A quality improvement initiative in community mental health in the republic of Ireland
Background: Shared decision making principles underpinned a co-production Quality Improvement (QI) initiative between service users, family/carers and healthcare professionals in the south sector community mental health service in the Republic of Ireland. Aim: The aim of the present study was to improve the experience for new referral service users and for their families/carers. Method and Material: The Model for improvement guided the sequence of work. Change packages developed collaboratively, were tested through Plan Do Study Act cycles. Stakeholder groups developed measurement tools. Quantitative and qualitative approaches with small random samples generated measurement for improvement data. Mainstay team and executive sponsors agreed targets. Statistical Process Control charts and qualitative data showed variation in processes and if changes were leading to improvements. Results: Goals were staged over an 18 month period. By December 2012, ≥ 88% of service users rated positive statements of their experiences as 4 (agree) or 5 (strongly agree) on a Likert scale. This provided optimism in reaching the 95% July 2013 target. Service user narratives further evidenced the Positive impact of changes. Response rate to surveys to measure family/carers experiences were insufficient to draw conclusions. Conclusion: Successes included shared involvement of family/carers and service users at multi-system level, senior leadership engagement, application of an improvement methodology, external Advisor support, and high level stakeholder commitment. Unanticipated outcomes encompassed the standardisation of appointment processes. Principal lessons/implications for future QI activity include opportunities for family centred QI initiatives, and maintaining transparency and positivity throughout QI activity.
