This post is part of a series about how quality standards can be used to support quality improvement together with others who are working on adopting the quality standards. The introductory post can be found here.
At Hawkesbury and District General Hospital, we run a psychiatry program for clients aged 16-years old and over. Most of our referrals come in from family physicians in the area. About a year ago, faced with an increasing demand for service, we decided to restructure our psychiatry program in order to reduce wait times and increase efficiency. We were also seeking a more standardized approach that our psychiatrists could use to guide their clinical and documenting processes.
In an effort to standardize how psychiatrists provide care, we thought that a pathway, or some sort of checklist, would be helpful to ensure providers were properly completing all the required stages of service provision and facilitate client flow through the program. We came up with a model that includes three stages:
- Rapid access to psychiatry (quick intervention, assessment and some stabilization);
- Treatment and Rehabilitation;
- Liaison (i.e., returning client to Primary Care).
We were really happy when I learned about HQO’s Mental Health Quality Standards. Finally we had some standards to which we could refer to in mental health. We use these standards to set up specific program goals. They also help us focus our attention onto the right questions to ask to improve quality of care.
We had already developed a first draft of our pathways when we were introduced to the standards, so we circulated the document (we mainly used the Major Depression Quality Standard) amongst our team and set up some implementation meetings to review them. We used each quality statement to validate and check that the timescales and processes included in our pathways aligned with those outlined in the quality standard and that we were not missing anything essential.
We believe better coordination between the Primary Care sector and our program is critical to be more efficient and achieve better health outcomes. For example, we would benefit if certain triage scales and treatment trials were completed within Primary Care and communicated to our team during the referral process. We also identified the need to better coordinate access to psychotherapy (Quality Statement # 4) for clients followed in primary care. With this in mind, we applied to the IDEAS program as there is a cohort that will be specifically working with the Major Depression Quality Standard; we hope this project through the IDEAS initiative will work as a lever to better integrate our work with Primary Care. Looking forward to hearing about other quality improvement initiatives related to major depression or mental health!