Team Stripes – Enhancing teamwork and communication in the Hornsby Adult Mental Health Unit

The Adult Mental Health Unit is a 35-bed inpatient unit for consumers aged 18-65 years who are experiencing an acute episode of mental illness. Care is provided by a multidisciplinary team of clinicians, nursing, medical, allied health and pharmacy as well as non-clinicians, peer support workers and staff in administrative roles.

The case for change

The team described multidisciplinary team (MDT) communication processes which were unstructured and sometimes ad hoc. This contributed to consumer harm related to gaps in communication; time wasted chasing clinicians for updates and orders and overall led to poor staff morale.

What the team achieved

Improvements were made to MDT communication which were reflected in a decrease in the number of recommendations from serious incident reviews which related to communication. There was a positive increase (12%) in the number of staff who felt that they were active participants in consumer care. An inpatient recovery care eplan was developed which resulted in 100% of consumers having a completed care plan on admission and updated within a week. Documentation of consumer goals increased from 14% to 100% and carer goals increased from 11% to 100%.

How the change was achieved

The team used the Team Stripes framework, which starts with a 'discovery' phase, to gain an understanding of the current state of the unit. This phase included an examination of local data such as patient experience data as well as measurement of the unit safety culture using a validated tool. Key areas for improvement which evolved out of the 'discovery' phase were prioritised by the team.

Quality improvement (QI) science methodology was used to develop, test and implement changes. The team used a flowchart to examine communication touchpoints and to help identify gaps. A driver diagram was developed to help plan the changes. Run charts were used to monitor changes along the way.

Changes included; adjustments to the daily handover through a change in location, increased access to hardware and software and targeted education and mentoring.

There was an increased presence of leadership at the point-of-care through the introduction of executive rounding and increased transparency was achieved through more regular updates to staff, meetings are now held closer to where hands on care is delivered and team planning days were introduced.

Reward and recognition were prioritised through the feedback of compliments received and the introduction of an employee of the month award.

Members of the team spoke to us about their experience of the culture change initiative

What are the three things that have had the greatest impact on this work?

The opportunity for the Quality and Risk Manager to participate in the Mental Health Improvement Coach (MHIC) program helped with practical tips and tools to drive the work and coach the team. Also changing the location of MDT meetings meant that more people could attend and there were less interruptions. When we extended input access to the electronic patient journey board there was an improved flow of communication.

What do you think were your greatest enablers?

Having a clinical leader at the point-of-care to lead the change as well as someone a step back from the point-of-care to help with strategy and drive the work. Executive sponsorship was also important. For us, the CNC led the change and the Quality & Risk Manager provided coaching and support with using QI methodology. Also, we involved as many members of the MDT as possible in the various working parties and divided tasks amongst each group which ensured accountability.

Tell me about your experience of using the Team Stripes framework

The framework provided us with a structure and format for our interventions. It was helpful to have the 'discovery' phase summary report which included the aggregated data. Overall it provided a direction and plan which helped us keep to our goals.

If you were to do this all over again – what would you do differently?

We would start with fewer changes and have a more robust communication plan to keep the staff 'on the floor up-to-date and involved.

How would you describe the engagement with other team members from a multidisciplinary perspective?

Overall it was good but not all disciplines were able to find the time to commit to the work on a regular basis. In hindsight, for those disciplines who found it hard to attend, we could have invited multiple representatives to join the team.

Is there anything you would do differently to enhance this?

We would have an executive sponsor from medicine as well as other disciplines to help support MDT involvement.

Do you think you can apply the QI methodology that you've learned to other areas? How so?

Yes, everything that has been learned through the MHIC program is now used across the service and we now use the QIDS database more widely.

What tips would you give to others who are beginning a similar process?

Make sure you have an achievable aim statement and revisit it throughout the process to keep you on track. And ensure you have a committed team who participate in the change in practical ways.