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Challenge: A forensic psychiatry service had not been accredited for six years and professional practice had deteriorated.  The Accreditation team was to arrive at the hospital in ten months.

Analysis: Outpatient services were excellent, but clinical practice in the secure hospital had fallen well below expected standards.  No patient had a multi-disciplinary care plan, compulsory staff training was thousands of hours behind schedule, physical and relational security were misunderstood and misapplied.  Decision-making was cumbersome and change had become difficult, in part because senior managers had become remote from practice.  Preparation for accreditation was underway and generally thought to be in a final stage of completion, but in terms of evidencing change, it had stalled.

Solutions:

• Focus all effort on inpatient services.
• Streamline accreditation efforts and make timely and evidenced based reviews.
• Reduce meeting time by 75%
• Introduce information system for ward areas (TV screens throughout facility, offering daily demonstrations of the standards, followed up in person two times each day by senior management on each ward)
• Spend $1 million to redress the shortfall of education of regular staff.
• Introduce urgent security measures.
• Innovate Lean technology to accelerate change in key areas.
• Introduce process to ensure each of the 2000 patients had current multi-disciplinary care plan and risk assessment within ten months of commencing.

Result:  Achieved ‘Exemplary Standing’ (top 1%) grading having attained 403 of 404 national standards reviewed by Accreditation Canada.

See HERE for Prezi summary of a successful change management project in psychiatric services.

Challenge: A Social Care Agency was developing new facilities, including a semi-secure facilities, for a remote population.  Some remedial design, service and staffing, and training advice was required.

Analysis: The proposed service model did not account for the particular challenges of combining types of residents in a small, unusually designed secure environment.  The proposed relationship between secure area and wider residential service needed to be articulated in order to avoidable costs and prevent harm to staff and patients.

Solutions:

• Identify design challenges that complicated care, offering remedial advice, and a service model to mitigate the challenges.
• Distinguish between types of clients, identifying needs and complexity of challenge for each category.
• Describe the training needs of staff.
• Provide an algorithm to determine staffing requirements in each level of security to ensure safe care and efficient operation.

Result:  Awaiting implementation.

• Report delivered on time and within budget.
• Recommendations are now under consideration.

Challenge: Academic standards had fallen in a Faculty at a post-secondary institution and staff morale was low.

Analysis: Determination by Faculty to be autonomous caused a failure in communication with the administration and prevented the Faculty from being recognized for good work.  Hampered by a lack of concurrent information on finance and performance the Faculty evolved outside of senior management, resulting in inequity of resource allocation and unnecessary costs.

Solutions: 

• Align recruitment and work by implementing a resource allocation algorithm
• Develop new data source for finance and workload
• Address grade inflation in key departments
• Strive for new academic status with application for new Bachelor program
• Advocate and celebrate achievements with Administration

Results:

• Grade inflation reduced from twice College average to below average
• Succeeded in bid for new Bachelor program
• Student FTE costs reduced by 10%
• President and Vice President expressed satisfaction with changes

See HERE for Prezi on Opportunities and Challenges in Post Secondary Education and Human Services

See HERE for Prezi illustration of Bachelor of Social Work process.

Challenge:  A Justice Ministry community treatment program for offenders was not meeting expectations, causing a blockage in the flow of offenders from custody into the community.

Analysis:  Staff in the community program displayed great commitment but had strayed from conventionally accepted norms. Moreover, staff were overwhelmed by external requests for advice and to provide reports for other purposes.

Solutions: 

• Introduce a process of benchmarking of performance against comparable programs in the country.
• Establish performance standards for internal administration.
• Enhance coordination with Custody areas to smooth the way into Community Treatment.
• ‘Advice’ and ‘Report Writing’ requests transferred and outsourced.
• In total, 17 recommendations were provided, 16 of which were adopted.

Results:

• One-year follow-up indicated the program was performing to the satisfaction of the Ministry.

Problem: A medium sized forensic psychiatry service was losing $3.5 million each year.

Analysis:  Staff were high quality.  Service model was excellent, identifying a whole pathway of care for patients, but was not matched by the cost structure.  Contracts had been agreed with purchasers that did not distinguish between patients whose care was high cost from those whose care were low cost.

Solutions:

• Identify and cost each step of the pathway
• Renegotiate contracts with purchasers
• Clarify budget and review process with service managers
• Provide monthly feedback of service performance for management team

Result:  Overspend eliminated within 12 months, with no loss of staff or quality.