Our services and teams in the Trust use the A3 as a structured problem-solving approach to deliver improvement projects.
Here are some examples of improvement projects.
Increasing the uptake of Physical Health Checks for Patients with Serious Mental Illnesses (SMIs)
National statistics show that people with a serious mental illness (SMI) are at greater risk of poor physical health, and have a higher premature mortality than the general population.
Our trust target of 60% compliance with annual physical health checks for these patients, on a Community Mental Health Team (CMHT) caseload less than 365 days, was not being met.
In June 2021, compliance for all 6 elements of the health check, including blood pressure, BMI, lipids, blood glucose, smoking and alcohol, was at 14% for the whole trust .
The Physical Health Team worked on this using QI methodology and the A3 with the CMHT across the county to better understand why compliance was at a low percentage, and create ideas to improve this.
The Physical Health Team have since provided more physical health checks through clinics and home visits. In April 2022, 79% of eligible patients have been offered all 6 elements of the health check with the appropriate interventions when results show these are needed. Those interventions include advice on reducing smoking, healthier eating and increasing activity as well as onward referral to a GP where there is a need, for example high blood pressure reading.
The team have continued to work on the uptake of these checks using QI methodology and aim to achieve an uptake of 95% over the next year.
This project aimed to identify the various health inequalities (both physical and mental) that exist among people who are diagnosed or suspected of living with neurodivergence.
By addressing these inequalities, we can continue to provide the right, outstanding service to all and support our staff in the best ways possible.
The project was split into three key workstreams;
1) Access to services
3) Training and Awareness.
Additionally, the Trust was identified as an NHS pilot site for the Oliver McGowan autism training with 5 sessions booked for September October which proved very popular.
Our Children, young people and families (CYPF) division undertook another A3 reviewing the ADHD Pathway, with the ultimate vision being to deliver ADHD assessment and treatment to CYPF in a way that is timely and clinically effective; minimising waste and maximising efficiency.
A project identified through the mother A3 was reducing time to initiate medication following ADHD diagnosis. Data illustrated almost 80% of C&YP who are assessed require medication, and approximately 50% have to wait longer than 50 days for this to be initiated.
The project objectives was to deliver a sustained reduction in waiting times for medication initiation following a diagnostic decision.
The project identified and tested serval countermeasures, (including protected time for assessment specific supervision that is co-ordinated between the prescriber & non-prescriber available on the same day as the assessment, and a clearly agreed process or rota for co-ordinating the protected time in advance in people's diaries etc.) The outcomes of PDSA testing showed; ADHD nurse received same day assessment specific supervision on 6/6 occasions.
Where medication was indicated, families were booked into the physical observation and medication clinics on the same day as they were given the diagnosis. All families received same day feedback about the outcome of the assessment including the opportunity to discuss next steps.
Work continues in the division and trust.