Productivity and Lean in the Delivery of Mental Health Services

The scale of the potential productivity challenge in mental health was highlighted in the King’s Fund report published at the end of 2010. Whilst the scale of the productivity opportunities are vast, the problems of realising them are equally vast.

Whilst it is possible to make improvements within an organisation’s own sphere of influence, the real productivity gains are only realised when organisations work together. For Mental Health this normally means working across health and social care boundaries and will often involve the third sector as well. No one should under-estimate the challenges this presents, particularly when the relationships between organisations are strained.

Shifting the setting of where care occurs, and indeed strengthening community based options, means changes to commissioning models and that affects the distribution of funding and often resources, for example moving a secondary care clinicians into a community setting to enable them to provide outreach support rather than staffing in-patient facilities causes the need for change in the funding structure of two and possibly more organisations.

Carla Bickley, Head of Specialist Mental Health Services at Wolverhampton City PCT commented, “The biggest improvements in mental health support comes when we are able to work across organisational boundaries to design the most effective pathways for service users. Increasingly service users have complex needs that require a different way of working to ensure success and by working across organisations we can minimise delays and costs whilst also improving the quality of care provided.”

Realising the productivity improvements in Mental Health needs a coordinated and strategic approach and this generally needs the application of concepts such as Transformation Mapping and Lean to bring a consistent focus to the problems. The benefits of undertaking Transformation Mapping, which is a way of bringing together all the strands of what would otherwise appear as a disjointed strategy and then putting together the requisite implementation plan, is that is allows people to coordinate activities and agree priorities.

Throwing unstructured ‘Rapid Improvement Events’ and tactical activities such as the ‘Productive’ series for Mental Health at the problem can actually make things much worse and create a legacy of bad feeling, especially when working across multiple organisations, many of whom will have different targets and objectives. You only have to annoy partners a few times before you lose their support for your improvement efforts and then the problems become significantly harder to tackle in mental health.

It is possible to make a step-change in the way mental health services are delivered but it needs coordination, consistency and the effective application of concepts such as Lean at a strategic level, linking together all the strands of improvement in mental health. Before this can be achieved there is a need to focus on creating a compelling need that spans multiple organisations, something that is easier to write than it is to achieve. Sitting above all of this is the need for effective sponsorship at a senior level. Together, this creates the right package needed to realise the productivity challenge in mental health, Without it, the challenge becomes exponentially more difficult.