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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. 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

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  1. Improving Healthcare Quality: Advanced Clinic Access in Mental Health Mary Schohn, Ph.D. April 24, 2004

  2. 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) • Overuse of procedures that do not help people get better • Under use of procedures that can help • Misuse or errors

  3. Roadmap to improvement • Identify gaps between current performance and desired performance • Seek new designs • Involve everyone (Berwick, 2003)

  4. VHA/IHI Collaborative • 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

  5. Improvement in Average Next Available Appointment

  6. Reduction in Wait Times While Patients Increase

  7. Mental Health and ACA • 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

  8. Current status

  9. Common Strategies Used in Mental Health ACA in VA • 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

  10. Common Strategies used in Mental Health ACA in VA • 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.

  11. Common Strategies used in Mental Health ACA in VA • 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

  12. Common Strategies Used in Mental Health ACA in VA • Shape the Demand • Work Down the Backlog • Hire temporary staff; detail staff, use OT • Review provider schedules • Reduce other demands on providers time temporarily

  13. Common Strategies used in Mental Health ACA in VA • 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

  14. Common Strategies Used in Mental Health ACA in VA • 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

  15. Common Strategies Used in Mental Health ACA in VA • 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

  16. Common Strategies Used in Mental Health ACA in VA • 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

  17. Common Strategies Used in Mental Health ACA in VA • Redesign System to Increase Supply • Synchronize patient, provider and information • Improve consult requests • Optimize rooms and equipment • eg. Telepsychiatry in CBOCs

  18. Role for Psychology Leaders • 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

  19. Role for Psychology leaders • Empower and Support Champions • Promote the project • Publicize team achievements • Present outcomes at regional/national meetings • Convert resistance • Research outcomes • Become a Clinical Coach

  20. Resources • 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

  21. Resources • VISN MH POC • MH ACA Mail group • MH ACA Satellite Videoconference • August, 2004

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