Mental Health Association (CMHA) in Sudbury Manitoulin manages a
Clinical Case Management program that supports
individuals to identify and progress towards goals in their living, working,
learning, and/or social environments. Historically, individuals referred to
CMHA-Sudbury/ Manitoulin waited almost 2 years to access service. Once
initiated, some individuals remained supported by case management services for
several years as they worked towards their recovery goals.
demands for CMHA-Sudbury/Manitoulin’s Clinical Case Management program further
increased when Health Sciences North, the hospital network in Greater Sudbury
and CMHA-S/M, redesigned their referral process into a centralized intake model
for several community-based mental health services. To accommodate the increase in demand, CMHA
removed the cap on their wait list, which then grew significantly, almost
Quality Ontario had a chance to catch up with Sue Tassé, Manager of Clinical
Services, Stephanie Lefebvre, Manager of Quality and Strategic Engagement, and
Ahmed Ejaz, Quality Improvement Coordinator to learn how their team was able to
respond to the increased demand and significantly reduce wait times.
How did you go
about decreasing your wait times?
a root cause analysis to determine the key factors contributing to our long
wait times, which was of utmost importance given the recent significant
increase in our wait list.
that we didn’t have clear admission and discharge processes for our program and
that many individuals did not have a clearly established care pathway towards
their recovery goals. After shadowing staff, we saw that work flow wasn’t
standardized. Based on our findings, we went about changing the delivery of
care across the entire work flow.
our current wait list:
We put some
effort into updating our current wait list by connecting with referred
individuals and asking if services were still wanted or needed. We made sure that these individuals were
still motivated to participate in case management services and supports.
care expectations with individuals:
Based on our
Ontario Perception of Care (OPOC) survey results and feedback from our
referring organizations, we knew that many individuals were dissatisfied with
how long it took to receive services and reach recovery goals.
Now, we help
individuals understand from the start of the care episode that this is a
time-sensitive pathway meant to help them reach their goals. We have
prioritized use of the Ontario Common Assessment of Need (OCAN) to define
concrete goals and create care plans, which creates a clearer care path for
individuals. The OCAN gets repeated at routine intervals to see if care needs change.
With our new
processes, more often than not, goals are met, and individuals are discharged
in a timely way. There is no time limit on the care provided to individuals,
but our aim is to help them to achieve their goals in a timely and efficient
standardized operating procedures:
our standard operating procedures, including options for the provision of
support within both office and community settings, our process for rescheduling
missed or cancelled appointments, and how we're managing coverage for staff who
are sick or on leave. Creating a shared
understanding at a branch level meant we were able to better shift services to
meet the needs of those we support.
standardized work flow, case managers had more time to dedicate to client care.
Through incremental changes, completed through Plan-Do-Study-Act cycles, our
staff’s caseload increased slowly from 25 clients to 30 and then to 35 clients
a collaborative care model:
impactful change was moving from a case ownership model to a collaborative team
looks very much like a walk-in clinic.
Although individuals have primary case managers, they are able to come
and see any staff member, which eliminates the wait that could occur when one
staff member is assigned to handle all the care needs of a particular
managers have access to client records, including updates and progress notes,
within our Electronic Client Record Management System. This has been a critical
element of an effective collaborative model.
“With our collaborative team model, service delivery is not disrupted
for our individuals. We’ve shifted our practice to make sure individuals can
continue their journey.”
been your results?
February 2019, our wait time has been zero days and this has been sustained.
Our two year wait list has been eliminated.
Did you face
We found that
some staff were concerned that the collaborative care model would hinder the
personalized care they could provide to individuals. Instead of trying to change hearts and minds,
we started with a pilot group of new and existing staff members willing to try
the new model.
pilot group, we implemented a client survey to determine if and how the quality
of care was being impacted within the new model. Overall, individuals reported continued
satisfaction with case management supports and appreciated the availability of
From a more
practical standpoint, we wanted staff to feel like this was their project. We put up a huddle board in an accessible
location within the team office space and included the project charter,
baseline graphs, the fishbone diagram and the problem statement. Staff were
able to add their own change ideas, which created a team drive to support
implementation. We added a space for
staff to include some data, such as adding the number of appointments completed
per day, beside their name.
Image: Huddle board for staff
over the full course of implementation of our new care model, staff turnover
has been high. However, as new staff are
onboarded, we’ve been able to orient them to the new standardized operating
procedures and instill the collaborative team approach right from the
would you give to another organization about a similar project?
presented our project at the CMHA Ontario conference. Many organizations have looked at the
literature that theoretically supports the collaborative care model, however,
we have been able to show the improvement and outcomes that come from
Our advice is
to start with a clearly defined problem.
Spend time on this to ensure you’re addressing the right issues. Implement slowly with small steps, because
you can’t boil the ocean! Finally, ensure you’re working alongside with your
staff. They are key to making change happen.