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Adult Acute Mental Health Inpatient Unit $23.6m

ACT HEALTH MENTAL HEALTH ACT Capital Asset Development Plan Your Health-Our Priority New Adult Acute Mental Health Inpatient Unit Stage 3 Implementation of The Model of Care Presentation to Mental Health Community Coalition ACT Friday 25 February 2011.

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Adult Acute Mental Health Inpatient Unit $23.6m

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  1. ACT HEALTHMENTAL HEALTH ACTCapital Asset Development PlanYour Health-Our PriorityNew Adult Acute Mental Health Inpatient UnitStage 3 Implementation of The Model of CarePresentation to Mental Health Community Coalition ACTFriday 25 February 2011

  2. Adult Acute Mental Health Inpatient Unit $23.6m • A new 40-bed unit is now being built at the Canberra Hospital allowing for expansion of the facility to 50 beds. • This unit replaces the existing PSU facility. • Construction commenced mid 2010. • Estimated completion late 2011.

  3. Steps for all CADP projects • Feasibility Studies • Budget appropriation Stage 1 Preliminary Model of Care • Design Options • Value Management Studies • Design Briefs • Way Showing Stage 2 Model of Care Gap Analysis • Preliminary and Final sketch plans Stage 3 Operationalising the Model of Care • Policy & procedures, change management & workforce planning • Tender for works • Construction • Commissioning • Post occupancy evaluation.

  4. Government Agenda for Change Current PSU described as less than optimal. A range of factors contributed to the decision to replace PSU: • Coronial Inquests • Service reviews • Adverse publicity • Failing public confidence • Human Rights Review • Significant structural limitations

  5. MHACT: Planning the Agenda for Change • Commissioning a new unit is special • Plan by asking where is everyone else at ? • Need to triangulate, what’s happening elsewhere at the international / national level. • What is best practice and how would we know ? • What’s going to make and keep us special and different to everyone else ?

  6. Adopting a change management process to support the change management plan • MHACT has the benefit of dedicated CADP and Human Resource Management resources. • The application of a change management process is crucial to success. • The change management process is underpinned by the learning organisation principles and practices.

  7. What has happened elsewhere? • Reviews and inquiries have been undertaken both nationally and internationally into acute mental heath inpatient care. • Result: Narratives concentrate on “what should be done ” not “how to do it”. • Result: No comprehensive “how to” manual developed.

  8. IN SUMMARY WHAT DO THESE REPORTS SAY?

  9. Expressed Themes of Concern • Limited consumer, carer participation in decision making • Limited information provided • Diminished dignity • Limited activities especially evening and weekends • Staff levels inadequate • Delayed discharge • Task Focussed, Staff Station Centric Staff

  10. Expressed Themes of Concern Cont’ • Consumers particularly female not feeling safe • Little one to one time • Rule bound staff • Little explanation about medication and side effects • Meagre or absent “talk therapies” • Physical health matters not followed up • Poor post discharge follow up

  11. Previous Efforts For Change REACTIVE PROACTIVE

  12. THE AGENDA FOR CHANGE HELPS DETERMINE ITS DIRECTION & SPEED AN AGENDA OF COMPLIANCETO MEET LEGAL, PROFESSIONAL AND COMMUNITY STANDARDS (IF IT WORKED ALONE WE WOULDN’T BE HERE) .............................REACTIVE AN AGENDA OF CO-PRODUCTIONTO MAXIMISE THE POTENTIAL OF INDIVIDUALS THROUGH THE EFFECTIVE AND EFFICIENT USE OF RESOURCES AND AVAILABLE SOCIAL AND SUPPORT SYSTEMS (THIS IS THE NEW WAVE OF CHANGE FOR SOCIAL POLICY MAKING AND SERVICE DELIVERY) ……………………PROACTIVE

  13. SO HOW DO WE GO ABOUT APPROACHING CHANGE?

  14. FIRSTLY WE NEED TO KNOW A BIT MORE ABOUT WHAT WE ARE CURRENTLY DOING AND WHY BEFORE WE CHANGE ANYTHING JUST YET

  15. MHACT Threshold Issues for Change • Unpicking and unpacking ourselves from our selves (what are we doing and why are we doing it that way?) • Not everything about the current PSU is “bad”. • Ensuring staff, consumers and cares make a direct contribution to the decision making process for change ?

