Reducing Waiting lists in mental health care
GGz Centraal is dedicated to the prevention, diagnosis and treatment of mental health problems, eating disorders and addictions for both adults and children/adolescents. We offer a wide range of evidence-based specialist treatments and therapies through outpatient, day patient and inpatient programmes in the middle part of the Netherlands. Every year we offer mental health treatment to 16.000 patients.
Waiting lists are one of the biggest problems in mental health care at this moment. In recent years, several news articles have been published about this and especially the effects it has on patients, who are at risk for crises as they do not receive the care they need! It is a problem for which there is still no solution; hiring more people was not possible for a long time as there was not enough money. Nowadays, there is more money but there are not enough clinicians available.
Specifically, teams involved in intake and diagnostic procedures are struggling with the enormous pressure at the front door. An example of such teams are psychodiagnostic assessment teams. These teams provide psychodiagnostic assessments on request to all in- and outpatient clinics and therefore all patients in treatment within a specific region. A psychodiagnostic assessment may consist of an intelligence assessment and / or a neuropsychological assessment and / or a personality assessment. For each type of assessment there are guidelines for time spent on all specific parts of the assessment.
To manage this, we have been working with the Lean method in the department for a year now with the aim of shortening the total time from start till finish to a maximum of 2 weeks. The range of total time of hands-on work is between 8 and 12 hours for the three types of assessments. A value stream map which was made showed that waiting between the different steps was by far the most important type of wasting. A planning board was introduced and we started working with fixed blocks in the agendas of the clinicians. The total time from start till finish is now reduced, only not as much as hoped for. Efficient planning of assessments is an important factor in this.
Not so much calling patients and making an appointment takes time, but scheduling the various appointments within the shortest possible period of time does. At least two and sometimes three clinicians of our team are required for a single assessment. This is due to specific expertise and that the various clinicians can only be deployed for the department on limited days. In short, the logistics of efficiently planning an assessment is a difficult puzzle. Valuable time of our clinicians is spent on this, time we rather spend on patients.
As already mentioned, the problem we have in our department is not exclusive; our outpatient clinics have the same kind of problem when it concerns their intake-procedure. And GGz Centraal is not the only (mental) health center dealing with this challenge. This puzzle needs to be solved. Patients are in need of care. It is our responsibility to make sure the available clinicians can use their time to serve as many patients as possible.
The ultimate goal is to be able to work without waiting lists! To make good use of our clinicians without wasting their time, and delivering qualitatively decent care within a time range that is not only acceptable but also fitting excellent care, so within days rather than weeks.
Working with Lean has strengthened the connection in the team and the goal set is a goal for the whole team instead of an individual goal. The solution for this problem should strengthen this team connection and should not rely on individuality. This might include a game element (e.g. monthly score based on least lost time) in the planning system that can act as a motivator for the team performance and stimulates clinicians to prioritize a more efficient choice for the planning – and therefore the team performance and thus the patient value – above a better choice for the individual agenda.
What we need:
- More transparency in the work flow and reduction of waiting lists. Less waiting for patients and improvement of patient care.
- Ideally the solution can be integrated within the electronic patient file.