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Service System Redevelopment

“ Through the Eyes of the Client ”. Service System Redevelopment. From the client’s perspective From the service providers perspective. Client Journey Experiential Study. Presenters:

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Service System Redevelopment

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  1. “Through the Eyes of the Client” Service System Redevelopment From the client’s perspective From the service providers perspective Client Journey Experiential Study Presenters: Lyn McKay, Service System Redevelopment Coordinator, FMPPCP Julie White, ICDM Support Officer, FMPPCP/ICDM , Peninsula Health Community Health

  2. What am I going to get out of this session? • An understanding of the: • Client Journey processes & challenges that went into the undertaking • Information about: • planning a service system redesign approach • A general framework for the project • Methodologies & tools used • Strategic outcomes

  3. Approach • System Wide • Systematic • Start broad • Finish targetted • Well developed implementation plans • Use of robust project management approach/tools • Practical/doable – delivering tangible results at the end • Factual information – not just ‘intuition’

  4. The Study • Documents and analyses the experiences of the service system from the perspectives of both: • Clients • Service Providers • Provides a comparative

  5. Study Objectives • Empower clients to: • navigate the service system • manage their needs across the continuum of care • Identify gaps/areas and changes needed to improve the client journey & outcomes • Enable improvements to be made in the health system across the FMP catchment

  6. Focus • Central Focus (in keeping with the SSR Plan) • Aging • Anxiety & Depression • Dementia

  7. Study – Target Sectors & Populations

  8. Client Inclusion Criteria • Primarily between the ages of 50-80 • Multiple agency involvement • Multiple co-morbidities • Met the profile for the anxiety & depression/dementia focus of the study • CALD group • Indigenous person • Family carer or have a personal/family carer • Relevant and current experience of the health system • Ability/assisted capacity to express how they think the system could improve

  9. Study Scope • 147 Clients • 87 Services / PCP Member agencies

  10. Client Sources • Brotherhood of St Laurence • Frankston Senior Citizens • Seagull Day Club – Frankston • Baptcare • Positive Aging Group, Frankston City Council • Access & Mobility Group, Somerville • Greek Women’s Group, Rye • Indigenous Group, Hastings • Villa Maria (home visits) - case managed clients • Telephone Interviews – Peninsula Support Services • Age Strong

  11. Study Inclusions • Assessment of: • Access/intake • Exit/discharge • Assessment and care planning • Referral • Care coordination • Self management • Chronic disease • Capacity of organisations – limitations to go beyond presenting issue or service programs • Communication between providers • Strengths and weaknesses of client journey processes for client feedback and quality improvement

  12. Methodology • Clients • Focus groups • Questionnaires • Open group discussion • Individual client interviews • Service Providers • Questionnaire – via Survey Monkey

  13. Supported by • clear governance structures • Use of System Frameworks • Victorian Service Coordination Practice Manual • Wagner Model • Project management processes & tools

  14. Project Management Processes & Tools

  15. Study Findings

  16. ServiceProviders were asked about: Clients were asked about: • Client demographics • Managing their condition • Getting into services • What has been done to manage their condition • Their experiences of the health system • Service provider demographics • Service provider client demographics • About structures & processes • Service accessibility • Assessment & Care Coordination • Referral & feedback • Client pathway information

  17. Key Themes • Service Access • Listening, noticing & follow up • Effective Communication between Services & Clients • Carers – Involvement • Waiting times and time management • Social Groups • Case Management

  18. Key Findings • Clients expect to: • be able to access the services they require in a reasonable period of time • receive help and be looked after • be given information appropriate to their situation

  19. "QUESTION: Do you feel you have been given sufficient information about your condition/ illness to manage it? medically yes-well informed / practically-NO"

  20. Clients’ Best experiences of the system were those that: • involved timely responses to clients’ concerns • related to particular programs where the leader provided friendly/appropriate service tailored for the individual client’s needs

  21. Clients’ Worst experiences of the system were those that included: • slow responses/lack of timeliness • apparent lack of concern/interest in individual client • service providers not taking the time to listen or pay proper concern to the client needs and issues

  22. Most Important to Clients • Being treated with decency, courtesy, respect • Receiving timely follow through

  23. Being listened to ‘Really heard’,

  24. Important Factor • Being involved in social & worthwhile activity together (social inclusion)

  25. Who do clients go to as a priority? • GP • Hospital • Pharmacists • Community Health • Local Government

  26. First Priority

  27. Second Priority

  28. Third Priority

  29. Of Interest • Many clients did not see that they actually had a ‘condition’ • Raises issues about the terms used in consultation with clients

  30. Key Findings Service Providers • Lack of awareness - internal processes for identification of clients with dementia, depression or anxiety. • More work required to further integrate/streamline access to services for clients.

  31. Many service providers are unsure about, or do not know if their organisation has a monitoring/reminder /recall system

  32. Wide range of timeframes for practitioners seeing clients from when clients first access services • There is evidence of a lack of clarity by service providers around what is ‘Client Focused Care’

  33. Diverse communication practice exists between service providers and GPs. • Extensive service provider practice variations between referral timeframes & transmission of referral acknowledgements.

  34. Perception (by Service Providers) • monitoring of client risk at presentation is supported by consistent practice across service providers regarding: • effective communication of timeframes • eligibility and prioritisation across services …….in accordance with good practice

  35. Example Care Plans Service Providers Responses Are your clients actively involved in developing their treatment/care plans?

  36. Client Responses Have you been actively involved in developing your treatment/care plan(s)?

  37. Client’s Responses Do you have a treatment/care plan(s)? If Yes, do you have a written copy of your treatment/care plan(s)?

  38. “My ex-wife may have it. There is a written contract but I don’t have it” “My own plan - I belong to a Bushwalking Group and walk 10 km /week”

  39. Example - Consent • Most service providers ask for clients consent to share personal details & information – Client perception - they (52%) had not been asked to give consent prior to service providers sharing their information with other services

  40. Service Providers Responses Client’s Responses

  41. What did we learn? • Processes always take longer than expected • Analysis of data & information - generally more complex than often anticipated in early stages of project/data collection phases • Timelines need to be realistic and flexible

  42. Project Evaluation • Governance/Leadership • Planning and scoping • Stakeholder engagement • Risk management • Resource management • Quality management • Reporting • System-wide/organisational change management • Impact evaluation • Outcomes/achievements evaluation • Learnings dissemination

  43. Outcomes/Impacts of the Client Journey Study Informed the development of numerous service improvement initiatives such as: Development & piloting of Broader Needs Assessment tool through the PCP “Working Together for Better Diabetes Care” Catchment planning initiative Informed individual agency service planning Informed Medicare Local discussions & included in MLO submission

  44. Project Review -lessons learned log • Being used for SSR planning – identification of key work priorities for remainder 2011-2012 • PCP strategic planning evidence base • Service providers using for QI purposes • Benchmarking resource for various entities

  45. Back to the Future Challenges • Address findings - prioritising • Developing & implementing models of care, access, etc. - client focussed care • Affect appropriate change at all levels of organisation & the system • Resourcing

  46. FMPPCP Lyn McKay Tel: 9788 1544 Email: lmckay@phcn.vic.gov.au Julie White Tel: 9784 7764 Email: jwhite@phcn.vic.gov.au Copies of the Client Journey Report available at: http://www.peninsulahealth.org.au/health-professionals/frankston-mornington-peninsula-primary-care-partnership/

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