Morningstar Centre is a 43-bed non-medical withdrawal unit managed by the Lake of the Woods District Hospital in Kenora Rainy River in northwestern Ontario. The Centre serves a large district that includes various small and remote rural towns.
Clients can be formally referred to the Centre from one of three streams: The Lake of the Woods District Hospital’s emergency department, the justice system, and community service providers in the district. Individuals can also self-refer or be referred by a peer, family member or friend.
Morningstar Centre is part of a Network in the region composed of leadership representatives from 40 different agencies and organizations. The Network looks at how client services can be optimized given the resources in place and the geographical barriers that exist.
A number of stakeholders in the Network have recognized the need to prioritize referrals from community service providers in the district to ensure clients who require immediate addiction detoxification receive withdrawal management services.
To understand and improve upon the referral process from community service providers, the Network set out to complete a quality improvement (QI) project with coaching from the E-QIP team.
Health Quality Ontario had a chance to catch up with Sara Dias, Executive Director of CMHA Kenora Branch, Patti Dryden-Holmstrom, Morningstar Centre Manager, Bruce Siciliano Vice President of the Mental Health & Addictions Programs at Lake of the Woods Hospital, and Alex Clement, QI Coach with EQIP, to find out more.
What were your first steps?
Our first step was to try to determine the barriers that currently exist for community service providers to refer to Morningstar Centre. One strategy we used was to develop a survey for Network members to provide feedback about the current referral process.
The survey revealed that community service providers find the referral package unclear and the referral process unstandardized. The survey also identified that Morningstar Centre is perceived to be unwelcoming to some demographic groups, particularly those that do not identify as living in poverty or being homeless. Clients from small towns that don't connect to the new bus route along the main highways find it difficult to travel to the Centre and some live as far as 3 hours away.
We also wanted to quantify the number of referrals initiated by community service providers. Our data system currently does not capture our referral source data in the detail we need.
We worked with CMHA in Kenora, which is one of the community service providers that can refer to Morningstar Centre. The CMHA is now collecting data by tracking referrals to Morningstar Centre to identify the barriers that arise during the patient journey.
Collecting data was an important first step to start making sense of a very complex environment and determine the root causes at play.
What adds to the complex environment is that the basket of services in the district often fluctuates and there are confusing and overlapping pathways to access programs district-wide. We had started a mapping exercise with the North West LHIN and hope that we can continue to engage at the systems level to map out the full spectrum of services that facilitate the continuum of care for patients.
How did you begin to address the barriers that you identified?
One of our main strategies is to provide education to community service providers across the district about the changes to the Morningstar Centre that we're working on. For example, our referral package is being redrafted to make it clearer and easier to use. We’ll then promote the referral package so that all community service providers are aware.
Since Morningstar Centre is perceived to be unwelcoming to some demographic groups, we'd like to have community service providers visit and become reacquainted with the environment. We have become a more welcoming place with the help of patient input.
As mentioned, we are still in the data collection phase and are working with CMHA in Kenora as a “pilot” to understand the referral process and the patient journey.
We are working towards defining our baseline and are still engaged in the coaching program offered by E-QIP.
What are your biggest lessons learned so far?
Having withdrawal management services available to those most in need is very important and is the driver for this work. The other closest withdrawal management service is in Dryden and it has been temporarily closed, so it’s more important than ever to remove any real and/or perceived barriers to accessing our service.
What we’ve learned is that data is so important to understand the complexities in the mental health sector. That’s why we took the time to collect survey and referral data to fully understand the barriers. We also completed a root cause analysis and process map facilitated by our E-QIP coach. We’ll also collect ongoing data by working with one of our community service providers.
We’ve learned that working in partnership is essential and it takes time to understand each other’s perspectives and challenges. Having support and guidance through the E-QIP program has started us on the journey towards success.