NHS Improving Quality held a webinar about basic service improvement tools and techniques for strategic clinical network and mental health teams with little or no service improvement experience. The aim was to raise awareness and gauge future training needs.

1. Welcome!
We will start shortly, but are waiting for people to join,
don’t worry if you can’t hear anything yet.
Before we start we will be going through some E-Seminar
housekeeping items, so that everyone can participate
fully in the online meeting
If you are having difficulties joining the meeting please
call Alyson Banks-Davies on 0116 295 0044
NHS Improving Quality
Service Improvement Tools
Overview for Mental Health teams

2. 1. Welcome & Introduction
2. Housekeeping
3. Achieving Excellence in Mental Health
4. The NHS Change Model
5. Benefits of Delivering High Quality Care
6. Process Mapping
7. Demand and Capacity
8. Measurement for Improvement
9. Clients/Patients, Carers and Public Involvement
10. Engagement, Getting Started and Sustainability
11. Case Studies Coming Online
12. Questions & Answers
13. Other Resources and e-Learning
14. What’s Next
AGENDA

3. NHS Improving Quality
Service Improvement Tools
Overview for Mental Health Teams
Jeri Hawkins Elaine Kemp
www.nhsiq.nhs.uk/
Welcome and Introduction
Anita Hayes
Programme Delivery Lead End of Life Care, Mental Health and Dementia

4. • During the E-Seminar we will mute all delegate’s lines throughout
the presentation.
• If at other times you are in a noisy environment please mute your
line by pressing the mute button on your screen (this can be
found on the right hand side of the screen)
• If you would like to ask a question please use the raise hand
button (this can be found on the right hand side of the screen)
• This is an interactive session, please add your comments, and
thoughts into the chat box as we go through the presentation.
• At the Q&A session, type your question into the chat, or raise your
hand, we will un-mute all lines during the Q&A.
• If you are having any technical problems, send a message to the
Host via the chat panel or call Alyson Banks-Davies on 0116 295
0044
• We will now start recording this Webinar

5. Achieving Excellence in Mental Health

6. The NHS Change Model
Today –
• Process mapping
• Demand and Capacity
• Measurement for improvement
• Patient and public involvement
• Engagement and ‘getting started’ and
sustainability
Where is NHS working now?
- Crisis support
- Cardiovascular physical Health Checks

8. Process Mapping

9. Process map of the pathway for an in-patient to receive CBT for psychosis.
Bayney R APT 2005;11:305-314
©2005 by The Royal College of Psychiatrists

10. 4

11. 4

12. DEMAND AND CAPACITY
Demand – How much work we are asked to
do - referrals
Backlog – Work we have been as yet unable
to do – waiting lists
Capacity – The amount of work we should
be able to do – beds
Waste – The amount of capacity lost –
cancellations, DNA’s
Activity – What we actually delivered

13.  Demand, capacity, activity and backlog need to be measured in the
same units for the same period of time
 Don’t compare unless they are measured in the same unit of time
 It is important to compare on a single graph and the same measures
must be used for each
• When you:
- have a completed process map, identified the long
delays and understand the variation
- need to focus improvement on flow and prove a variance between
demand and capacity
Examples:
• Reducing the time from receipt of referral to first assessment
appointment for CMHT
• Improving the transition time between liaison psychiatry assessment
in the ED and provision of appropriate further services, eg inpatient
specialist bed
When to look at demand and capacity

14. A Few benefits of looking at demand and capacity
• Flow can be improved by reducing the variation in capacity and
ensuring that the capacity meets the variations in demand,
particularly where there is a constraint (bottleneck) in the
process
• Balancing demand and capacity can help reduce errors by
ensuring staff are not working in an environment where there
is a constant backlog
• Most delays and inefficiencies in the healthcare system are not
the result of excess demand or the shortage of resources. The
key issue is a mismatch between when capacity is available and
when demand presents to a service.

