Measurement and teamwork matter – wait times drop for mental health services

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If you don’t track it as a team, you don’t know what could be done better for patients.

That’s what staff and psychiatrists learned in mental health outpatient services at Rouge Valley Centenary.

Prior to getting coordinated numbers, and reviewing wait times to see one of Rouge Valley’s 11 psychiatrists, patients were waiting up to eight months to a year for an appointment. Patients referred by family physicians to Rouge Valley’s crisis clinic were, however, seen the same day or the next day.

“Our process wasn’t working well for patients. Our patients were either going somewhere else or coming in to emergency when things had reached a crisis point for them,” says Julie Kish, manager of mental health.

“We knew we had a problem. Some people were waiting far too long. It was unacceptable. We were unable to determine the exact wait times because of a disjointed referral system. We needed a process where no one could fall through the cracks.”

Kish explains, “Our psychiatrists each had their own intake and referral process. They were doing it their own way, which worked in their practices, but it didn’t work for the tracking of all patients.” The hospital did not have a central coordinated tracking method for mental health patients waiting to see a psychiatrist.

Mental health manager Laura Boyko says, “We needed a central registry so we could track all of our patients, see how long they were waiting, and see how many patients we were getting each month. Without a central registry, we simply didn’t know.”

So Boyko organized a Kaizen event (a Lean improvement set of team meetings) in July of 2012 with the psychiatrists, who were initially hesitant to change as things were working for them individually. Hospital staff members were also apprehensive, at first, about changing their processes.

“Once three different referral approaches were exposed in our Kaizen event, staff and psychiatrists realized the inefficiencies and soon recognized how one approach could benefit everyone; staff, physicians and patients,” says Boyko.   “The light bulb went off. They saw that an improvement was needed and one system would be best for the patients,” she adds.

The three-day Kaizen event brought together psychiatrists, secretarial staff, information technology staff, managers, acute and mental health vice-president Cheryl Williams, and chief of psychiatry Dr. Steve Fishman.

“The volume of referrals seen highlighted the lack of alternate resources in Scarborough and necessitated changes to streamline access for patients in our communities,” says Dr. Fishman.

Kish says she knows this new process is working for patients. “Now, there are fewer no-shows for psychiatrists’ appointments, and that’s simply because patients aren’t waiting a year to get them. The appointment wait time has moved from a high of 12 months, a year ago, down to two months in April 2013.”

Having one coordinated list in a computer system tracking the patients has made a big difference. However, it was the work of the psychiatrists in agreeing to pick up patients, who were not specifically referred to them, that also made a big impact.

Kish says, “It’s the difference between having a bunch of private practice doctors working independently and having one central clinic for mental health patients with everyone working together. The team engagement from our psychiatrists has been great and really made this work for patients.”

She adds, “It was also great for teamwork for everyone. Now our secretaries work as a team, rather than for a specific psychiatrist.”

Here are the improvements from last summer’s Kaizen event:

• Wait times have gone from one year, to 111 days in October 2012, to 64 days in April 2013;

• Patients are happier because they are being seen more quickly;

• There are fewer patient no-shows for psychiatrists’ appointments;

• There are fewer preventable visits to the emergency department by mental health patients;

• Each appropriate referral is given an appointment and no one gets missed;

• It’s a more efficient use of staff and physician resources.

Ultimately, the entire mental health team at Rouge Valley has put the patient first in this process.