The co-design of an integrated Gastro Pathway- Can we improve the emotional well-being of patients

in the Gastroenterology pathway

Pre-Phase

Action-phase

Why

emotional

health and

gastro ?

Results

GPRoutine

GP-Out-Patient Gastro Process Map V1

RD& EConsultant

DRSSChoose & Book

MOPD

Updates spreadsheet with

outcomes

Gastro referral service

Consultant Grades referral

Colorectal Pathway

Gastro Secretary’s Office

Consultants Deskx11

Outpatient Folder

Endoscopy Folder

Other Tests

Gastro outpatient slots allocated

OPD

Patients

Occupational Health

Calprotectin Test

Hospital DOS

Prints referral lettersChecks details

Pending list

Connecting Pathway

Creates a Spreadsheet

Liver Pathway

Connecting Pathway

Secretary picks up letters

Gastro referral service

Pending list updated Micro system mapped CXC

Dr Calverts Clinic

OPD

Process Step Information

GP referrals sent via E-referrals ElectronicInformation Systems

/Data flow

Con to Con via white card/letters via sec to sec internal mail

DRSS triage? referral

Received in MOPD Printed added to

pending list ungraded

Paper received and pending list updated

Graded

Returns back to electronic process

Process now becomes paper

based

Slot allocated via E-referrals app booked letter generated on

PAS

Sent to patient via synertec with

questions

Data Flow – Electronic process

Data Flow- Paper process

KeyGastro OP Referral Process to Talking Health -V1

Issue

PDSA Screening Process

Talking Health 1

Health Psychology

2

Psychiatric liaison

3

Pt attends clinic -HCA asks patient to

complete questionaire

Pt hands questionnaire to

clinician

Clinician to review and score

questionnaire

Discuss outcome from questionnaire

with patient

Referral recommendation for

Talking Health

Email/send copy of letter to TH

Future state this can be sent via

appointment letter

PDSA information held on secure

research database

Give patient leaflet -if unsure may wish

to self refer

TH receive referral What happens when

in TH ?????

Health

Psychologist

Senior

leader

Gastro

Consultant

Dietitian

IBD Nurse

30% of people with a long-

term physical condition

also have a mental health

problem

Visualising the

pathway and creating

opportunities for

improvements

Understanding the

scale

IPS/GI Pathway Mind Map

Big Room

Comm’s Plan

Pre-Phase Data

Coaching Time

Research

What is happening in other Trusts

Our 3 Key Messages

Venue, time of first Big Room

Attendance list

Presenting the information

Progress reports

Promoting the FCA Framework & Method

Social Media

Face to Face

Movable display boards

High influence -High Interest

ED summit -existing work in other areas- H&N Debates

CAMS PAEDS

What is the problem and the aim

Observational audit/patient survey

Sharing with other pathway coaches

Intranet

Email

To FCA Sheffield

RDE&DPT Faculty/Exec Sponsor

Process Map-Pathway value stream map

Twitter #DevonFCAWeekly catch up’s face to

face

Structure the Problem ?

Aligning with existing work streams

Why look at this area as oppose to anywhere else

ISP- Map & Measure GI O/P Clinic

Data capture with patients -Screening tool barometer

Primary

Secondary

Complaints

121 conversations with identified pathway leads

Pathway associated Diagnostics/investigations

Referrals

Pathway admissions Datix Incidents

Improve patient & staff experience

Reduced cost in investigation procedures, reduced waiting lists,

reduced F/U

Will inform pathway process map

How do we identify where Psychological

interventions would be beneficial?

Using the data to inform a starting point

for improvement efforts

Site visits- clinics, wards, GI MDT meeting

Site visits- clinics, wards

What are they?

Post GI MDT meetings Friday afternoons ?RDE Wonford E

template

National guidelines -other similar work -lessons learned

Learning from each other, sharing success

and failures

Define our communication

strategy for FCA and internally for pathway-

tailor accordingly to improve success

Pathway metrics essential to measuring

improvements both qualitative and

quantitative

Risk Creating a local

optimal and displacing issues elsewhere in the

system

Big Room-ground rules, active listening,

respect, coaches to coach not lead

What we think the problem is

+ What the data tells us

+ What the stakeholders

tell/show us

–

Any bias

=

A starting point for improvement

Lost leader What's the ROI for the time out from Job plan

Risk Not knowing what data we have and

how to use it

Risk Not creating a

consistent message

Risk Jumping to

solutions forcing a predetermined

agenda

Risk Comorbidity shift

to other areas- missed

opportunities

Patient voice/stories co-design principles

Specific Aims:

By designing an integrated service we will:

• Assess/Screen for co-existent psychological distress and

mental health disorders

• If mental health issues are identified, patients will be seen

by the right services in a timely manner

• Improve all HCPs knowledge and understanding of mental

health and how to access these services (education)

• Improve communication across organisations as well as

between primary and secondary care

• Improve patient experience

• Improve health outcomes and reduce unnecessary health

utilisation

Global aim:

To improve the identification and management of

mental well-being across the whole

gastroenterology pathway

Co-designing the best

pathways to access

services

Around 50% of medical gastro outpatients have no clear organic pathology and investigations

for medically unexplained symptoms cost between 20-50% more than for other patients.

‘I keep having the

same tests and

hearing the same

things, but I'm not

feeling any better’

What are

patients

telling us…

Gastro Screening Tool

Screening

for

Depression

& Anxiety/

Somatic

Symptom

burden

Screening Tool Data collection

160 patients screened in O/P

New Follow-up

47 patients screened positive for D&A

36%

Pos 28%

Pos

23 patients

referred for

CBT treatment

‘More confident in

approaching the

topic of MH’

Dietitian

‘Fantastic, being

genuinely

integrated with

Gastro Clinicians’

DAS Manager

‘I have been

encouraged to

speak and

suggested ways to

improve the

patient experience’

Patient

Feedback