15. Demand and Capacity Top Tips
• Always compare like with like – e.g. time as a unit of measure
• Start simple and use existing data where possible
• If no data exists complete a snap shot audit
• Be aware of the impact on other services of efforts to deal with
backlogs (surges of work) and focus on the whole journey
• Even in a well designed process flow will be affected by capacity and
demand
• Make sure clinical and administrative processes are aligned

16. “You can’t fatten a cow
by weighing it”
(Palestinian proverb)
Improvement is not about measurement,
but……..
How do we know if a change is an
improvement?
“If you can’t measure it, you can’t improve it”
Measurement for improvement
16

17. Measurement throughout
the project cycle
Project
Identification
Getting a
baseline
Did project
make a
difference
Will project
sustain
Evaluating
worth of the
project
A P
DS
A P
DS
A P
DS
A P
DS
A P
DS
17

18. 7 Repeat
steps 4-6
7 Steps to measurement
1 Decide
Aim
2 Choose
Measures
3 Define
Measures
4 Collect
Data
5 Analyse
& Present
6 Review
Measures
18

19. The improvement process
WaitingTime
0
200
150
100
50
250
Performance Report
Week
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Act Plan
DoStudy
Special causes
present -
unpredictable
Process
predictable (within
control limits)
Process improvement

20. To identify whether we are meeting service requirements: How do we know that we
are providing the services/products that our service users and carers require?
To help us understand our processes: To confirm what we know or reveal what we
don't know: Do we know where the problems are?
To ensure decisions are based on fact, not emotion: Are our decisions based on
well-documented facts and figures or on intuition and gut feelings?
To show where improvement needs to be made: Where can we do better? How can
we improve?
To show if improvements actually happened: Do we have a clear picture?
To reveal problems that bias, emotion, and longevity cover up: If we have been
doing our job for a long time without measurements, we might assume incorrectly
that things are going well. (They may or may not be, but, without measurements,
there is no way to tell.)
To identify whether others are meeting our requirements: Do people giving us a
service know if our requirements are being met?
20
Some Benefits of Measurement

21. 1. All your gut should tell you is when to eat
2. Measurement is not the goal; improvement is
3. Remember that variation exists
4. Define what you are collecting clearly
5. It is better to measure a few simple things well than to
develop many complex metrics and measure them badly
6. A few key measures plotted over time is all you really need
to know if there has been an improvement
7. Only interpret data using statistically significant measures
8. Statistical Process Control was designed to be used with
PDSA cycles - use it for all stages of your project
Measurement Top Tips
21

22. Clients/Patients, Carers and
Public Involvement
http://www.nhsiq.nhs.uk/improvement-programmes/experience-of-care.aspx

23. The secret of getting ahead is
getting started. The secret of
getting started is breaking
your complex overwhelming
tasks into small manageable
tasks, and then starting on the
first one.
Mark Twain
Engagement, getting started and
sustainability

24. The work before the work….
• Stakeholder
profiling
• Engagement and
working with groups

25. The work before the work….
• How to manage the
project
• Sustainability

26. 3
Case Studies coming online….

27. 3
Next case study ….
Webinar: Wednesday 23rd July, 10am

28. 3
• Any Questions?
If you have a question, either type it into the chat
box or raise you hand and we will unmute your line
so you can ask us directly.

30. Other resources and e-Learning
http://mentalhealthpartnerships.com/
Mental Health Innovation Hub
http://www.yhpho.org.uk/default.aspx?RID=191242
Mental Health Dementia and Neurology Intelligence Network
http://www.jcpmh.info/
Joint Commissioning Panel for Mental Health. Co-chaired by RC Psych/RC GP.
http://www.wardipedia.org/
Ideas, examples, information and research about therapeutic inpatient mental health care
http://www.rcpsych.ac.uk/workinpsychiatry/qualityimprovement.aspx
Royal College of Psychiatrists College Centre for Quality Improvement (Note: Access to resources may
require membership or subscriptions)
http://www.piramhids.com/home.aspx
Positive and innovative resources: A Mental Health Interactive Database (Scotland)
http://www.icptoolkit.org/home.aspx
Integrated Care Pathways for Mental Health (Scotland)

31. What Next?
• We are going to run a poll (insert
explanation) to find out if you have
any service improvement training
needs
• We would also like to hear if you have
good examples of service
improvement

32. 3
Thank you
A link to this webinar will be sent out to you shortly
along with a link to the slides which will be made
available through our website