Source: Health Quality and Safety Commission
Kia ora and welcome to this update from the mental health and addiction (MHA) quality improvement programme | Whakapai i ngā mahi hauora hinengaro waranga hoki. This update focuses on the programme approach to the end of June 2022. Thank you for your ongoing support of the programme.
Summary
In consultation with the MHA leadership group, the Māori advisory group and the consumer advisory group, the MHA quality improvement programme team has identified several next steps.
The programme is currently made up of five priorities. The focus to date has been on the first three priorities, and attention is now turning to the final two – ‘Maximising physical health’ and ‘Improving medication management and prescribing’. Work will also continue on the ‘Zero seclusion’ project. The ‘Connecting care’ and ‘Learning from adverse events and consumer, family and whānau experience’ projects will be transitioned back to district health boards (DHBs) as planned, with some ongoing support from the Commission’s MHA quality improvement programme team.
The table below shows the high-level approach for each priority area, with more detail provided later in this update.
| Zero seclusion |
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| Connecting care: improving service transitions |
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| Learning from adverse events and consumer, family and whānau experience |
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| Maximising physical health |
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| Improving medication management and prescribing |
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In more detail
Zero seclusion: safety and dignity for all | Aukatia te noho punanga: noho haumanu, tū rangatira mō te tokomaha
The name of the Zero seclusion project has been updated. The updated name captures the importance of safety for the consumer, staff and whānau. It speaks of the need to ensure the dignity and mana of the consumer is preserved, including mana motuhake (self-determination), wherever possible, as is our obligation under Te Tiriti o Waitangi. It has been developed with input from our leadership group, Māori advisory group, consumer advisory group and sector representatives. The te reo name has been given by Ahuahu Kaunuku, the Commission’s Māori health outcomes team.
Eliminating seclusion is a challenging area and some good progress has been made. The most recent data (November 2020) has signals of positive change. There is a downward trend in national data for duration of seclusion in DHB mental health units, including for Māori and Pacific consumers. Ten DHBs have seen signals of improvement in a particular unit and indicator/population or have at times reached zero seclusion.
In consultation with our leadership group, Māori advisory group and consumer advisory group, we are planning for the project in 2021/22 and will be able to share more detail soon. Our focus areas include:
- working with the sector, considering the approach to Zero seclusion aims – this could include aims nominated by each DHB, a national aim, or both. We will continue to seek feedback and update the sector on this work
- developing a plan to best use the skills of our Zero seclusion champions’ group
- undertaking a series of visits to DHB senior management and senior MHA clinicians to discuss seclusion and the programme in general.
Connecting care: improving service transitions | Te tūhono i ngā manaakitanga: te whakapai ake i ngā whakawhitinga ratonga
This project was planned to run from August 2018 to December 2019, but was extended to June 2020, at the request of DHBs. The timeline was then further extended to October 2020 in response to COVID-19-related constraints. Now that this extension period has ended, the project will begin to be transitioned to DHBs, with some support from the MHA quality improvement programme team continuing.
The team will:
- monitor community follow-up within first seven days of mental health inpatient discharge data, and provide support to DHB project teams as required
- develop at least two videos illustrating a consumer’s lived experience during service transitions, as part of the ‘Pono’ consumer video series we are developing for the different projects
- develop a transition report, which will include national outcome data (including for Māori and Pacific peoples as available) and the most important learnings from the project
- undertake interactive networking sessions via Zoom, driven by project teams, to enable project teams to network and share successes and challenges
- continue to profile Connecting care project work and achievements.
Learning from adverse events and consumer, family and whānau experience | Te ako mai i nga pamamae taumaha me te wheako tangata whaiora me te whānau
This project was planned to run from September 2019 to July 2020, with preliminary workshops held with the MHA sector in March and June 2019, but was extended to November 2020, at the request of DHBs. Now this extension period has ended, the project will begin to transition to DHBs, with some support from the MHA quality improvement programme team continuing.
The team will:
- provide support to project teams on conducting adverse event reviews differently, including templates and tools, as outputs from the time-limited working group established as part of this project
- coordinate a networking event for project teams in mid-2021
- work with a small number of project teams to further explore the restorative practice approach as phase 2 of this project
- provide MHA-focused adverse event education, introducing the learning review methodology
- support project teams on a case-by-case basis as requested or in response to data outcomes
- develop at least two videos illustrating a consumer or whānau member’s lived experience during an adverse event process, as part of the ‘Pono’ consumer video series.
Final two priority areas
The final two priority areas for the national MHA quality improvement programme – ‘Improving medication management and prescribing’ and ‘Maximising physical health’ – were due to begin in early 2021. However, because of the impact of the COVID-19 response and feedback from the MHA sector about current workload, we will be taking a different approach to the end of June 2022.
Maximising physical health | Te whakanui ake i te hauora ā-tinana
We will work with Te Pou on this priority area to define a specific project or projects that are informed by the evidence generated in the existing Equally Well collaborative, and which would benefit from a quality improvement approach. A group will be convened to scope the best topic to choose, using criteria such as impact on equity, ability to measure change and outcomes (data availability), potential to show change in a short timeframe, and transferable learnings. That group will include consumer and Māori representation, and representatives from the Commission’s MHA leadership group, primary care and non-governmental organisations, the Equally Well collaborative, Te Pou and the Commission.
At the start of 2022, we will start to scope a more comprehensive approach to Maximising physical health for the next three years (providing further MHA quality improvement programme funding is secured). This is likely to comprise a series of projects.
Improving medication management | Te whakapai ake i te whakahaere rongoā, i te tūtohu rongoā hoki
Rather than start a specific project now, we will begin a comprehensive scoping of this priority area to be certain our approach makes the most difference for people who use MHA services and is supported by the sector. A comprehensive quality improvement project will then be developed, and implementation will begin in early 2022, continuing for several years (providing further programme funding is secured).
No smaller project in the medication management and prescribing area will be undertaken in 2021.
Comings and goings
The MHA quality improvement programme team is pleased to welcome Deirdre Maxwell, Karl Wairama and Amy O’Connell.
Deirdre is our new senior programme manager and will be starting on Monday 3 May. Currently, Deirdre is the general manager for the Northern Regional Cancer & Blood Service at Auckland DHB and has held this role since 2015.
As you may know, Roz Sorenson, our programme manager and manager of the Zero seclusion project, left the Commission at the end of December 2020. Roz was with us for four years and was instrumental in leading the team that has planned for and is now implementing the Commission’s MHA quality improvement programme.
Karl Wairama is our new project manager for Zero seclusion, and Amy O’Connell joins us as a data analyst. Karl comes to us from the Hawke’s Bay Civil Defence emergency management group, where he was team leader, community engagement. Before that he was project manager at Te Taiwhenua o Heretaunga in Hastings, where he created and ran programmes with youth, with a focus on mental health
Amy joins us from Victoria University of Wellington, where she graduated with a Master of Science in cognitive and behavioural neuroscience, with a research background in behavioural psychology.
