Service System Redevelopment
“Through the Eyes
of the Client”
Client Journey Experiential Study
From the client’s perspective
From the service providers perspective
Presenters:
Lyn McKay, Service System Redevelopment Coordinator, FMPPCP
Julie White, ICDM Support Officer, FMPPCP/ICDM , Peninsula Health
Community Health
What am I going to
get out of this
session?
• An understanding of the:
– Client Journey processes & challenges
that went into the undertaking
• Information about:
– planning a service system redesign
approach
– A general framework for the project
– Methodologies & tools used
– Strategic outcomes
Approach
• System Wide
• Systematic
– Start broad
– Finish targetted
• Well developed implementation plans
• Use of robust project management
approach/tools
• Practical/doable – delivering tangible
results at the end
• Factual information – not just ‘intuition’
The Study
• Documents and analyses the
experiences of the service
system from the perspectives
of both:
–Clients
–Service Providers
• Provides a comparative
Study Objectives
• Empower clients to:
– navigate the service system
– manage their needs across the
continuum of care
• Identify gaps/areas and changes
needed to improve the client journey &
outcomes
• Enable improvements to be made in
the health system across the FMP
catchment
Focus
• Central Focus
(in keeping with the SSR Plan)
–Aging
–Anxiety & Depression
–Dementia
Study – Target Sectors
& Populations
Mental Health
Aged
Local Government
GPs
Drug and Alcohol
Acute
Sub Acute
Community
Disability
Neighbourhood/
Community Renewal
Indigenous
Culturally And
Linguistically Diverse
(CALD)
Client Inclusion Criteria
•
•
•
•
•
•
•
•
•
Primarily between the ages of 50-80
Multiple agency involvement
Multiple co-morbidities
Met the profile for the anxiety &
depression/dementia focus of the study
CALD group
Indigenous person
Family carer or have a personal/family carer
Relevant and current experience of the
health system
Ability/assisted capacity to express how they
think the system could improve
Study Scope
• 147 Clients
• 87 Services / PCP
Member agencies
Client Sources
•
•
•
•
•
•
•
•
•
Brotherhood of St Laurence
Frankston Senior Citizens
Seagull Day Club – Frankston
Baptcare
Positive Aging Group, Frankston City Council
Access & Mobility Group, Somerville
Greek Women’s Group, Rye
Indigenous Group, Hastings
Villa Maria (home visits) - case managed
clients
• Telephone Interviews – Peninsula Support
Services
• Age Strong
Study Inclusions
• Assessment of:
–
–
–
–
–
–
–
–
Access/intake
Exit/discharge
Assessment and care planning
Referral
Care coordination
Self management
Chronic disease
Capacity of organisations – limitations to go
beyond presenting issue or service programs
– Communication between providers
– Strengths and weaknesses of client journey
processes for client feedback and quality
improvement
Methodology
• Clients
– Focus groups
– Questionnaires
– Open group discussion
– Individual client interviews
• Service Providers
– Questionnaire – via Survey Monkey
• Supported by
– clear governance structures
– Use of System Frameworks
• Victorian Service Coordination Practice
Manual
• Wagner Model
– Project management processes &
tools
Project Management
Processes & Tools
• Initial Project Information &
Discussion Paper - issues for
consideration
• Letters to service providers
• Service provider project
information template
• Consultant project discussion
information & for quotation
template
• Working Group Terms of
Reference (inc. work-plan)
• Project brief
• Task team brief
• Detailed Implementation
Plans and Gantt Chart
•
•
•
•
•
•
•
•
Issues Register
Risk Register
Learning’s Register
Project budget and
implementation estimates
Reporting frameworks
(minutes, actions sheets,
SSRC /OMC /SDC
Implementation Plan Activity
and Outcomes Reports)
Project Evaluation
Framework
Service Providers
Questionnaire
Clients Questionnaire
Study
Findings
Clients were
asked about:
• Client demographics
• Managing their
condition
• Getting into services
• What has been done
to manage their
condition
• Their experiences of
the health system
Service
Providers were
asked about:
• Service provider
demographics
• Service provider client
demographics
• About structures &
processes
• Service accessibility
• Assessment & Care
Coordination
• Referral & feedback
• Client pathway
information
Key Themes
• Service Access
• Listening, noticing & follow up
• Effective Communication
between Services & Clients
• Carers – Involvement
• Waiting times and time
management
• Social Groups
• Case Management
Key Findings
• Clients expect to:
–be able to access the services
they require in a reasonable
period of time
–receive help and be looked
after
–be given information
appropriate to their situation
"QUESTION: Do you feel you have been given
sufficient information about your condition/
illness to manage it?
