Archipelago Healthcare – Better Healthcare in Mind

Introduction

In 2007 OBMH reorganised its specialist psychological therapies services based around the commissioning of these services by the local Primary Care Trusts (PCT).

The Psychology Departments and Psychotherapy Departments in Oxfordshire and Buckinghamshire and the Isis Centre in Oxfordshire were amalgamated into one Psychological Services (PS) within the CAMHS and Specialist Services Directorate. The service included therapists for adults of working age, older people and those who worked with both. Staff from all the different therapeutic approaches and professional backgrounds came together. The Oxfordshire staff were to cover three areas across the county designated by; North (Banbury and Bicester), City and South (Witney, Abingdon, Didcot, Henley and Thame). Buckinghamshire staff were split into North (Aylesbury) and South (High Wycombe and Amersham). These five teams were led by Clinical Managers with the support of Consultant Psychiatrists in Psychotherapy. Work is carried out on the main OBMH inpatient sites and team bases. There is an overall Service Manager and a Clinical Head who cover both counties.

Bringing together the clinicians also brought together differing systems of recording activity and waiting lists. All staff other than those at the Isis Centre were using the Patient Centred Recording System (PCIS), the central database and recording system for OBMH patient records. All patients entering a service are given a unique hospital number and their demographic details are stored in this system.

The psychologists had kept waiting lists on their own locality MS Access database. Psychotherapy in Oxfordshire had moved to the Outpatient Module in PCIS that allowed them to set up clinics for each of the Therapies such as Cognitive Behavioural Therapy (CBT), Cognitive Analytic Therapy (CAT), individual Psychodynamic Psychotherapy and various groups, but still had waiting lists on a separate MS Access database. The Isis Centre had their own database waiting list and did not use PCIS as most of their patients self referred. The Buckinghamshire teams used PCIS and their own databases. This variation in data collection resulted in limited accuracy of information held, slow access to information and wasted managers’ and clinicians’ time having to collate information from a number of sources.

What Happened Next?

Work was led by Archipelago Healthcare Ltd who specialise in transformation of mental health services and use Lean methods,

Lean thinking involved a number of stages including

Clarifying the key elements of the patient pathway
Identifying the main decisions and transition points
Streamlining all the systems into one
Working with IT to ensure that the Trust’s data requirements were met
Cleansing the data
Producing a manual for staff
Staff training
Rolling out the new system and embedding

What improvements has this made?

Applying LEAN thinking to PS patient data produced one system for all which has led to the following improvements:

Oxfordshire localities record all data into PCIS; Buckinghamshire will have the same system before end 2010. There are virtual clinics which help to track the progress of each patient from point of referral, to treatment and to discharge. Once a patient is entered on the system correctly they do not get lost in the system.

In the South Oxfordshire locality, 805 patients were identified in the system and a number of duplicate referrals were identified. All eligible patients were distributed into the appropriate clinics and 399 were discharged from the service.

Triage Clinics hold the referrals, they are discussed by the locality PS staff in triage meetings and either accepted for assessment if meeting the now clearly defined criteria or returned to the referrer with suggestions for care.

Clinicians are able to see all waiting lists accountable to them including the length of wait and proposed date for first contact. The patient should be seen within 8 weeks assessment period or 18 week treatment period measured from entry into the Triage clinic.

Timely recording of contacts in line with PCIS guidance has allowed more accurate reporting for each individual staff member, each locality and the service as a whole in terms of productivity and quality
Data reports are collated into the Operations and Commissioning excel spreadsheet, colour coded to enable lead clinicians in each locality to follow up those patients who have been waiting the longest where there is no appointment yet offered. This is pulled from the PCIS data and refreshed by IT Analysts weekly.

Use of the staff calendar having assessment slots booked 8 weeks in advance has speeded up booking and choice where resources permit this.

Appointments in the staff calendar allow the clinician to record their contact more efficiently.

A handbook available for admin and clinicians to aid them in correctly applying the new system. A separate clinician guide is also available. The clinician guide is more specific in detailing the clinicians’ responsibilities for data entry and monitoring of their caseload.

What Next?

We are rolling the system out into Buckinghamshire for the Aylesbury and Amersham Psychological Service localities.

The weekly data reports are being revised and modified to make them more accessible, precise and informative for the clinicians and managers alike. This will be an ongoing project with the imminent introduction of RIO (new patient information centre).