  16. MAPPING CONNECTIONS • What we know (facts) • What we think we know (supposition) • What we don’t know we don’t know (ignorance) • What we know we don’t know (the opportunity to learn)

  17. Mapping Connections What can we learn? • That clear processes are required to “co-define” what is required in order to deliver services in a values based practice environment. • There is a need to effectively manage and avoid“home spun” views about what’s right and what will improve things. • That having “access to contemporary knowledge” about good/best evidence practice is a must do? • Finding ways to “adopt, implement and evaluate” these practices is even better.

  18. UNDERTAKING A PRELIMINARY WORK STUDY

  19. Current V’s Desired Reality “Changing” from where we are to where we need to be

  20. Challenges for Transformational Change • Initiating • Re-thinking and re-designing • Implementing and sustaining new systems

  21. A process for change and change management • Making the experience positive and uplifting. • Promoting a sense of pride. • Defining what success looks like ? • Adopting measures for success ? • Making a national contribution to the literature about “how to” implement an acute inpatient model of care.

  22. Ethical Practices • Values based care. • What do we believe in (our philosophy). • Actions (the things we do in support of these beliefs). • Identify them. • Make them visible. • Make them known. • Be accountable for them. • Ask consumers and carers to verify and measure them.

  23. MEETING COMMUNITY EXPECTATIONS Of our service and ourselves A complex and complicated task

  24. Building a Co-participation System involves Staff, Consumers, Carers & the Community we serve

  25. THRESHOLD ISSUE The need for a A TWO-WAY FEEDBACK SYSTEM to make good on “co-defined” expectations

  26. A TWO WAY FEEDBACK SYSTEM NEEDS TO BE • ADJACENT • IMMEDIATE • RESPONSIVE IN MEETING EXPECTATIONS

  27. Meeting Staff Expectations • Services are adequately resourced • Staff are well led, valued and respected by their own management • Training, professional and career development are provided • Working conditions are supportive of professional effort • The environment is safe

  28. Meeting Staff Expectations • Senior staff take an interest and support staff at the coal face • Issues are responded to and managed effectively • Regular opportunities occur for staff to communicate and be communicated with • The workplace is free of bullying and harassment

  29. Meeting Community Expectations • Human kindness, sensitivity and compassion for vulnerable people • Standards are met • The law is upheld • Governments are accountable • Services are resources, sustainable and accessible • Staff are trained and available • High quality care is provided in a timely manner

  30. Meeting Community Expectations Cont’ • There is a treatment and recovery plan • Consumers and carers are kept informed and involved in decisions • Transparency applies to decision making by professional staff • Consumers are helped supported and treated with respect • Physical facilities are supportive of treatment and recovery ** Recovery is a key driver for the way services are delivered ** Treatment is the best and most contemporary available

  31. WHAT IS THE BASIS OF THE APPROACH TO IMPLEMENTATION?

  32. “EXPECTATION GENERATOR” CONSUMER/CARER/STAFF [TREATMENT & RECOVERY PLAN] STAFF CLINICAL/ ADMINISTRATIVE SERVICE DELIVERY SYSTEM CONSUMER/CARER/ STAFF SERVICE CO-PARTICPATION FEEDBACK SYSTEM THERAPEUTIC PROGRAM “EXPECTATION EVALUATOR” CONSUMER/CARER/STAFF [OUTCOME/ INDICATOR MEASURES] GOVERNANCE VALUES

  33. EXPECTATIONS FOR THE ADULT ACUTE INPATIENT MODEL OF CARE 1. PURPOSE OF WARD 1. 1. CARE PATHWAY CO-ORDINATION 2. GOVERNANCE 2. 2. CLINICAL LEADERSHIP & WORKFORCE 3. LEGAL REQUIREMENTS 3. 3. CLINICAL PRACTICE 4. ENGAGEMENT & THERAPY 4. 4. BEST EVIDENCE PRACTICE 5. CLINICAL PRACTICE GUIDELINES 5. RECOVERY & PERSONALISATION 5. 6. 6. QUALITY IMPROVEMENT 6. SAFETY & RISK MANAGEMENT OUTCOMES PROCESS STRUCTURE CHANGE MANAGEMENT PROGRAM TWO WAY FEEDBACK SYSTEM

