Having had the fortunate luck to have worked on a wide variety of projects, all of which have been focused on delivering improvements in the cost, quality, and performance of care, I am in the privileged position to share some great ways that organisations can make significant improvements in the way they work.
One of my favourite projects early on in my career was with a mental health trust in the North. This was with an organisation that was heavily reliant on the provision of out of area beds (this is where, due to the lack of beds within the Trust, patients requiring a mental health acute ward are sent to privately provided beds that are often very far from where they live, at a very high financial cost to the NHS).
This is a common situation that many mental health Trusts still face. We believe the issue can be addressed by significant cultural and behavioural change. What does this mean in practice?
This means creating a real discharge culture, that can begin by:
1) Ensuring all patients have an estimated discharge date that is visible to all staff and is provided within a week of the patient being admitted. Doing so not only enables the countdown to discharge to begin, and helps clinicians know exactly what they are working to, but also manages the expectations of patients;
2) Clearly recording and identifying the barriers to discharge for each patient, with a regular reporting process that enables quick and easy escalation through the various levels of management.
3) Ensuring each patient has a clear, prescriptive care plan that has SMART (Specific, Measurable, Achievable, Realistic, Time based) goals that everyone in the provision of care can see and have access to at any point in time.
Getting started with the above can be helpful in beginning to change the culture at the frontline, and as we have seen, reap huge benefits for mental health organisations that provide acute care.