Knowing the People Planning

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Knowing the People Planning

• Measuring to improve the quality of care for
  long-term mental health patients

International Forum on Quality and Safety in
Health Care Paris, 22-25 April 2008
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Knowing the People PlanningKPP

• Not rocket science
• Applied common sense
• A census of need costing nothing extra to compile
• Simple, anyone can do it
• Produces real information for action and results
• is very effective in improving the quality of
  care and treatment outcomes

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Knowing the People PlanningKPP

• Purpose and global changes
• How it works and grassroots results
• Customer Relations Theory and the difference KPP
  is making in New Zealand
• Some Feedback

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NZ mh individual patients yearly

• Total 100,000 (2.5 of NZs 4m population)

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NZ mh individual patients yearly

• Total 100,000 (2.5 of NZs 4m population)
• 14,000 attend once

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NZ mh individual patients yearly

• Total 100,000 (2.5 of NZs 4m population)
• 14,000 attend once
• 65,000 lt 1yr

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NZ mh individual patients yearly

• Total 100,000 (2.5 of NZs 4m population)
• 14,000 attend once
• 65,000 lt 1yr
• 6,000 lt 2yr

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NZ mh individual patients yearly

• Total 100,000 (2.5 of NZs 4m population)
• 14,000 attend once
• 65,000 lt 1yr
• 6,000 lt 2yr
• 15,000 gt 2yr

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NZ mh individual patients yearly

• gt 2 years 15,000
• 60 acute bed days
• 95 NGO social support

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KPP 10 Key Featureswe consulted patients and
clinicians

• Learn how to manage mental illness and get on
  with life
• Recognised as a person, not a statistic
• Accountability for consistent service provision
• Health and social needs addressed
• Mutual responsibility for staying in contact
• Personal Recovery Plan - leading to discharge
• Relapse Prevention Plan - stay well and reduce
  admissions
• Health needs - medications, primary care link
• Social needs - home and work
• Results evaluated to see if service is fit for
  purpose

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Nothing new? whats the difference?

KPP focuses on meeting a persons real
needs Helping to get patients jobs Not Stopping
at measuring their capability to work
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Recovery Plans

• KPP has identified importance of purposeful
  recovery plan

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Reduction in acute bed days
KPP
OTHERS

• 26 reduction in 8 KPP DHBs - KPP method
• All DHBs now reducing - KPP critique

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Discharge Rate

• KPP have higher discharge rates

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Knowing the People PlanningKPP

• Purpose and global changes
• How it works and grassroots results
• Customer Relations Theory and the difference KPP
  is making in New Zealand
• Some Feedback

16
KPP 10 Key Features

• Learn how to manage mental illness and get on
  with life
• Recognised as a person, not a statistic
• Accountability for consistent service provision
• Health and social needs addressed
• Mutual responsibility for continuous contact
• Personal Recovery Plan - leading to discharge
• Relapse Prevention Plan - stay well and reduce
  admissions
• Health needs - medications, primary care link
• Social needs - home and work
• Results evaluated to see if service is fit for
  purpose?
• Acute admissions in previous 12 months

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KPP Data the deliverables

• Consumer details
• Personal Recovery Plan - a purpose with a
  timetable
• Relapse Prevention Plan - staying well and out of
  hospital
• Medication - what suits that individual
• GP contact
• Home
• Work
• Acute admissions in previous 12 months

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Spreadsheet
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Spreadsheet Template
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Spreadsheet
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Spreadsheet

• A census of needs
• Easy to maintain
• Often compiled quarterly
• Easiest if up-dated daily
• Data objective and verifiable

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Results

• Caseload management improves too many patients
  retained for routine follow-up

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Caseworker Performance
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Results

• Caseload management improves too many consumers
  retained for follow-up
• Lack of resources not a problem
• Small numbers, bite size tasks, not endless,
  teeming worries
• Accommodation not a significant problem
• Most patients have GPs
• Funders more confident to finance packages of
  care

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Results

• Caseload management improves - many consumers
  retained for follow-up
• Lack of resources not a problem
• Small numbers, bite size tasks, not endless,
  teeming worries
• Accommodation not a significant problem
• Most clients have GPs
• Funders more confident to finance packages of
  care
• Thorough casework needed
• Too many have no Recovery Plan
• Too many have no Relapse Prevention Plan
• Too few have jobs

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Results

• KPP plans things to do for real people
• Traditional plans things to buy for normative
  populations
• KPP gives a record of caseworker performance
• KPP ensures outcomes are related to treatment
• KPP is non-expert, no cost, fast, accurate
• KPP is flexible but important to keep data
  collection simple
• KPP measures results