  34. EXPECTATIONS FOR THE ADULT ACUTE INPATIENT MODEL OF CARE Emphasis on Structure 1. CARE PATHWAY C0-ORDINATION 2. CLINICAL LEADERSHIP & WORKFORCE 3. CLINICAL PRACTICE 4. ENGAGEMENT & THERAPY 5. RECOVERY & PERSONALISATION 6. QUALITY IMPROVEMENT 1. PURPOSE OF WARD 2. GOVERNANCE 3. LEGAL REQUIREMENTS 4. BEST EVIDENCE PRACTICE 5 CLINICAL PRACTICE GUIDELINES 6.SAFETY & RISK MANAGEMENT CHANGE MANAGEMENT PROGRAM TWO WAY FEEDBACK SYSTEM

  35. EXPECTATIONS FOR THE ADULT ACUTE INPATIENT MODEL OF CARE Emphasis on Process 1. PURPOSE OF WARD 2. GOVERNANCE 3. LEGAL REQUIREMENTS 4. BEST EVIDENCE PRACTICE 5. CLINICAL PRACTICE GUIDELINES 6.SAFETY & RISK MANAGEMENT 1. CARE PATHWAY CO-ORDINATION 2. CLINICAL LEADERSHIP & WORKFORCE 3. CLINICAL PRACTICE 4. ENGAGEMENT & THERAPY 5.RECOVERY & PERSONALISATION 6. QUALITY IMPROVEMENT CHANGE MANAGEMENT PROGRAM TWO WAY FEEDBACK SYSTEM

  36. PURPOSE OF WARD GOVERNANCE & LEGISLATIVE REQUIREMENTS 1. PURPOSE OF WARD - Co-definition - Aims and Objectives - Values - Philosophy - Professional ethical and moral tone 2. GOVERNANCE - Collaborative Engagement Forum 2.LEGISLATIVE REQUIREMENTS - Mental Health (Treatment & Care) Act 1994 QUALITY IMPROVEMENT, SAFETY &RISK MANAGEMENT CARE PATHWAY CO-ORDINATION • 6. QUALITY IMPROVEMENT • - Policies & Procedures (SOP’s) • - Activities • - Indicators • - Outcomes • - Consumer Carer Family Feedback • - Ward Atmosphere (WAS) • - Research • Balanced Score Card • Accreditation

  37. CLINICAL LEADERSHIP & WORKFORCE BEST EVIDENCE PRACTICE, CLINICAL PRACTICE GUIDELINES • 3. CLINICAL LEADERSHIP & WORKFORCE • - Team work • New Ways of Working • Workforce • Learning and Development • Multidisciplinary roles & functions • Operations Director • Clinical Director • Team Leader • Clinical Staff • Non Clinical Staff • Volunteers • 4. BEST EVIDENCE CLINICAL PRACTICE • - Reception • - Admission • - Comprehensive Assessment • - Collaborative Care Planning • - Treatment and Physical Care • - Clinical Review • - Ward Rounds • Handover • Documentation • - Clinical Teaching and Supervision • - Discharge Planning and After Care ENGAGEMENT & THERAPY RECOVERY & PERSONALISATION • 5.ENGAGEMENT & THERAPY • - Reception and Orientation • - Collaboration and Communication • - Carer and Family Connection • - Ward Rules and Handbook • - Tidal Interaction Model • - Psychotherapeutic Program • - Complimentary Therapies • - Leisure and Activity Program • Health Education and Medication • Star Wards

  38. HOW WILL IT BE IMPLEMENTED?

  39. Project Governance • AAMHIU Stage 3 Model of Care Planning and Implementation groups • Planned / staged implementation through 2011. • Senior staff manage completion of “key pieces of work”. • Staff, consumers and carers are integral to implementation and will contribute as active participants in the process. • Reporting system on the basis of “done” or “not done”.

  40. RISKS • Poor leadership and management • Lack of commitment, priority and interest • Lack of resources and know how • Lack of time and insufficient lead time • Relevance transfer • Implementation plan not sufficiently dynamic in engaging stakeholders • Lack of involvement of staff, consumers and carers • To mention a few !!

  41. NEXT STEPS • Communicate understanding of the Stage 3 Implementation objectives with stakeholders. • Identify and convene Model of Care Planning and Implementation Groups. • Develop working relationships and Stage 3 Implementation Governance processes. • Implement Work Plan. • Focus available Resources and Co-ordinate Effort through 2011. • Monitor and evaluate results.

  42. DISCUSSION !!

  43. Contact us Kevin Kidd • Director MH CADP and Principal Nurse • kevin.kidd@act.gov.au David JacksonHope • CADP Senior Project Officer • david.jacksonhope@act.gov.au

  44. THANK YOU TIL NEXT TIME : )

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