There is NO magic bullet!(The TDHB journey to good collection compliance)

Graham DonlonOutcomes & Clinical Information Projects Officer

Mental HealthTaranaki District Health Board

Taranaki – where is it?

Taranaki background:• Taranaki is a rural, comparatively isolated area• Population 108,100 (June 2009 estimate)• Major Industries: Farming, Energy, Tourism• Winner of several ‘Most liveable’ city awards• Gorgeous parks, gardens and walkways• Taranaki is a rich in the arts + culture• Cosmopolitan café culture• Surf and ski• Fishing and hunting • Sports/fitness

Context:At the time of writing, Taranaki District Health Board has one of the best outcomes collection compliance rates in New Zealand

However

• Compliance could always be better• Good compliance does not equate with good quality

data!

We still have a long way to go...

TDHB community compliance

Taranaki inpatient compliance

TDHB Community compliance

Why this sudden climb in collection compliance?• The ‘Carrot’ Line managers nominated staff who were diligent in staying on top of their HoNOS

collection or those staff who supported others to do so - awarded ‘Star Performer’ certificates. Also, those who made a huge effort to get on top of overdue forms were recognised

• The ‘Stick’Memo circulated to all staff stating that overdue HoNOS tasks would be performance managed

• Staff realisation“It’s not going away, so I may as well get on with it!” (start collecting)

• Hard workTo be covered soon.

Other factors that influenced compliance:• Resourcing:

Outcomes coordinator position is 1FTE. Enables more ‘hands on’ support. ‘Go-to’ person both within and outside DHB

• High coordinator profile: Coordinator is well-known to clinical staff, having worked in most teams over two decades (“Polyfilla Man”). Open-door policy.

• Size:TDHB is comparatively small - easier to effect change. Coordinator knows all mental health staff

Another factor that influenced compliance:• Leadership, leadership, leadership!

Without a robust support framework, the Outcomes Coordinator position would fail. This support came from:

• Service Manager• Governance Group• Implementation Team• Training Team• Clinical staff themselves • IT staff

Damaging factors• Continual IT problems (AKA The 3D effect)

Delivery delays (system almost two years late), vendor absenteeism, bugs, wrong versions, etc.

• Absence of reports from systemOnly reports – overdue, upcoming and graphical report of progress of single consumer over time

• Environment of changeManagement restructuring, Acute Services review, proposed CAMHS review, PHO tendering > OUTCOME: dispirited workforce

• Fear of changing practiceAn IT-driven initiative not universally welcomed by staff (older workforce), resistance to changing practice, i.e., not used to preparing for MDT reviews, power issues

• Outcome measures still sit outside routine clinical practiceHoNOS is well collected but only used in a few small teams. Not shared with consumers. Major challenge!

• Misconception about purpose of the HoNOS tools“This is something we only collect for the Ministry of Health”

PRESENTATION SUMMARYThere really is no magic bullet, good compliance is dependent on many factors including:

• Adequate Resourcing (FTE)• Leadership & governance• Hard work• Coordinator profile• Size of the DHB• The use of the ‘carrot’ and ‘stick’

Any Questions?