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

n Background to CBIT n Aims and objectives of service improvement n Outcomes n How change was achieved n Challenges n Future

Background to CBIT

Background n Community Brain Injury Service n CARF accreditations 2003/2006, Chartermark x3, Investors in People x2 n Public Servant of the Year Team Award n Waiting list problems &service flow pathway n Processes not optimal n Trust support

DLT- CBIT Context n First team in Northern Ireland n Developed in response to local study of need n Uses interdisciplinary model of assessment, goal planning and case co-ordination n Grown from core therapeutic expertise and knowledge base, funded from Disability savings in n In 2003 EHSSB additional Health and Wellbeing Investment monies allowed development of model

CBIT – Results /Outcomes Focus n 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 n 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 n 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 n To improve access to the Community Brain Injury Service n 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.

Objective 2: Clients are planned within 12 weeks of screening

Objective 3: Length of time waiting is below 52 weeks

Longest wait reduced to 46 weeks ( 1 client ) Next longest wait is 5 weeks Reduction from 170 weeks to 5 weeks

How change was achieved

How.. n Overcoming inertia n Streamlining referral process n Segmented time - screening, assessment n Waiting list validation/management

n Information - letters, folders, reception staff n Streamlining CBIS - 3 options of service n Fast track service - specific, intensive n DNA/CNA procedure

n Professional service users n Regular, short project meetings n Additional hours n Representation at higher level in Trust

Challenges

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

Lessons learned

n Process mapping - lengthy but necessary! n Demand and capacity - effective planning n Medical/Neuro assessment informs access to service n Waiting list review/validation - service process

Lessons learned…. n Working groups - effective problem solving n Innovative practice doesn’t necessarily fit the service eg. partial booking n Discharge policy - a ‘must have’! n Keep it simple!

Spread and Sustainability

Short term: 3stringent processes within service 3renewed motivational drive 7Withdrawal of additional 6 hours per week which meets demands of administration and data collection

Spread and Sustainability Long term: 7Threat to service model due to RPA 3Down Lisburn Trust CBIS will inform service delivery within RPA arrangements

The future…..

Future n Continue with Service Improvement n Service user consultation n Address bottleneck after planning stage n Liaise with Trust Community Stroke Team n Develop communication further with N.I.Regional BI Unit n Brain Injury Quality Conference 2007 n Promote service model within Public Administration arrangements