Building and Sustaining a Patient-Centred System: The Transformational Journey of a Mental Health and Addictions Program. NHLC June 10, 2013

Transcription

1 Building and Sustaining a Patient-Centred System: The Transformational Journey of a Mental Health and Addictions Program NHLC June 10, 2013

2 Our Past: Amalgamation of NHS mental health and addictions November 2011; Building of new St. Catharines Hospital open March 24, 2013; Consolidation of three inpatient acute mental health units; Specialized bed transfer from St. Joseph s Hamilton; Expansion of mental health services at new hospital; Future redevelopment of addictions services.

3 Our Present: Largest clinical program within the new hospital; 44 inpatient acute beds with growth to 54 over next four years; 24 inpatient specialized beds with growth to 30 over next four years; NEW 4 bed Psychiatric Emergency Service; NEW 4 adolescent mental health beds on Children s Health Unit; NEW

4 Ambulatory Mental Health Services: Adult Outpatient Mental Health (offered at three sites); Medication Clinic (offered at three sites); Child & Adolescent Outpatient Mental Health (offered at three sites); IMPACT Niagara Program; Community Treatment Order CTO Program; Psychiatric Emergency Response Team (PERT); ECT Program (open Oct/13); NEW Day Hospital Program; NEW Consultation Liaison Service; NEW Psychogeriatric Clinic; NEW Rapid Consult Clinic; NEW Telepsychiatry Program. NEW

5 Addiction Services: Withdrawal Management Services (Men s/women s); New Port Centre Residential Treatment Program; Out and About Program; Eating Disorders Program; A Better Choice (ABC) Program; Problem Gambling Prevention Education for Multi-Lingual Communities; Methadone Clinics (2).

6 Our Vision Together in Excellence Leaders in Healthcare. Core Values - CPR Compassion We focus on patient needs, concerns and feelings We display courtesy and helpfulness to others at all times We take time to listen first We speak to others in a dignified and understanding manner We demonstrate sensitivity to the situation of others. Professionalism We strive for quality in all aspects of work We take responsibility for actions

7 We acknowledge the contributions and success of others We welcome new ideas and innovative thinking We take advantage of and encourage new learning opportunities Respect We value the ideas and opinions of others We promote and support teamwork We communicate with others in a positive, considerate and open manner We display trust and integrity at all times We respect everyone s privacy We treat others fairly

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9 Cycle of Change: Assessing impact and learning Creating systematic alignment Determining the (longer term) path forward Assessment & Pursuing Alignment Clarifying Purpose Defining the change destination Initiating Commitment Building the case for change Showing progress Sustaining momentum Reinforcing Change Planning the Change Developing the plan Identifying stakeholders Assessing readiness Identifying obstacles Communicating Creating dialogue Educating Building Capability Creating Followership Building support Addressing behaviour Every step in the cycle is important! (Giral, 2010)

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11 Planning Process: Clarifying Purpose What is our goal with the change and what do we want to look like as a program after? Overall vision of centre of excellence for Mental Health and Addictions was known. End state not always clear. Initiating Commitment Build the case or why for change to gain initial buy-in and commitment. Reasons for change articulated through multiple staff engagement venues: Regional Psychiatry meetings. Bi-monthly regional engagement sessions. Bi-monthly unit engagement sessions. Planning the Change Do the research identify and prioritize your stakeholders to assess readiness and potential obstacles and develop a project plan. Internal and external stakeholders identified. Collaborative process mapping occurred with cross-programs such as ED and Children s Health. Community Advisory Group developed to inform planning. Regular meetings for two years.

12 Planning Process: Creating Followership/ Building Capability Reinforcing Change Create dialogues with your stakeholders about how change impacts them personally; address behaviour change and provide training/education if needed to build skills. Regional engagement sessions bi-monthly starting in November Unit engagement sessions bi-monthly. Regional psychiatry meetings were organized monthly for the psychiatrists and Mental Health and Addictions Leadership Team. Monthly Community Advisory Group Meetings. Cross-program meetings monthly. Monthly newsletter highlighting planning process and change that was occurring. Engagement of staff in operational readiness coordinator positions. Training/orientation organized for staff. Standardization of policies/procedures/processes. Continue to build momentum by reinforcing key messages about the positive impact of change and how you will support people going forward. Positive messaging about new hospital. Tours for staff, families, public, community partners. Large gala event to celebrate our past, present and future.

