10 January 2018

Reducing Time Taken to Complete Neuropsychological Assessments in Memory Assessment Services in Luton and Bedfordshire

Memory Assessment Services in Luton and Bedfordshire have been working hard to reduce time taken to complete  neuropsychological assessment. Read more about their journey and achievement below.

The Psychology members of four multidisciplinary Memory Assessment Service (MAS) Clinics across Luton and Bedfordshire, collaborated on a cross-clinic project to reduce the time taken to complete a neuropsychological assessment to six weeks.

The team, made up of Clinical Psychologists, Trainee Psychologists and Assistant Psychologists used a nominal group technique to build their driver diagram. The team found this method to be inclusive of everyone in the team and an efficient way to decide on the important factors which made up their primary drivers.

Click on the image to see the flow chart ion full size

Since the QI Project spanned over four MAS Clinics, it was vital that operational definitions were clarified so that the data collected were comparable across teams. To do this the team decided to flow chart their assessment process to ensure that all teams were following the same procedures and to clarify when and how data would be collected.

 

Through process mapping it became apparent that each Clinic had difficulties in different parts of the process. Therefore, the teams decided on testing some ideas across all teams, as well as some change ideas which were specific to their Clinic.

The teams started with change ideas in areas which they felt they had most control over. For example, they wanted to reduce the delay between the assessment taking place and the draft report being available by allocating specific time for this as close as possible to the assessment appointment. Initially this was trialled with one Assistant Psychologist, using a number of Plan Do Study Act (PDSA) cycles to refine the changes to account for competing priorities, before scaling up to all Assistant Psychologists utilising this method.

Implementing this change led to greater efficiency in writing reports, as the information was clearer in mind. Assistant Psychologists report that the new structure helped to manage the workload and clear backlog. Since testing this change, all four MAS clinics have seen reductions in time from assessment to draft report ranging from 52% – 92%.

Click on the Image to see the charts in full size.

The teams have also been testing team specific change ideas through PDSA cycles and have already seen significant reductions in the time from referral to final report. Mid Bedford are already averaging 38.5 days; Luton at 42 days, Bedford is averaging at 39 days and South Beds is at 44 days. Although the aim was to reach 42 days, teams believe more can be done to reduce this time further and are now looking to gain service user feedback to inform their next change ideas.

The project team used a force field analysis to reflect on challenges they faced, such as the changeover in Assistant Psychologists. They also identified that working in small teams meant having to take on multiple roles and manage workloads with competing priorities. However, they found the QI meetings to be a useful platform to discuss these difficulties, which helped the team stay focussed and motivated.

Initially the team struggled to understand the progress of the project in the context of the wider team. However, having clear operational definitions helped them to develop a consistent data collection plan, which led to having visible data to illustrate how the changes had affected their system. This helped them to celebrate their successes and to consider the bigger picture by taking into account balancing measures to provide more clarity on how the system was performing.

The team also shared learning on their experience of running a project across four different Clinics. They recognised that each Clinic had differences in their process, which had to be considered when thinking of change ideas and developing a data collection plan. The project team found QI life to be a useful platform, as it could be accessed from anywhere. Together with Skype and disseminating minutes QI project meetings were made more accessible.

The team also appreciated the energy and enthusiasm bought to the project meetings by the Assistant and Trainee Clinical Psychologists. Project Lead, Emma Ellis has also bought forward great leadership skills to the team, moving the project forward through setting meetings and keeping on top of the process. We look forward to hearing how the project develops over the next couple of months.

 

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