Increasing time available for direct consumer-care in a rural community adult mental health service by streamlining team meetings

Abstract

This Quality Improvement (QI) activity was undertaken in a rural community adult mental health service which historically ran Multidisciplinary Team (MDT) meetings daily for one hour. All clinicians and psychiatrists were expected to attend all meetings, regardless of consumers discussed. Psychiatrist attendance was low and there was no formal method of allocating consumers to clinicians and psychiatrists. The aim of this QI activity was to increase the time that mental health clinicians have available for direct consumer care by decreasing time at MDT meetings. Methods: The intervention allocated consumers and clinicians to psychiatrist-led MDTs. Each MDT would have a single meeting, once per week (one hour). Clinicians and psychiatrists were not expected to attend meetings for other MDTs. Total clinician time at MDT meetings and psychiatrist attendance was calculated using meeting minutes. Improvement was measured by comparing median six-week values pre-intervention to post-intervention. Weeks containing public holidays were excluded. The health service incident and feedback management system was used to identify serious incidents and consumer feedback related to MDT meetings. Clinicians were invited to provide feedback via anonymous online surveys. Results: Clinicians spent 21.83 hours less in MDT attendance post-intervention (pre: 40.5 hours, post: 18.66 hours) and psychiatrist attendance increased from 28.5% to 94.4%. No serious incidents or consumer feedback related to MDT meetings were reported. Five clinicians provided anonymous feedback. Feedback was generally positive with clinicians reporting the added structure, increased time for consumer care, reduction in low-value tasks, streamlined decision making and ability to take meal breaks being positive aspects. Suggestions for further improvement included additional refinement of meeting structure and better integration with allied health professionals. Discussion: This QI activity successfully created almost 3 days of clinician time, per week which is available for direct consumer care by revising a longstanding approach to MDT management. This intervention required no additional resourcing and is anticipated to be sustained due to positive staff engagement and clear benefits. Although this activity was undertaken in a specific setting, the use of MDT meetings is widespread in healthcare and similar opportunities for improvement may exist in other settings.