13 Planning Process: Assessment & Pursuing Alignment Measure the impact of change did it accomplish what you wanted it to? Merging three cultures has been difficult. Patient flow/bed capacity issues. Recruitment challenges. Staff expressing concern that communication is poor. Environmental issues. Staff issues: Increased staff sick time; Use of overtime; Workload issues; Union grievances; Increased movement of staff across the program. Difficult to look ahead when faced with day to day challenges!

14 Skipped Step Results: Clarifying Purpose What is our goal with the change and what do we want to look like as a program after? Confusion Initiating Commitment Build the case or why for change to gain initial buy-in and commitment. Complacency Planning the Change Creating Followership/ Building Capability Do the research identify and prioritize your stakeholders to assess readiness and potential obstacles and develop a project plan. Create dialogues with your stakeholders about how change impacts them personally; address behaviour change and provide training/education if needed to build skills. False Starts Resistance Reinforcing Change Continue to build momentum by reinforcing key messages about the positive impact of change and how you will support people going forward. Inaction/Lost Momentum Assessment & Pursuing Alignment Measure the impact of change did it accomplish what you wanted it to? Chaos

15 True leadership lies in guiding others to success. In ensuring that everyone is performing at their best, doing the work they are pledged to do and doing it well. Bill Owens

16 Using LEADS Framework for Transformational Change

17 Five Domains: Five Leadership Domains L Lead Self E Engages Others A Achieves Results D Develops Coalitions S Systems Transformation Four Capabilities Per Domain

18 Lead Self: L Lead Self Demonstrate character Develop themselves Manage themselves Are self-aware Lead Self

19 Lead Self: Application: Leadership team model NHS CPR values. Role modeling of desired behaviours for staff. Coaching of staff. Leaders aware of strengths and seek out learning opportunities as needed. Alignment of project leads based on leader strengths. Lead Self

20 Engages Others: E Engages Others Foster the development of others Communicate effectively Build teams Contribute to the creation of healthy organizations Engages Others

21 Engages Others: Application: Ongoing professional development for staff. Clear communication with staff. Address issues in timely manner and ensure staff are aware of timelines. Leadership presence in the front-line is crucial. Coaching in the moment to encourage desired behaviours. Address performance issues as needed. Wellness program for staff. Recruitment of staff with key values/behaviours. Engages Others

22 Achieves Results: A Achieves Results Set direction Strategically align decisions with vision, values and evidence Take action to implement decisions Assess and evaluate Achieves Results

23 Achieves Results: Application: Set clear expectations and accountabilities at all levels. Ensure staff understand context for Program priorities. Support staff during ongoing change. Leader presence in the frontline as change continues. Monthly Program on a Page to monitor key indicators to inform actions. Use RAI data to understand gaps and program development opportunities. Achieves Results

24 Develops Coalitions: D Develops Coalitions Develops Coalitions Purposely build networks and partnerships to create results Demonstrate a commitment to customers and service Mobilize knowledge Navigate socio-political environments

25 Develops Coalitions: Application: Engagement with the LHIN regarding funding opportunities. Work closely with community partners to develop programs and media briefings regarding regional services. Quality, risk and patient safety structure for Program. Use of RAI data to understand patient profile for Niagara. Patient focus groups and satisfaction surveys to inform service development. Develops Coalitions

26 Systems Transformation: S Systems Transformation Systems Transformation Demonstrate systems/critical thinking Encourage and support innovation Orient themselves strategically to the future Champion and orchestrate change

27 Systems Transformation: Application: Identify issues and map out action plan to address with identified MRP and timelines. Regular leadership check-ins to stay focused on priorities. Ensure that all planning incorporates current evidence and best practices. Challenge the status quo and look at ongoing opportunities for improvement. Be open to new ways of doing things. Look for efficiencies wherever possible. Systems Transformation

28 LEADS Framework:

29 Change is complex; People, culture and processes take time to develop; Staying focused on the end vision is key; Be kind and patient to each other; Invest in people who are the strength of the system; Focus on wellness; Be action oriented and do not get caught up in the negativity; Ensure clear communication at all levels; Learn from others; Priorities must be clear; Align leaders based on their strengths; Ensure leaders are visible to staff; Identify staff champions; Focus on morale; Do not make assumptions base planning on facts. Key Lessons Learned:

30 Questions?

31 Dr. Edgardo Pérez, Regional Chief Mental Health and Addictions Program Linda Boich, Vice President Mental Health and Addictions Program Heather Scott, Director Mental Health and Addictions Program Barb Pizzingrilli, Manager Program Development and Evaluation