medically yes-well informed /
practically-NO"
• Clients’ Best experiences of
the system were those that:
–involved timely responses to
clients’ concerns
–related to particular programs
where the leader provided
friendly/appropriate service
tailored for the individual client’s
needs
• Clients’ Worst experiences of the
system were those that included:
– slow responses/lack of timeliness
– apparent lack of concern/interest in
individual client
– service providers not taking the time
to listen or pay proper concern to the
client needs and issues
Most Important
to Clients
• Being treated with decency,
courtesy, respect
• Receiving timely follow
through
• Being listened to
‘Really heard’,
Important Factor
• Being involved in
social &
worthwhile
activity together
(social inclusion)
Who do clients go to
as a priority?
1.
2.
3.
4.
5.
GP
Hospital
Pharmacists
Community Health
Local Government
First Priority
Second Priority
Third Priority
Of Interest
• Many clients did not see that
they actually had a
‘condition’
• Raises issues about the
terms used in consultation
with clients
Key Findings
Service Providers
• Lack of awareness - internal
processes for identification of
clients with dementia, depression
or anxiety.
• More work required to further
integrate/streamline access to
services for clients.
• Many service providers are
unsure about, or do not
know if their organisation
has a monitoring/reminder
/recall system
• Wide range of timeframes for
practitioners seeing clients from
when clients first access services
• There is evidence of a lack of
clarity by service providers
around what is ‘Client Focused
Care’
• Diverse communication practice
exists between service providers
and GPs.
• Extensive service provider practice
variations between referral
timeframes & transmission of
referral acknowledgements.
Perception (by Service Providers)
• monitoring of client risk at
presentation is supported by
consistent practice across service
providers regarding:
• effective communication of
timeframes
• eligibility and prioritisation across
services
…….in accordance with good practice
Example
Care Plans
Service Providers Responses
Are your clients actively involved in
developing their treatment/care plans?
Client Responses
Have you been actively involved in
developing your treatment/care
plan(s)?
20
no. of res pondents
18
16
14
12
10
8
6
4
2
0
V ery
involved
all of the
Involved
mos t of
the time
Involed
s ome of
the time
Not
Told w hat
involved
to do
at any
no. of res pondents
19
17
1
4
8
% of res pondents
24%
22%
1%
5%
10%
Client’s Responses
5%
32%
Y es
No
Uns ure
63%
Do you have a
treatment/care
plan(s)?
4%
38%
Y es
No
Uns ure
58%
If Yes, do you
have a
written copy
of your
treatment/car
e plan(s)?
“My ex-wife may have
it. There is a written
contract but I don’t
have it”
“My own plan - I belong
to a Bushwalking
Group and walk 10 km
/week”
Example - Consent
• Most service providers ask for
clients consent to share personal
details & information –
Client perception
- they (52%) had not been asked
to give consent prior to service
providers sharing their
information with other services
Service Providers Responses
Client’s Responses
What did we learn?
• Processes always take longer than
expected
• Analysis of data & information generally more complex than often
anticipated in early stages of
project/data collection phases
• Timelines need to be realistic and
flexible
Project Evaluation
•
•
•
•
•
•
•
•
Governance/Leadership
Planning and scoping
Stakeholder engagement
Risk management
Resource management
Quality management
Reporting
System-wide/organisational change
management
• Impact evaluation
• Outcomes/achievements evaluation
• Learnings dissemination
Outcomes/Impacts of the
Client Journey Study
•
Informed the development of
numerous service improvement
initiatives such as:
–
Development & piloting of Broader
Needs Assessment tool through the
PCP
– “Working Together for Better Diabetes
Care” Catchment planning initiative
•
•
Informed individual agency service
planning
Informed Medicare Local discussions
& included in MLO submission
• Project Review -lessons learned log
• Being used for SSR planning –
identification of key work priorities for
remainder 2011-2012
• PCP strategic planning evidence base
• Service providers using for QI
purposes
• Benchmarking resource for various
entities
Back to the Future
Challenges
• Address findings - prioritising
• Developing & implementing
models of care, access, etc. client focussed care
• Affect appropriate change at all
levels of organisation & the
system
• Resourcing
FMPPCP
Lyn McKay
Tel: 9788 1544
Email: lmckay@phcn.vic.gov.au
Julie White
Tel: 9784 7764
Email: jwhite@phcn.vic.gov.au
Copies of the Client Journey Report
available at:
http://www.peninsulahealth.org.au/healthprofessionals/frankston-morningtonpeninsula-primary-care-partnership/