Sometimes all you need is a little perspective

Melissa CaseyJustin ConaghanToday’s guest post is from Justin Conaghan and Melissa Casey, who are co-presenting a session at Agile Australia 2014.

Justin and Melissa’s presentation, Agile In Health: success is not a colour printer, will tell the story of their experience of enacting change in an organisation that seems immune to it and the importance of having a strong leader, an adaptable approach and the right stories to tell along the way.

Justin is a consultant at ThoughtWorks, and Melissa is the Director of Psychology at Monash Health


Help me live, love and work.

In the mental healthcare system, that’s the reason we exists. Our purpose.

We’ve identified that something is missing. There are some patients that slip through the cracks and we want to create another option for them. A new clinic that will fill this gap and our redesigned clinic will make sure that the patient is put first.

There is a mountain of information. Hospitals and their related services capture meticulous data about what they do.

The volume of presentations at the emergency department and calls at the triage service is tracked. The number of admissions into the hospital from each of these is known. We know the most common clinical diagnoses, the top callers into the triage service (and it’s not the patient) and the busiest periods for demand. It’s no problem getting a statistical breakdown of the amount of time spent in emergency and the proportion of patients that end up with a mental health care worker. We know that all the government mandated targets are being met.

It is typical to know these measures and to use them to manage healthcare services. It’s the way all hospitals operate and a necessary part of obtaining crucial government funding.

They also show us the gap that justifies the redesign.

But our hypothesis is that the new clinic will be an improvement over the existing system. We need a baseline. Do we understand the extent to which the current system does what it is meant to do for people? These conventional measures don’t tell us. They are all telling us what is going on inside the system. We know very little about what its like from the outside. What does it look like from the perspective of a patient?

What is the nature of their problems?
How often we help them?
What is their journey through the system actually like?
What matters to them?

Healthcare, especially mental healthcare, isn’t simple. We can’t simply ask. People’s experience may well be clouded by their illness and repeated use of the service is common, even appropriate. A lot of patients will not get better – recidivism is normal.

We need to understand the patient but equally (if not more so) the patients story, including their relationships with carers and their care providers.

So we begin a process of piecing these stories together, one at a time. It feels slow but it reveals things that we couldn’t see before. We see from the perspective of a patient, just how the system of care is designed and how well it meets its purpose.

There is a lot that could be fixed and although we can’t fix it all now we have made a start. For our new clinic, this process of learning and keeping this perspective will be crucial.

One thought on “Sometimes all you need is a little perspective

  1. “A lot of patients will not get better – recividism is normal” is neither a helpful nor an accurate statement when it comes to describing the mental health concerns of Australians.

    About 1 in 4 or 5 Australians will experience a mental health concern in their lifetime. The most common mental health condition that Australians experience is anxiety disorder. Depression is the next most common. A number of psychological therapies have been shown to be very effective in the treatment of anxiety and depression and the vast majority of Australians experiencing anxiety disorder can reasonably expect to gain significant benefits from appropriate treatment and accurate information. The overwhelming majority of people experiencing anxiety or depression do not require treatment in an Emergency Department or public hospital outpatient clinic.

    In common English language the term “recidivism” generally refers to repeated or habitual relapse, especially in to crime.

    The term is therefore an unfortunate choice in this article. The authors risk perpetuating the common misconception that those with mental health concerns are prone to crime. This is not the case. The statement communicates a lack of hope when there is in fact good reason to be hopeful.

    Australians experiencing mental health concerns have a range of options available to them for appropriate information, advice and treatment. Help is available and relapse is not necessarily the norm.

    We can all take steps to reduce stigma associated with mental health concerns. And sometimes hope is all we have for the moment. I agree with the authors of this article that perspective is important. However in this particular instance the perspective that is offered is overly narrow, and warrants careful revision.

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