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Improving Healthcare Quality: Advanced Clinic Access in Mental Health. Mary Schohn, Ph.D. April 24, 2004. Background. Quality of healthcare is determined by the design of the healthcare system (Berwick, 2003). Three major gaps in the current delivery of healthcare are: (IOM, 2001)

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Improving healthcare quality advanced clinic access in mental health

Improving Healthcare Quality: Advanced Clinic Access in Mental Health

Mary Schohn, Ph.D.

April 24, 2004


Background
Background Mental Health

  • Quality of healthcare is determined by the design of the healthcare system (Berwick, 2003).

  • Three major gaps in the current delivery of healthcare are: (IOM, 2001)

    • Overuse of procedures that do not help people get better

    • Under use of procedures that can help

    • Misuse or errors


Roadmap to improvement
Roadmap to improvement Mental Health

  • Identify gaps between current performance and desired performance

  • Seek new designs

  • Involve everyone (Berwick, 2003)


Vha ihi collaborative
VHA/IHI Collaborative Mental Health

  • Started in 1999

  • Goals

    • Reducing Delays and Wait Times by 50% in six pilot clinics

    • Redesign clinic scheduling based on model of “open access”

    • Spread across all of VHA




Mental health and aca
Mental Health and ACA Mental Health

  • Director’s Performance Measure FY04

    • Added three Mental Health Clinics (502, 509, 510) to the ACA Initiative for reducing waiting times

  • Director’s Performance Monitors FY04

    • Number of clinics with wait time greater than 45 days includes 502,513,531,540 and 547

    • Number of patients waiting more than 30 days beyond the their desired appointment date.

    • Percentage of appointments scheduled as “next available” compared to the national average for the MH Performance clinics.

    • No show rates


Current status
Current status Mental Health


Common strategies used in mental health aca in va
Common Strategies Used in Mental Health ACA in VA Mental Health

  • Match Supply and Demand

    • Measure supply and Demand

      • Define supply

        • Sum of clinic slots

        • Based on FTEE assigned to clinic

        • Panel sizes

      • Define demand

        • Sum of consults, walk-ins, calls for appointments, rebooks


Common strategies used in mental health aca in va1
Common Strategies used in Mental Health ACA in VA Mental Health

  • Match Supply and Demand

    • Reduce appointment types

      • Review appointment types to see if efficiencies can be gained by eliminating appointment types; eg. Reduce/eliminate intake appointments; provider who does initial assessment provides the ongoing care; 30 minute appointments only; triage appointment completes the intake appointment.


Common strategies used in mental health aca in va2
Common Strategies used in Mental Health ACA in VA Mental Health

  • Match Supply and Demand

    • Plan for contingencies

      • Be aware of seasonal variation in demand and supply

      • Plan for variations; develop time off policies to ensure coverage; cross coverage arrangements


Common strategies used in mental health aca in va3
Common Strategies Used in Mental Health ACA in VA Mental Health

  • Shape the Demand

    • Work Down the Backlog

      • Hire temporary staff; detail staff, use OT

      • Review provider schedules

      • Reduce other demands on providers time temporarily


Common strategies used in mental health aca in va4
Common Strategies used in Mental Health ACA in VA Mental Health

  • Shape the Demand

    • Reduce the Demand

      • Reduce return rate visits “what’s the value of the next appointment?”

      • Increase graduation rates

      • Develop specialty agreements

      • Reduce no-show rate

      • Reduce automatic “rebooks” for no-shows

      • Increase group visits

      • Make the first visit count


Common strategies used in mental health aca in va5
Common Strategies Used in Mental Health ACA in VA Mental Health

  • Redesign system to increase supply

    • Manage the constraint

      • Figure out the bottleneck in the process eg. Lack of intake slots; drop-ins; telephone calls; documentation time


Common strategies used in mental health aca in va6
Common Strategies Used in Mental Health ACA in VA Mental Health

  • Redesign System to Increase Supply

    • Optimize the care team

      • Review team functions and assignments – don’t have MDs doing work that clerks or nursing staff can do eg. AIMS, care coordination, scheduling; use of dictation

      • Redistribute case load to mid-levels


Common strategies used in mental health aca in va7
Common Strategies Used in Mental Health ACA in VA Mental Health

  • Redesign System to increase supply

    • Predict and anticipate patient/system needs at time of appointment

      • Max packing- ensure clinical reminders are done at time of visit

      • Depression follow-up preset orders


Common strategies used in mental health aca in va8
Common Strategies Used in Mental Health ACA in VA Mental Health

  • Redesign System to Increase Supply

    • Synchronize patient, provider and information

      • Improve consult requests

    • Optimize rooms and equipment

      • eg. Telepsychiatry in CBOCs


Role for psychology leaders
Role for Psychology Leaders Mental Health

  • Make it a priority

  • Develop Teams

  • Review actions

    • Aims and goals

    • Monthly progress report

    • Plans for testing and implementing changes

    • Provide for spread activities and opportunities

    • Identify opinion leaders


Role for psychology leaders1
Role for Psychology leaders Mental Health

  • Empower and Support Champions

  • Promote the project

  • Publicize team achievements

  • Present outcomes at regional/national meetings

  • Convert resistance

  • Research outcomes

  • Become a Clinical Coach


Resources
Resources Mental Health

  • ACA Liaison to MHSHG

    • Robert Gresen, Ph.D.

  • MH Liasion to ACA Steering Committee

    • Mary Schohn, Ph.D.

  • ACA website

    • http://vaww.vsscportal.med.va.gov/aca/

  • ACA MH Monthly Conference Calls


Resources1
Resources Mental Health

  • VISN MH POC

  • MH ACA Mail group

  • MH ACA Satellite Videoconference

    • August, 2004


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