Posted on: 19 December 2024
What originally began in the Kensington and Chelsea (K&C) Child and Adolescent Mental Health Service (CAMHS), has now been scaling up and spreading through other teams in London and Milton Keynes. Award winning innovations were developed during the CNWL Improvement Collaborative 2021/22, and the average time taken for each new assessment was reduced from 6 hours 15 minutes to 4 hours (a 30% reduction!) – you can read more about the initial journey here. Because of its success in K & C CAMHS, there was a need to test broader applicability and impact, and to understand system and infrastructure issues that might arise. Therefore, in September 2023, the Happy Doc “Adoptathon” was launched.
Whilst K&C CAMHS continued to sustain and spread their improvement work, other teams (across sites in Milton Keynes, Westminster and Harrow) joined in to adopt and adapt successful initiatives into their own services. This diversity of teams allowed testing and adaptation across very different localities, differently focussed sub-teams (such as extending to Neurodevelopmental Team in Harrow) and brought together the London CAMHS Teams with the Milton Keynes CAMHS Team into collaborative working.
Teams from London and Milton Keynes needed to test the application of previously efficacious change ideas from K&C CAMHS to see if it would also reduce the time resource used to complete clinical assessments. Three change ideas were implemented across the new test sites (although previously tested in K&C, there may be a difference in learning for the new teams). PDSA cycles were the following:
- Completion of a Medical and Developmental History form by families prior to assessment
- Use of the Happy Doc New Assessment Template with a Care Plan Letter that is automatically populated by System One
- Use of digital dictation software (dragon medical One or Microsoft Dictate)
Teams were also offered the opportunity to develop a ‘Wild Card’ – a final change idea which would reflect a locally driven focus for change. All of the teams had input from Experts by Experience.
The ‘Adoptathon’ is nearing completion early in 2025, and this has only been possible with the support of local teams, senior leaders and managers. It has progressed steadily and the programme has provided rich learning - bearing in mind that in any improvement work ‘Failure is Learning’. Our top learning takeaways so far:
Scale up takes much longer (probably closer to 16 months to complete the full program than earlier plans to complete testing in 4 months).
That the heterogeneity of local circumstances and processes means more time is needed for set-up and start – we learnt this one very quickly!
High enthusiasm from frontline teams spurred us into moving from one test site to 3 new sites, which may have probably been too big a jump for the first stage of scale up!
Staff from all teams continue to contribute to further improvement to the documents and have begun looking at how further mechanisation of electronic records could be used to free up time. EbE colleagues have given valuable feedback on what is important to families in relation to the care plan letters they receive.
In addition to the learning from the Adoptathon, staff have improved understanding of improvement methodology in a collaborative learning environment, helping them to feel empowered to participate in projects to improve care. Shared ideas and common experiences developed appreciation of the need to reduce unwarranted variation in processes between teams. Staff motivation and commitment to improvement meant that despite the challenges, engagement with the project and to succeed continued, trying where possible to make small changes that can bring BIG gains to all.
The programme updates are bought together during a monthly CAMHS Quality Improvement Forum (QIF) where teams share their learning with each other (what went well) and any areas for improvement (even better if).
EbE (Parent):
“Participating in the project gave me true insight into the care and time given to an evidence-based approach to not only therapies but the processing of our cases. All the teams were focussed on finding efficiencies that worked in their settings.”
Clinician 1:
“I think that the quality of my care plan was far higher using this method”
Clinician 2 on new Initial Assessment proforma:
“Amazing! Intuitive and supports clarity of thinking. Respectful of experience.”