHAAT to plan to set aside a capacity that is equal to the demand coming in through the door, hence ensuring they are able to hit the 5 or 10-day service target.
A complete change to the processes used to process and triage all referrals that were received by the service. Referrals were being processed on the day of arrival and not left for a day before they were looked at. This prompted faster decisions to be made by the Triaging Team and by the end of week 3 it was standard process for the MHAAT to process all referrals the day they arrived.
A robust follow-up process where management were assessing their performance daily was a significant change in the culture of the team and manner in which it was run. The management control system identified variances which prevented the MHAAT from hitting its goals and gave the MHAAT the tools to deal with them quickly.
The new booking template has given the MHAAT management team full control on their ability to hit the 5 / 10-day service targets. Combined with the management control system and constant review the MHAAT is able to adapt their ringfenced capacity according to changes in demand. This resulted in 90% of the clinician assessments being booked within the 5 / 10 day target shortly after being implemented, a significant improvement from 30%.
DNA rates fell to 18% from 34% at the end of the project. The implementation of two way service user engagement through phone and text enabled the right clinicians to be chosen to see the service user at a time and location they were able to attend.
Tools which have been developed with the team over the course of the project enable them to quantify and measure the demand and capacity of the service. This data had historically never been gathered before. This data will be used by the Executive to identify any excess capacity at the end of the year, which could be either used to pitch for more work or generate cost savings.