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This edition of Healthcare Review – OnlineTM is the second in a two-part series focussed on mental health services.
Mental illness constitutes a major component of the morbidity, costs and health burden for society. From a background of institutionally-based care, there has been a significant shift towards mental health service delivery in the community.
There is an increasing commitment internationally to integration in mental health. Numerous integration initiatives abound, generally with an aim to increase the quality, appropriateness, cost-effectiveness, sensitivity, and accessibility of mental health services. As a result, the mental health arena has provided an important learning ground for the application of organizational change and integrated care principles in general.
This edition focuses on organisational change in mental health services and lessons for the wider health care system from this experience.
Dr Dinesh Arya, Clinical Director of Mental Health Services at MidCentral Health in Palmerston North, New Zealand, reviews his experience with restructuring the Mid Central Mental Health Service.
The MidCentral mental health service holds the contract to provide comprehensive mental health care to a population of approximately 160,000 in New Zealand’s central North Island. The service provides all aspects of mental health care including inpatient care, community care, crisis care, general hospital liaison, child, adolescent and family service, alcohol and drug services and Maori mental health services.
Arya describes changes to clinical care delivery that have produced encouraging preliminary results. Continuity of care for consumers and minimal duplication of service are key components of the vision for the service.
He notes in particular that changes to the way clinical care is delivered require thorough analysis and clear decision-making. He also notes that such change requires courage if the change is not supported by current popular trends.
In the abstract "Organisational change in mental health services. The how and the why", Dr Margaret Tobin, Director, Mental Health Services, South Australia, highlights the challenges of using change management strategies to implement local service unit level interpretations of national strategy.
In her full paper which will be added to the journal in May 2002, Tobin will describe examples of linking national policy with local organisational change based on her past experience of institutional change management and regional service developments and her current role at the state level as policy driver for a major reform agenda.
The focus in the first edition of the series was on other lessons gleaned within the mental health sector that are applicable elsewhere in the wider health care arena.
In that edition, Dr Arya, presented two papers that summarise important general principles collated as a result of his experience in the Mid Central mental health service.
The paper ""On A Question Of Informed Consent"", considers the questions of why is it important to have informed consent and how much and what should be disclosed.
In the paper "A Framework for Continuous Quality Improvement in Health Care Organisations", Dr Arya discusses the concept of quality improvement and the importance of system improvement when aiming to improve service quality. He highlights leader commitment to quality improvement and the development of a "quality culture" as essential prerequisites for undertaking quality improvement initiatives.
Readers may also wish to refer to earlier papers on quality management systems published in Healthcare Review - Online from Professor John Øvretveit, Professor of Health Policy and Management at the Nordic School of Public Health in Goteborg, Sweden. His January 2001 paper "Evaluating Quality and Quality Measures for Comparison " overviews different quality evaluation and indicator schemes, based on the experiences of quality specialists and leaders in the Nordic countries who have applied various schemes in public hospitals and health care services. This paper further expands the concept of an evidence base for use in quality programme development, which Professor Øvretveit introduced in his July 1998 paper "The Convergence of Evidence-based Health Care and Quality Improvement".
