Understanding your system
The MHAIST collaborative teams wanted to make changes to their current practices. To do this, they first worked to understand the current ways of working in more detail. The various tools used by different teams are below:
- Process mapping
Process mapping was one method teams used to capture this information and target improvement efforts. A collaborative team from NHS Dumfries and Galloway used this method to create a visual example of the process (PDF). Process mapping can also highlight overall team functioning and identify wasteful elements of the system such as excessive travel time or bottlenecks because of room availability.
The benefits include:
- capturing and visualising all the steps in an existing process
- visually representing new processes
- showing all team members how a process works in practice rather than what they think is happening
- identifying change ideas for improvement, and
- facilitating team building and appreciation of team roles.
- Pareto charts
Another tool used by NHS Tayside CAMHS (PDF) was the Pareto chart to better understand the reasons for rejected referrals. A Pareto chart is a type of bar chart which helps to identify the "vital few" — the factors at play that warrant the most attention. More information about Pareto charts is available on the QI zone website.
- Demand, Capacity, Activity and Queue analysis
Demand, capacity, activity and queue (DCAQ) analysis is another tool that can assist you in analysing service processes. DCAQ can provide greater detail on current and required resources, demand for services and capacity to deliver services which can direct improvement efforts. The process requires consideration of factors such as:
- available funding
- current staffing
- time allocated to certain tasks, and
- access to technology such as NHS Near Me or website development.
The following guides on demand (PDF) and capacity and activity (PDF) provide more context to DCAQ in mental health work. In addition, the Handy Guide to Mental Health Waste Spotters (PDF) outlines common mechanisms to reduce waste in services.
The National Capacity Calculator can also help as part of a DCAQ analysis. This is a simple Microsoft Excel tool that helps teams/services to understand the time available for main work activities (e.g. seeing patients or managing a service). It is available on the QI Zone website.
Improving system flow - people’s experience of moving through different services, or the movement of work through different processes - is often a focus of improvement work. The QI Zone provides further guidance and tools on system flow which teams may wish to consider.