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Experiences and lessons from benchmarking Older Persons Mental Health Services. Dr Rod McKay . Braeside Hospital. National Mental Health Benchmarking Project 27 November 2008. Goal of this presentation.
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Experiences and lessons from benchmarking Older Persons Mental Health Services Dr Rod McKay . Braeside Hospital National Mental Health Benchmarking Project 27 November 2008
Goal of this presentation Describe results of participation in national benchmarking of mental health services for older people Demonstrate how KPI data was used to explore clinical practice
Method Review of documents utilised for the benchmarking forums was conducted Reflection upon the author’s experience of participation and discussion with other participants.
Who was involved? • Seven older persons mental health services from five Australian states • Selected as representative of ‘good practice’ • Expected to have a history of using data within service • Facilitator and 2 project staff • 3 to 5 individuals from each service • Combinations of • Senior clinicians (multiple disciplines) • Service managers • Information support staff • Service project staff
What did we focus on? • Understanding indicators and how to use them • Understanding each others services • Length of stay and factors that may impact upon this • Diagnosis • Outcome measure profiles • Allied Health Practice • ECT practice • Bed management
What did we find? • All services provided ambulatory and community services to consumers with mental illnesses including psychotic illnesses, mood disorders and BPSD • Consumer profiles on the HoNOS 65+ were consistent with nationally available data; and consistent with diagnostic mixes of services • We had sufficient similarity to compare practice and performance; despite significant differences in • the proportions of consumers with different diagnoses • Available resources, and • Proportion of patients who were born overseas • All services had both strengths and weaknesses in profile and performance
What did we do regarding differing Length of Stay between services? • All selected a sub set of patients staying less than, or more than 60 days to identify differences in • Age • Gender • Language and residential care status • HoNOS 65+ profile • Diagnosis • ECT use
What did we find - Length of stay Each service could identify groups who stayed longer, but the factors were not the same between all services Trend for LOS over 3 years was a slow gradual increase Extracts from benchmarking workbook
One service synthesis • Factors that appear to be most associated with increased LOS are • High scores on HoNOS65+ item 8 (‘other’) and item 9 (relationships’) • Living at home at admission • requiring hostel care on discharge • Being aged <=70yrs • Having a psychotic illness • Factors with weaker associations are • High score on HoNOS65+ item 1 (behaviour) and item 11 (living conditions) • Requiring a change in residence
What did we do - Length of Stay • Discussed findings of analysis • Explored together different practice regarding • Allied Health staff resources and roles • Discharge practices • Flow to other services, where available • ECT practice • Each service commenced their own improvement project based on their own needs • Eg changes to bed flow, ECT practice, social worker practice, identifying consumers ‘at risk’ of long length of stay for more intense early discharge planning • BUT these were mostly only starting implementation by the end of benchmarking
What was useful? Extract from benchmarking workbook Using HoNOS 65+ (Routine Outcome Measure) to understand clinical profiles of consumers within teams
What was useful? Improving understanding of the similarities and differences in service provision between organisations Identifying areas of key differences in service provision and performance Establishing informal networks and contacts Sharing intellectual resources (eg job descriptions, clinical tools uses)
What was useful? • collaborating in generating projects to explore differences • initiating local projects to improve practice. • (with some limitations) • the national KPI set and data from routine outcome measurement collections have been valuable tools to assist these processes. • Improved understanding of the use, and limitations of the national Mental Health KPIs; and indicators and related data in general
What was problematic? Poorly compatible IT systems and financial systems across states Conducting ‘joint projects’ to change practice within services Range of data literacy of participants Ability to recruit support/ project staff Providing feedback to staff from participating organisations not attending forums Lack of rules regarding withdrawal from the forums Time frames of forums vs time for practice change Services finding time to do ‘homework’ Services integrating ‘benchmarking’ into ‘quality improvement’
BUT….. • All this considers mental health services for older people as a ‘separate being’ to other mental health services • What happens when we look into the results of the adult mental health service benchmarking?
What are there lessons to be learnt? • For OPMH services? • For Adult MH services? • For the use and creation of KPIs?
Conclusion • Benchmarking can assist mental health services for older people to • improve their understanding of differences in practice and performance; • generate useful local actions based upon these • KPI sets and routine outcome measurement assist these processes • They can also assist discussions about differences between mental health services for different age groups; and their relative performance
Conclusion • Rewards for services require • Staff to be supported to develop appropriate skills • Integrating benchmarking with service quality processes • A willingness to question established ideas and practices • Time
