A Ko Awatea-led project to improve Mental Health Act administration has dramatically reduced the rate of errors in section papers used to admit people for mental health assessment and treatment.
The Director of Area Mental Health Services (DAMHS) contacted Ko Awatea because high error rates, missing information and unclear writing in the section papers were frustrating mental health service staff and creating a potential breach of patient rights. Fifty per cent of section papers were incomplete or inaccurate.
Ko Awatea improvement advisor Lawrence Wong worked with a team comprising Mental Health Service administrators, a physician, psychiatric nurses and district inspectors to understand the problem and find a solution.
First, they agreed on the scope and objectives of the work. These were laid out in a charter of agreement created between the DAMHS and the team.
To understand the problem and its causes, Lawrence helped the team to apply tools to gain insight into their current processes. The first steps were to create a high-level view of operations using SIPOC (supplies, inputs, process, outcomes, customers) picture mapping and to collect data on the number of section papers with errors. This data was tallied to understand the types of errors that were occurring and keep a weekly record on a check sheet.
Next, the team delved into their current processes in greater detail. They observed work processes in practice and mapped them out to identify issues and opportunities. They also interviewed Mental Health Service users to understand the experience of their patients. The team used the insights gained to undertake a root cause analysis. They identified a lack of standard rules and processes and insufficient documentation and communication of processes to be the causes of the problem.
Once the team understood the problem, Lawrence led the team in future state mapping to visualise what they wanted the Mental Health Act administration process to look like in 12 months.
To get to the future state they wanted, the team brainstormed an improvement plan. Under the improvement plan, they:
• created a workflow map to clarify processes and roles, and to identify key points in the process to prevent errors
• placed bundled documents in a universally-accessible filing system with all the forms staff needed
• defined standard operating procedures to set down specific processes
• created visually appealing user guides and one-page instruction sheets
• created a checklist to prevent errors
• switched from mailing and faxing section papers to scanning
Lawrence helped the team to establish weekly data collection and to set up and use control charts to monitor their progress and identify any issues.
As a result of the project, the error rate in section papers has fallen by 46 per cent. They have established five straightforward visual control documents, where there were previously none. Staff satisfaction has improved, with reduced stress for administrators and less time wasted correcting errors.
To learn more about quality improvement methodology, register for Ko Awatea’s courses Fundamentals of Improvement, Improvement Advisor – Leading and Managing Improvement, and Data for Improvement: Using Data to Diagnose, Problem-Solve, Improve and Succeed.