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STANDARDISING ACAT INTAKE, ALLOCATION AND WAIT LIST MANAGEMENT SYSTEMS IN NSW

STANDARDISING ACAT INTAKE, ALLOCATION AND WAIT LIST MANAGEMENT SYSTEMS IN NSW. ‘The Business of ACAT’ Jenny Fitzpatrick Lisa Diett Senior Policy Analyst- Aged Care Richmond Valley ACAT Manager NSW Department of Health North Coast Area Health Service National ACAT Conference May 2010.

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STANDARDISING ACAT INTAKE, ALLOCATION AND WAIT LIST MANAGEMENT SYSTEMS IN NSW

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  1. STANDARDISING ACAT INTAKE, ALLOCATION AND WAIT LIST MANAGEMENT SYSTEMS IN NSW ‘The Business of ACAT’ Jenny FitzpatrickLisa Diett Senior Policy Analyst- Aged Care Richmond Valley ACAT Manager NSW Department of Health North Coast Area Health Service National ACAT Conference May 2010

  2. The Reviews • National ACAT Review: commissioned by DoHA- 2006 • NSW ACAP Structural Review: commissioned by NSW Dept of Health (DOH) utilising ACAP COAG funds- 2007 • Specific review of Area Health Service (AHS) structures and ACAT operational frameworks: commissioned by NSW DOH utilising ACAP COAG funds- April- June 2008 • NSW Structural Reform Framework developed by NSW ACAP COAG Advisory group- Nov 2008

  3. The Plan Individual Area Health Service (AHS) Structural Reform Plans developed and signed by AHS Chief Executives – Dec 2008 • Key aspect of these plans: to implement proven standardised, efficient intake, allocation and wait list management systems for ACATs in NSW

  4. The Change Management plan Implement standardised forms and tools for intake, prioritisation, allocation and wait list management General approach to review of business processes and practices: If it’s not broken leave it alone If it is broken - fix it now

  5. What did we change? INTAKE: Intake to be undertaken either by an experienced and trained Administration Officer with clinical back-up for complex or urgent cases or an experienced clinician with administration back-up for data entry and file management. Both systems work well

  6. What did we change? ALLOCATION: • Allocation of clients to clinicians happens weekly or fortnightly depending on the size/ needs of the team • Allocation is done either by the team leader or senior ACAT clinician who has been delegated the task. • Allocation requires clinical skill. Issues such as travel time and complexity of current case load taken into consideration.

  7. What did we change? ALLOCATION (cont.): • The day before allocation each clinician completes a sheet which details any leave/ holidays and incomplete assessments. • A Formula of 1.8 cases / clinical working day is applied and number of cases allocated accordingly. • Not a rigid system • Person allocating needs to be aware of guardianship/ complex cases either being allocated or already being held by clinicians and adapt accordingly • Weighting for complexity is done informally.

  8. What did we change? WAIT LIST MANAGEMENT: Two main tools • The Phone Blitz • WHO? Whole of team one afternoon, or one person over a week. • WHAT? Phone every person on the wait list to see if their situation has changed? still need ACAT assessment? now a higher priority category? • OUTCOME? Experience demonstrates consistently that 10- 20% of clients no longer require ACAT assessment, a proportion are up-graded in their priority category and the rest are unchanged. In several instances in NSW, ACAT wait lists were halved

  9. What did we change? 2. The Wait list Blitz • WHO? Whole of team effort over a period of weeks • WHAT? Entire team cancel all meetings/ all leave/ all training and simply do back-to-back assessments. • OUTCOME?Example: Central Coast ACAT July 2009 • Average number of assessments in usual four week =275 • Number of completed assessments over equivalent period during ‘the blitz’= 489. COMMENT This type of activity is not recommended in any greater frequency than yearly. Exhausting and concentrated effort for staff

  10. Understanding the Business of ACAT Lisa Diett Richmond Valley ACAT North Coast Area Health Service NSW Health May 2010

  11. Understanding the Business of ACAT

  12. Various understandings of ‘the business’ • Established auspiced Team moved back under Area Health Service management and into a new environment (Lismore to Ballina) Dec 2006 • New manager appointed Dec 2006 - no ACAT experience and responsible for multiple community health teams (most unrelated to ACAT) • ACAT geographically and philosophically isolated from rest of the Area Health Service • At times ‘the business’ felt like it was ‘secret ACAT business’

