In 2016, the Older People’s Mental Health Service (OPMHS) within Bedfordshire and Luton (provided by East London Foundation National Health Service Trust) faced considerable challenges in providing an accessible service for assessment of suspected dementia. Those referred to the Memory Assessment Service (MAS) encountered waiting times exceeding national recommendations. A quality improvement (QI) project was initiated by OPMHS Psychologists within all four multidisciplinary MAS clinics in Bedfordshire and Luton. The project aimed to reduce the time from the date of referral for within-team neuropsychological assessment to finalisation of the report to 6 weeks (42 days) by April 2017. In parallel to the initiative, the wider impact of the QI project was investigated. Through the combination of change ideas tested and implemented, all four MAS clinics were successful in meeting the primary project aim. The combined mean time between referral received by psychology and report finalised reduced by 28.76 days from 65.1 to 36.34 days, and with reduced variation across the clinics. These changes were sustained throughout the duration of the project and beyond, and successful change ideas were incorporated into routine practice with control methods developed. Exploring the wider impact, a focus group with six psychology staff members involved in the project was also completed. Thematic analysis identified three themes from the focus group: staff impact, service impact and service user impact. Further subthemes were identified regarding both desirable and undesirable impact across the system. The approaches used may be useful for other services embarking on reduced wait time initiatives for access to care. Additionally, understanding ongoing areas of impact on staff, the wider service and service users can help reduce or mitigate undesirable or unintended consequences and work towards sustainability of such changes.
- waiting lists
- process mapping
- control charts/run charts
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Contributors HD initiated the project and acted as project sponsor, contributed to project design, data collection and analysis and drafted and revised the paper. She is guarantor. EE acted as project lead, contributed to project design, data collection and analysis, and drafted and revised the paper. LC designed the qualitative project, collected and analysed qualitative data, and drafted and revised the paper. ET contributed to project design, data collection and analysis, and drafted and revised the paper. AC contributed to project design, data collection and analysis, and drafted and revised the paper.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article.
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