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Project information


 

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Who we are working with


The CTG Team is carrying out topic-based work with pilot services/wards from five of the CCQI’s networks:

 

  • Prescribing Observatory for Mental Health (POMH);
  • Accreditation for In-patient Mental Health Services - Working Age Adults (AIMS-WA);
  • Community of Communities (C of C);
  • Quality Network for In-patient Child and Adolescent Mental Health Services (QNIC);
  • Quality Network for Forensic Mental Health Services (QNFMHS)

 

These networks were chosen as each has been working with mental health service providers over sustained periods to improve quality, and has identified areas for imporvement.  Teams from the pilot services/wards will be brought together into four collaboratives.  During a ten-month period, the CTG Team will work closely with each collaborative using the ‘Model for Improvement’ to develop and test ways of overcoming their particular barriers to improvement.

 

What we are working on


We will be focusing our work on 4 key area for improvement:.

 

  • POMH - screening for the metabolic side effects of antipsychotic drugs.

 

  • AIMS & QNFMHS - range and access to non-therapeutic activities for patients.

 

  • QNIC - transitions in care between in-patient and community-based services.

 

  • C of C - the ways in which therapeutic communities demonstrate their effectiveness.

 

 

How we are working


Collaborative working

For each topic, 4 to 6 teams will be brought together to form a collaborative. Each team will be made up of 4-6 representatives from the participating services.

 

Learning events

During the 10-month period, the teams within each Collaborative will come together on four occasions for a learning event.  The first will be focused on the Model for Improvement, how to apply it and developing individual action plans.  Subsequent learning events will focus on shared learning.

 

Action periods

Each learning event will be followed by a three-month action period where teams will be expected to carry out small PDSA cycles, and collect simple on-going measures. During the action period there will also be monthly teleconferences to review progress, discuss challenges, and agree ways forward.

 

Our Approach


The Model provides a framework for developing, testing and implementing changes leading to improvement.  It is based in scientific method and moderates the impulse to take immediate action with the wisdom of careful study.  It applies the five principles of improvement:

 

1. Knowing why you need to improve

2. Having a feedback mechanism to tell you if the improvement is happening

3. Developing an effective change that will result in improvement

4. Testing a change before attempting to implement

5. Knowing when and how to implement the change

 

The Model is based on three fundamental questions:

 

  • What are we trying to accomplish?
  • How will we know that a change is an improvement?
  • What changes can we make that will result in improvement?

 

These three questions are combined with the Plan-Do-Study-Act (PDSA) cycle - the process for testing change ideas.

 

Model of Improvement

 

Underlying the Model is the recognition that there is no such thing as a ‘perfect change’.  It uses an approach to change that is built on trial and error, hence the use of rapid and initially small-scale PDSA cycles that incorporate learning.  Improvement then becomes the application of knowledge acquired through systematic measurement, testing and learning.  Only when a change is seen to be an improvement, can it be fully integrated into the system or ‘spread’.

 

Why test change before implementing it?

 

  • It involves less time, money and risk
  • The process is a powerful tool for learning, both from ideas that work and those that don't
  • It is safer and less disruptive for patients and staff
  • When people have been involved in testing and developing ideas, there is often less resistance to implementing them.

 

Why do you need on-going measurement?

 

  • To encourage others to adopt new practices, it is important that the benefits of the improvement initiative can be demonstrated.  It is therefore essential that there is an understanding of the need to collect and use evidence and data.

 

  • If data are available from both before and after a planned change, a simple graph of data over time can be used to see if the change resulted in improvement.

 

 

CTG, 4th Floor Standon House, Mansell Street, London, E1 8AA    

Tel: 020 7977 6686   Fax: 020 7481 4831   Email: sholder@cru.rcpsych.ac.uk

 

© 2011 Royal College of Psychiatrists