Down Lisburn Trust Community Brain Injury Team Better Access to Brain Injury Rehabilitation B.I. Conference Dublin, September 2006.

Down Lisburn Trust Community Brain Injury Team

Better Access to Brain Injury Rehabilitation

B.I. Conference

Dublin, September 2006

Background to CBIT

Aims and objectives of service improvement

Outcomes

How change was achieved

Challenges

Future

Background to CBIT

Background

1997 - Community Brain Injury Service CARF accreditations 2003/2006,

Chartermark x3, Investors in People x2 Public Servant of the Year Team Award Waiting list problems &service flow

pathway Processes not optimal Trust support

DLT- CBIT Context

First team in Northern Ireland Developed in response to local study of need Uses interdisciplinary model of assessment,

goal planning and case co-ordination Grown from core therapeutic expertise and

knowledge base, funded from Disability savings in 1997.

In 2003 EHSSB additional Health and Wellbeing Investment monies allowed development of model

CBIT – Results /Outcomes Focus

Key Results:• Rehabilitation Goals set with individual persons served

and % attained over rehabilitation period.• Satisfaction of persons with outcomes achieved• Brain Injury Community Re-integration Outcome

questionnaire {BICRO} as a measure• Access to service within desired timeframes see –

Service Improvement Project

{CARF Accreditation examines standards in Business Practices, Rehabilitation processes and Brain Injury Program specific standards here Home & Community}

Community Brain Injury Team

Resource 1997– Clinical Co-Ordinator-0.5– Neuro-Psychologist -0.6– Speech &Language

Therapist 0.3wte– Social Worker 0.4wte– Physiotherapist 0.3wte– Occupational Therapist 0.6

wte– Admin support 0.5wte

Resource 2006– Team Leader 0.3wte– Neuro-Psychologist1.5wte– Speech & Language

Therapist 0.4 wte– Social Worker 0.5 wte– Physiotherapist 0.4 wte– Occupational Therapist

1wte– Rehabilitation Nurse 0.8– 3 x Rehabilitation Assts

1.8wte – Admin Support 0.8 wte

Aims and Objectives

Aim of project To improve access to the Community Brain Injury Service

Objectives:

• To reduce waiting time from referral to first face-to-face contact from 5 weeks to 10 days.

• To reduce waiting time from first face-to-face contact to start of intervention from 51 weeks to 12 weeks.

• To reduce waiting time from 170 weeks to a maximum of 52 weeks

• To achieve a high level of client and carer satisfaction with quality of information given on entry to the service.

Outcomes

Objective 1:

New referrals are seen within 10 days.

No of working days clients waited for screening interview after referral

0

20

4060

80

100

Jul-05 Aug-05

Sep-05

Oct-05

Nov-05

Dec-05

Jan-06

Feb-06

Mar-06

month screening carried out

No.

of w

orki

ng d

ays

wai

ted

Objective 2:

Clients are planned within 12 weeks of screening

No. weeks client waited for first planning meeting after screening

0

10

20

30

40

50

60

Jul-05

Aug-05

Sep-05

Oct-05

Nov-05

Dec-05

Jan-06

Feb-06

Mar-06

month planning meeting

No.

wee

ks c

lient

wai

ted

Objective 3: Length of time waiting is below 52 weeks

No. of weeks waited by client longest on waiting list

0

50

100

150

200

Jul-05

Aug-05

Sep-05

Oct-05

Nov-05

Dec-05

Jan-06

Feb-06

Mar-06

Month w aiting

No.

of w

eeks

wai

ted

target = 52 weeks

Longest wait reduced to 46 weeks ( 1 client ) Next longest wait is 5 weeks

Reduction from 170 weeks to 5 weeks

No. of clients waiting more than 52 weeks

02468

1012141618

Jul-05

Aug-05

Sep-05

Oct-05

Nov-05

Dec-05

Jan-06

Feb-06

Mar-06

month w aiting

No.

of c

lient

s

How change was achieved

How..

Overcoming inertia

Streamlining referral process

Segmented time - screening, assessment

Waiting list validation/management

Information - letters, folders, reception staff

Streamlining CBIS - 3 options of service

Fast track service - specific, intensive

DNA/CNA procedure

Professional service users

Regular, short project meetings

Additional hours

Representation at higher level in Trust

Challenges

Challenges Project Manager left post Social worker leaving post Team working relationships Thompson House Hospital renovations Time commitment Service user satisfaction -methodology New Trust Community Stroke Team Review of Public Administration – A4C

Lessons learned

Lessons learned

Process mapping - lengthy but necessary!

Demand and capacity - effective planning

Medical/Neuro assessment informs access to service

Waiting list review/validation - service process

Lessons learned….

Working groups - effective problem solving

Innovative practice doesn’t necessarily fit the service eg. partial booking

Discharge policy - a ‘must have’! Keep it simple!

Spread and Sustainability

Spread and Sustainability

Short term: stringent processes within service renewed motivational drive

Withdrawal of additional 6 hours per week which meets demands of administration and data collection

Spread and Sustainability

Long term:

Threat to service model due to RPA

Down Lisburn Trust CBIS will inform service delivery within RPA arrangements

The future…..

Future Continue with Service Improvement Service user consultation Address bottleneck after planning stage Liaise with Trust Community Stroke Team

Develop communication further with

N.I.Regional BI Unit Brain Injury Quality Conference 2007 Promote service model within Public

Administration arrangements