  13. Prior to ‘The Change’ • Intake done by clinicians and allocated according to designated geographic areas, so waiting list for that specific area was held by individual clinician • No standard system to deal with Priority Category 1 clients • No standard system for caseload management • Delegation once a week • Service demand escalating • Staff had developed a siege mentality

  14. Staff comments on ‘what it was like’ • “…it was a mess, massive wait lists, no direction, it was like being in a pressure cooker with the staff, totally on edge about to burst..” • “..always a sense of an enormous waiting list, and pressure to wade through an impossible ocean of referrals.” • “all the anger towards ACAT.” • “Answering the phone often met with frustrated and abusive clients, families and service providers, angry that we could not provide an estimated time for assessment, despite the reported urgency”

  15. ‘The Change’ Oct 2007 A 3 week process: 2 days of review and implementation commenced on day 3 • New Intake system • New allocation system • New Delegation system • New wait list management system NB: Change management process adopted was more directive than ‘consultative’

  16. Staff comments on ‘the change’ • “it was a pronouncement that this would just happen without an explanation of the potential benefits and with an implication that Richmond Valley ACAT was a problem” • “With too much consultation we would still be chasing our tails.”

  17. After ‘The Change’ • Intake Screening Tool adopted and intake attended by administration officer for whole team: Geographic caseload allocation abandoned • Intake officer had access to an allocated Priority 1 worker • ACAT inpatient assessment process streamlined • Case allocation tool adopted and allocation fortnightly • Set times to access Delegates established- 4 times a week • Improved communication with key stakeholders • Waitlist spreadsheet adopted and Waitlist Blitz attended- went from wait list of 385 to 179

  18. Staff Response Now • “Now: it is fantastic, staff are happy, the community is happy, the hospitals are happy, the service providers are happy…it is a great place to work….” • “….Most of all, our valuable clients the frail aged are seen in a timely manner!” • “…means we are seeing people referred in a sensible time frame.” • “The transition was not difficult for admin but rather liberating.” • “I have never had so many ‘thankyou’s’ from families and service providers”

  19. Mobile Assessment Support Team Project ADDITIONAL SUPPORT TO THE RICHMOND ACAT Oct-Dec 2008 • 2 experienced clinicians for 10 weeks • Waitlist numbers went from 203 to 64 clients • Wait list times went from 7 months to 6 weeks

  20. A Sustainable Business in Richmond • Strong senior management support and leadership • Extremely capable Intake Worker and experienced clinicians willing to support the role • Set the rules and stick to them • Make sure that others understand ‘the business’

  21. NSW Evaluation of ‘the change’ • NSW ACAP MDS Data- comparing Q1 2008 to Q1 2009 • Review: To determine uptake and embedding of ‘the change’ - commissioned by NSW DOH in April 2010 using ACAP COAG funds • Further independent evaluation currently underway by NSW Clinical Excellence Commission - commissioned by NSW DOH using ACAP COAG funds. Report due June 2010.

  22. ACAP MDS DATA: COMPARING Q1 2008 TO Q1 2009 Decrease in total number of accepted referrals: • from 21,898 to 19,269 • reduction of 2,629 or 12% Across all teams significant improvement in the times across all settings: • 16 day reduction from referral to first intervention • 17 day reduction from referral to first face to face • 19 day reduction from referral to end of assessment • 22 day reduction from referral to delegation

  23. ACAP MDS DATA: COMPARING Q1 2008 TO Q1 2009  The percentage of clients ‘seen on time’ improved in each setting

  24. Review: To determine uptake and embedding of ‘the change’- April 2010 • 92% teams implemented ‘Assigning a Priority Category’ Guide • 82% teams effectively implemented standardised case allocation systems- Team Leaders report system assists to ensure equity of workload and to monitor ‘outliers’ • 94% teams implemented formal Delegation processes. Team leaders reporting it is excellent learning opportunity for new staff and access to Delegates improving timeliness of delegation • 77% teams implemented the standardised screening tool. Team Leaders reporting significant benefits in determining appropriateness of referrals at intake • 79% teams reporting a significant reduction in wait list numbers and reduced length of time to ‘first face-to-face’

  25. CHALLENGES OF MAINTAINING THE GAIN • Staffing and recruitment • Training new staff particularly new ACAT Managers • Maintaining momentum and morale in a rapidly changing Aged Care environment

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