Second Edition Miranda Wolpert, Rita Harris, Sally Hodges, Peter Fuggle
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25 PERFORMANCE MANAGEMENT, QUALITY IMPROVEMENT AND THE THRIVE MODEL We propose employing the MINDFUL approach to performance management (Wolpert, Deighton, et al., 2014) alongside the THRIVE model. This involves the consideration of multiple perspectives, interpretation focused on negative differences and use of directed discussions. Funnel plots should be used as a starting point to consider outliers, always keeping in mind an appreciation of uncertainty with learning collaborations of clinicians, commissioners and service users supporting data analyses. This would require a seven-step process to be applied separately to each of the five groups of need or choice included in the THRIVE model, with the relevant lead funder/commissioner for each leading on the review. 1. At regular time periods e.g. in line with contract or commissioning intentions, commissioners, providers and service user representatives would jointly agree high-level key quality indicators in areas of weakness relating to that particular aspect of THRIVE, using a mix of process and outcome measures (based on CORC annual reports and/or other sources of information): • Thriving - e.g. community indicators of emotional wellbeing • Getting advice - e.g. access to online support/levels of resilience • Getting help - e.g. access to NICE interventions/levels of recovery or reliable change • Getting more help - e.g. length of inpatient stay/functioning • Getting risk support - e.g. response to A&E admissions/management of crises 2. Data about children and families involved, activities and outcomes would be collected routinely to help shape service provision. Measures and approaches to support this would be tailored to each element of the THRIVE model: • Thriving - e.g. to include measures of self-assessed wellbeing • Getting advice - e.g. to include measures of resilience • Getting help - e.g. to include measures of symptom change • Getting more help - e.g. to include measures of impact on life • Getting risk support - e.g. to include measures of risk management 3. Leads for each area of provision would collate information relevant to the KPIs regularly (e.g. monthly) and feed this information back to staff. Data will be considered relative to others involved in similar THRIVE activity using appropriate statistical analyses. 4. Where there is information that suggests outcomes or activities that vary significantly from others in a negative way, then that group of staff will be supported to explore if variation is warranted. 5. These explorations should include directed discussions in which the team are invited to consider, if these differences were unwarranted, what they would do differently using the MINDFUL approach. 6. Staff groups are encouraged to trial improvements aimed at addressing unwarranted variation and enhancing service quality. This may involve the use of statistical process control methodology, such as run charts, to consider and review improvements and impact on patient care, and use of plan, do, study, act (PDSA) cycles (see figure 5) and learning sets.
26 7. Quarterly meetings of users, commissioners and providers will review progress against KPIs for each of the elements of the THRIVE model separately, spreading any learning and improvements across the service. 8. Annual review of the whole system to enable any relevant adjustments to be made to contracts or specifications. Act • What changes are to be made? • Next cycle? Plan
• Objective • Predictions • Plan to carry out the cycle (who, what, where, when) • Plan for data collection Do • Carry out the plan • Document observations • Record data Study • Analyse data to predictions • Summarise what was learned Figure 5: PDSA cycle 27 CONCLUSION The THRIVE model offers a way forward for child and adolescent mental health provision. Distinguishing different groups in terms of their needs and/or choices enables: • greater clarity about agency leadership • greater clarity on skill mix required • potential for more targeted funding • potential for more transparent discussion between providers and users • options for more targeted performance management • options for more targeted quality improvement • alignment with emerging payment systems • alignment with best practice in child mental health To reiterate, we are not presenting THRIVE as a tried-and-tested one-size-fits-all implementation model, nor is the language and terminology for different groups fixed at this point. Whilst AFC and Tavistock do have thoughts on implementation in particular contexts, this paper does not purport to be a how-to guide. Rather, we are sharing our developing thinking at this point to contribute to current national debate because we feel that this may help form a way forward for future provision across a range of sectors (health, education and social care). We hope that the thinking underpinning this model may become embedded across the UK and beyond to point the way forward for child and adolescent health promotion, intervention and support in the years ahead. 28 REFERENCES Bevington, D., Fuggle, P., Fonagy, P., Target, M., & Asen, E. (2013). Innovations in Practice: Adolescent Mentalization-Based Integrative Therapy (AMBIT) – a new integrated approach to working with the most hard to reach adolescents with severe complex mental health needs. Child and Adolescent Mental Health, 18(1), 46-51. doi: 10.1111/j.1475-3588.2012.00666.x Bickman, L., Kelley, S. D., Breda, C., de Andrade, A. R., & Riemer, M. (2011). 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BMJ Quality & Safety, 23(4), 272-276. doi: 10.1136/bmjqs-2013-002557 Wolpert, M., Harris, R., Jones, M., Hodges, S., Fuggle, P., James, R., … Fonagy, P. (2014). THRIVE: The AFC-Tavistock model for CAMHS. London: CAMHS Press. Wolpert, M., Harris, R., Hodges, S., Fuggle, P., James, R., Wiener, A., … Fonagy, P. (2015). THRIVE Elaborated. London: CAMHS Press. Wolpert, M., Vostanis, P., Young, S., Clark, B., Davies, R., Fleming, I., … Whale, A. (2015). Child and Adolescent Mental Health Services Payment System Project: Final Report. London: CAMHS Press. Wong, N., Kady, L., Mewton, L., Sunderland, M., & Andrews, G. (2014). Preventing anxiety and depression in adolescents: A randomised controlled trial of two school based internet-delivered cognitive behavioural therapy programmes. Internet Interventions, 1(2), 90-94. doi: 10.1016/j.invent.2014.05.004 World Health Organisation. (2012). Caring for children and adolescents with mental disorders. Setting WHO directions. Retrieved from http://www.who.int/mental_health/media/en/785.pdf York, A, & Kingsbury, S. (2013). The Choice and Partnership Approach: a service transformation model. Surrey: CAPA Systems Limited. YoungMinds. (2013). Local authorities and CAMHS budgets 2012/2013. Retrieved from http://www.youngminds.org.uk/assets/0000/6845/CAMHS_2012.13_briefing_local_authorities.doc 31 APPENDIX 1: CURRENT VIEW TOOL CAMHS Press is the publishing arm of the Evidence Based Practice Unit (EBPU), based at the Anna Freud National Centre for Children and Families. CAMHS Press brings you academic research and mental health practice in support of children, young people and mental health practitioners, through booklets, leaflets and other publications. CAMHS Press publications are free of charge. CAMHS Press is proud to work with frontline practitioners, service users and policy makers to share knowledge and information, and is committed to serving its readers. www.ucl.ac.uk/EBPU ISBN 978-0-9933436-4-3 Yüklə 1,66 Mb. Dostları ilə paylaş:
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