Scotland's national approach to improving mental health services: integrated care pathways as tools for redesign and continuous quality improvement

Quality improvement (QI) approaches are becoming increasingly important in the delivery of mental healthcare internationally. They were originally developed in the manufacturing industry, but the principle of having a systematic approach to improvement has spread to many other industries, not least to healthcare. Quality improvement approaches in healthcare were pioneered in the USA at organisations such as Virginia Mason and the Institute for Healthcare Improvement. In recent years, they have become firmly established in mental health services in the UK's National Health Service (NHS). There are a number of different approaches to quality improvement, but two leading models have taken root: ‘lean thinking’ (also known as ‘lean methodology’ or simply ‘lean’), which arose out of Virginia Mason, and the ‘Model for Improvement’, which came out of the Institute of Healthcare Improvement. This article describes these two quality improvement approaches, critiques their philosophy and explores how they can apply in the provision of mental healthcare, particularly with reference to the use of data, evidence and metrics.

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Quality of mental health services: a self audit in the South Verona mental health service

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00004346 ◽

2006 ◽

Vol 15 (2) ◽

pp. 138-147 ◽

Cited By ~ 6

Author(s):

Liliana Allevi ◽

Giovanni Salvi ◽

Mirella Ruggeri

Keyword(s):

Mental Health ◽

Mental Health Service ◽

Mental Health Services ◽

Community Mental Health ◽

Health Service ◽

Health Services ◽

Community Mental Health Services ◽

Community Mental Health Service ◽

Continuous Quality ◽

One Year

SUMMARYAims – To start a process of Continuous Quality Improvement (CQI) in an Italian Community Mental Health Service by using a quality assurance questionnaire in a self audit exercise. Methods – The questionnaire was administered to 14 key workers and clinical managers with different roles and seniority. One senior manager's evaluation was used as a benchmark for all the others. Changes were introduced in the service practice according to what emerged from the evaluation. Meetings were scheduled to monitor those changes and renew the CQI process. Results – There was a wide difference in the key workers' answers. Overall, the senior manager's evaluation was on the 60th percentile of the distribution of the other evaluations. Those areas that required prompt intervention were risk management, personnel development, and CQI. The CQI process was followed up for one year: some interventions were carried out to change the practice of the service. Conclusions – A self audit exercise in Community Mental Health Services was both feasible and useful. The CQI process was easier to start than to carry on over the long term.

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Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services

BJPsych Advances ◽

10.1192/bja.2020.3 ◽

2020 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Derek K. Tracy ◽

Frank Holloway ◽

Kara Hanson ◽

Nikita Kanani ◽

Matthew Trainer ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Integrated Care ◽

Healthcare Delivery ◽

Local Implementation ◽

The Past ◽

Care Systems

SUMMARY Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.

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Variability of clinical and managerial decisions in mental health services of Region Lombardia: the vignette method

Epidemiologia e Psichiatria Sociale ◽

10.1017/s1121189x00008630 ◽

1997 ◽

Vol 6 (1) ◽

pp. 48-58 ◽

Cited By ~ 2

Author(s):

Giuseppe Biffi ◽

Giuseppe Cuttitta ◽

Roberto Bezzi ◽

Germana Magnani ◽

Daniele Piacentini ◽

...

Keyword(s):

Mental Health ◽

Mental Health Services ◽

Health Services ◽

Clinical Epidemiology ◽

Continuous Training ◽

Managerial Decisions ◽

Continuous Quality ◽

The Family ◽

Quality Assurance Project ◽

Good Agreement

SUMMARYThis paper concerns one of the four research projects developed during a training course in clinical epidemiology managed by the Lombardy training centers IREF. Objectives — To compare the recommandations for treatment concerning 9 vignettes derived from the Australian Quality Assurance Project. Setting — Six Mental Health Services of Regione Lombardia. Design and Participants — For each vignette, all psychiatrists working in the 6 Mental Health Services were asked to fill in a questionnaire about treatment location, psychopharmacology, psychotheraphy, priority between psychotherapy and psychopharmacology and degree of difficulty in answering. Results — 44 out of 52 target psychiatrists took part to the study. Remarkable variability for treatment location and psychotherapies; moderate variation for psychodrugs prescriptions and a good agreement for diagnoses were observed. In drugs prescription an eccess of association was observed. The most prevalent model of psychotherapy was the psychodynamic, followed by the cognitivebehavioural and the family-systemic. There was a tendency toward a flexible approach, as suggested by recommendations of different psychotherapeutic models according to the nature of the disorder. No case were judged very difficult; only in 3 cases a judgement of «somewhat difficult» was expressed by more than 20% (but less than 30%) of the psychiatrists. Conclusions — Studies of this type are very easy to carry out and give useful information for continuous training programs and Continuous Quality Improvement projects.

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