Major depression affects people of all ages and is one of the most common mental illnesses. Across Ontario there are significant gaps in the quality of care that people with major depression receive. Health Quality Ontario’s Quality Standard for Major Depression aims to fill these gaps with 12 Quality Statements that outline what quality care looks like.
As an QI Advisor for the Improving & Driving Excellence Across Sectors (IDEAS) Program, I have the pleasure of working with different health care teams as they embark on projects to improve the quality of health care in their organization through the Advanced Learning Program (ALP). This program is designed to equip health care professionals with the knowledge, skills and tools to lead quality improvement initiatives.
In 2018, the entire IDEAS ALP cohort, which consisted of 14 teams, used the Quality Standard for Major Depression as the basis for their quality improvement projects.
Below I’m pleased to share the work that two of the IDEAS ALP teams undertook to implement specific Quality Statements from the Major Depression Quality Standard in their organizations.
Lessons learned from William Osler Health System
William Osler Health System worked on implementing Quality Statement 12: Transitions in Care from the Major Depression Quality Standard. Their focus was to improve patient transition from William Osler Health System's Mood and Anxiety Adult Inpatient Unit to home, and to have consistent 7-day post discharge follow-up care.
Their ideas for improvement included:
- Increasing the use of the Ontario Telemedicine Network (OTN)
- Starting discharge planning earlier
- Improving documentation of patients’ community connections
- Improving communication between in-patient and out-patient Osler programs
- Having one psychiatrist keep open timeslots in their calendar to schedule follow-up appointments with patients who couldn’t be scheduled for an appointment elsewhere within 7-days post discharge
Team member Tina Smith Krans, Research Analyst at William Osler Health System shares:
“Staff have come up to me and stressed the importance of involving frontline staff in problem and solution identification because this results in positive buy-in. Small changes put in place meant that staff were able to adapt quicker and follow through with the new processes.
We have also learned that it’s an ongoing process. We continue to identify areas for improvement and put potential solutions in place. If an idea doesn’t work we adapt the process.
A key enabler is definitely that staff believes in the importance of the project to improve patient care and they were open to new ideas.”
Check out the project details here.
Lessons learned from University Health Network (UHN)
UHN worked on implementing Quality Statement 4: Treatment after Initial Diagnosis from the Major Depression Quality Standard. Their focus was to ensure patients with a PHQ-9 Depression Test Questionnaire score greater than 20 (high level of severity) at the time of their assessment were offered a treatment intervention of evidence-based psychotherapy or antidepressant medication within 7 days of their assessment.
Their ideas for improvement included:
- Involving both clinicians (psychologies, social workers) and psychiatrists in scheduling appointments. Clinicians offer bridge appointments if seeing the psychiatrist is not possible within 7 days
- Using a newly hired Mandarin speaking psychiatrist to provide consults to Asian patients with mental health conditions
- Having clinicians book earlier appointments facilitated by the use of interpretation services
Team member Judite Cadete, Clinician at UHN shares:
“[One enabler for this project was the] consistent use of the PHQ-9 as a clinical decision tool given to every new patient and then reviewed by the clinician. Staff became aware of scores higher than 20 and the implications in terms of prioritizing access to the psychiatrist and/or treatment.”
Check out the project details here.
Take home message
There is no “one size fits all” approach to improve care for patients with major depression. The IDEAS ALP teams were glad for the opportunity to pick and choose the Quality Statement and ideas for improvement that best suited their own local needs.
Congratulations to the entire cohort and all team members who completed projects!
Are you working with the Quality Standard for Major Depression to make improvements to health care in your organization? I encourage you to comment below!