1. There is NO magic bullet! (The TDHB journey to good collection compliance) Graham Donlon Outcomes & Clinical Information Projects Officer Mental Health Taranaki District Health Board

2. Taranaki – where is it?

3. Taranaki background: Taranaki is a rural, comparatively isolated area Population 108,100 (June 2009 estimate) Major Industries: Farming, Energy, Tourism Winner of several ‘Most liveable’ city awards Gorgeous parks, gardens and walkways Taranaki is a rich in the arts + culture Cosmopolitan café culture Surf and ski Fishing and hunting Sports/fitness

4. Context: At the time of writing, Taranaki District Health Board has one of the best outcomes collection compliance rates in New Zealand However Compliance could always be better Good compliance does not equate with good quality data! We still have a long way to go...

6. Taranaki inpatient compliance

7. TDHB Community compliance

8. Why this sudden climb in collection compliance? The ‘Carrot’ Line managers nominated staff who were diligent in staying on top of their HoNOS collection or those staff who supported others to do so - awarded ‘Star Performer’ certificates. Also, those who made a huge effort to get on top of overdue forms were recognised The ‘Stick’ Memo circulated to all staff stating that overdue HoNOS tasks would be performance managed Staff realisation “It’s not going away, so I may as well get on with it!” (start collecting) Hard work To be covered soon.

9. Other factors that influenced compliance: Resourcing: Outcomes coordinator position is 1FTE. Enables more ‘hands on’ support. ‘Go-to’ person both within and outside DHB High coordinator profile: Coordinator is well-known to clinical staff, having worked in most teams over two decades (“Polyfilla Man”). Open-door policy. Size: TDHB is comparatively small - easier to effect change. Coordinator knows all mental health staff

10. Another factor that influenced compliance: Leadership, leadership, leadership! Without a robust support framework, the Outcomes Coordinator position would fail. This support came from: Service Manager Governance Group Implementation Team Training Team Clinical staff themselves IT staff

11. Damaging factors Continual IT problems (AKA The 3D effect) Delivery delays (system almost two years late), vendor absenteeism, bugs, wrong versions, etc. Absence of reports from system Only reports – overdue, upcoming and graphical report of progress of single consumer over time Environment of change Management restructuring, Acute Services review, proposed CAMHS review, PHO tendering > OUTCOME: dispirited workforce Fear of changing practice An IT-driven initiative not universally welcomed by staff (older workforce), resistance to changing practice, i.e., not used to preparing for MDT reviews, power issues Outcome measures still sit outside routine clinical practice HoNOS is well collected but only used in a few small teams. Not shared with consumers. Major challenge! Misconception about purpose of the HoNOS tools “This is something we only collect for the Ministry of Health”

12. PRESENTATION SUMMARY There really is no magic bullet, good compliance is dependent on many factors including: Adequate Resourcing (FTE) Leadership & governance Hard work Coordinator profile Size of the DHB The use of the ‘carrot’ and ‘stick’

13. Any Questions?