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Knowing the People PlanningKPP

• Purpose and global changes
• How it works and grassroots results
• Customer Relations Theory and the difference KPP
  is making in New Zealand
• Some Feedback

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• It is not possible to learn without measuring
• but it is possible - and very wasteful -
• to measure without learning
• Donald M Berwick
• July 1998

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Customer Relations Management and KPP

• Customer strategy - people the unit of
  measurement
• Dual value - negotiated plan with role for
  patient as well as clinician plans and outcomes
  known to management
• Multi-service integration - plans include all
  service elements
• Information management - KPP spreadsheet
• Performance assessment - KPP annual plan

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Customer Relations Management and KPP

• All eyes on outcomes for customers/patients

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A Consumer Focus for All

• Patient
• No specified service
• Re-entry delays
• Some now have service specified
• All should know of Health Target for Relapse
  Plans
• Recovery Plan for every consumer
• With a copy for every consumer

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A Consumer Focus for All

• Caseworker
• Supervision of consumers risk management
• Service given at personal discretion
• Some know what is expected
• Can give account of their work
• Can organise support for consumers
• Job specification
• Job training

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A Consumer Focus for All

• Team Leader
• Maintain team relations
• Team management optional
• Can measure caseworker performance
• Manages caseload
• Can organise support for consumers
• Job specification
• Job training

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A Consumer Focus for All

• Service Manager
• Obtain resources
• Influence staff relations
• Manage inter-team performance in acute care
• Measure value to consumers and staff
• Arranges support for consumers
• From administration to management
• Job specification
• Job training

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A Consumer Focus for All

• Funding
• Ration scarce resources
• Cost and volume contracts
• Measure demand
• Provide personal packages of care
• Job specification
• Job training

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A Consumer Focus for All

• Planning
• Norms, ratios, service models
• Plans based on purchased facilities
• Vapid strategic plans
• Little change yet
• Annual plans to address current demand
• Strategic plans based on changes in clientele

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A Consumer Focus for All

• Ministry of Health
• Receive expert advice
• Obtain/allocate resources
• Influence field by promulgating advice
• No lack of funds
• Organising to improve performance
• Health target reporting
• Review all activities to retain only those with
  direct consumer benefit

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A Consumer Focus for All

• Minister of Health
• Deals with issues and events serially
• Clarity about purpose of services, reasons for
  and results of Health Targets
• Grasp of service contribution
• Manage public response to rare but notorious
  events

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A Consumer Focus for All

• Public
• Services in disarray
• Insatiable demand
• Inadequate resource
• Poor risk management
• Less call for return to long-stay hospitals
• Information programme all to do

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A Consumer Focus for All

• Public and Politicians
• All people with mental illness potentially
  violent and to be locked away
• More humane not to lock them away.but
• Some suicide and homicide to be expected, with or
  without hospitals it is inevitable. See what can
  be learned from every event

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Knowing the People PlanningKPP

• Purpose and global changes
• How it works and grassroots results
• Customer Relations Theory and the difference KPP
  has made in New Zealand
• Some Feedback

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A Psychiatrists Feedback

• I am writing in all seriousness to describe
  my concern about his presentation, and that
  appearing as a guest lecturer in this course may
  seem to validate his message. His research is
  gravely flawed and his interpretations even more
  so. He may achieve some effect with the less
  knowledgeable or in small DHBs who do not have
  any analysts. But essentially he is either a con
  man, riding on the back of the recovery
  principles etc, or else he lacks insight and/or
  is so arrogant that he actually believes his own
  rhetoric. I am shocked that an academic
  department gives him air time.

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A Professors Feedback

• ...I believe the changing of my mind was to
  do with the focus on the proper management of
  information within the system.  It links  with a
  number of other things we are doing in the Health
  Informatics area and in disease/disability
  management.
•  
•  

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A Consumers Feedback

• This is a eureka moment in data collecting
  that makes real tangible difference in people
  lives.
• Finally, a measure that relates to the
  needs of people  who find themselves perpetually
  using a system that records what doesnt matter
• Consumer Representative at National level

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Youll never get that accepted, it makes too
much sense.
said by an elderly, and wise dad at an
Schizophrenia Fellowship meeting in Christchurch
the night after we invented the idea.....
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Knowing the People PlanningKPP

• Not rocket science
• Applied common sense
• A census of need costing nothing extra to compile
• Simple, anyone can do it
• Produces real information to drive action and
  results
• is very effective in improving the quality of
  care and treatment outcomes

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An MA for KPP!.and better results for her
patients