Restructure of the model of care in a regional psychology department, in order to increase provision of service to consumers

Rachel Bega

Queensland Health, 475 Bridge Rd, QLD, 4740, Rachel.bega@health.qld.gov.au

Most Allied Health departments in the public health system adopt one of two models of care: a centralised referral system where all referrals are received through a single point of contact and then triaged and allocated to staff, or an allocation of staff to the various units or areas within the hospital. This latter model was the one initially adopted at the Mackay Base Hospital, which resulted in an inefficient use of very limited resources. A restructure of the model of care was implemented, which included two major changes: 1) A change from allocation of staff to various units, to a central referral system and 2) a change in semantics. These changes resulted in an increase of 100% in the number of patients seen by the psychology department. It is suggested that this model of care is ideal in a regional setting, where limited resources are available.

Background

The Psychology Department at the Mackay Base Hospital comprises 6 staff members, typically allocated to various units such as the Renal unit, Diabetes clinic, Paediatrics etc. This led to an inefficient use of clinician time as staff would for example be allocated to a unit for 2 days a week but only be utilised at 25%. Flexibility to shift the workforce to areas of greater need was limited, due to the fact that they had been allocated to a specific unit. This model also limited access for patients who would only be provided with Psychological Services if they were already receiving services from the units that had an allocated psychologist. It was very conservatively estimated that approximately $67000 in labour was being wasted every year by utilising this model.

Methods

A centralised request system was established whereby requests were accepted from all areas of the Mackay Hospital and Health Service (both inpatients and outpatients).

A distinction was made between referrals and requests. Whilst a referral implies the patient’s care is being handed over, a request allowed us to provide services in a variety of ways: direct service to the patient, consultation with the treating team and occasionally redirection to a more appropriate service.

All requests were actioned.

This model enabled increased flexibility in the allocation of psychological services by allowing the department to move its labour resources according to demand. In some cases, where it was deemed that a single clinician would be more beneficial in order to ensure excellency in patient care, an individual psychologist continued to be allocated. For units that did not have an allocated psychologist, every effort was made to triage referrals from specific units to a single clinician in order to encourage relationship-building within the unit. For example, the majority of the oncology referrals were sent to a specific clinician who also attended oncology clinical reviews. At times of high demand from the oncology department however, we were able to draw upon other psychologists.

Results

The number of Occasions Of Service (OOS) were utilised as a measure of the effectiveness of this model of care.A survey is also currently being developed in order to collect qualitative data regarding satisfaction levels with the use of the service.

As a result of the new model of care, we were able to double the number of Occasions Of Service, resulting in approximately 100 patients receiving psychological services over a period of 3 months, who would not have previously benefited from psychological input.

Discussion

Modelling suggests that our Health System will come under increased pressure with an ageing population. It has also been suggested that the growth required is unsustainable.

It is therefore important that we identify models of service that maximise on our resources, especially in regional, rural and remote areas, where resources can be limited.

This model of service did not require any additional funding, yet resulted in a 100% improvement in efficiency.

Biography

Rachel Bega holds a Masters in Clinical Psychology and a Certificate in Business Management. She initially trained and worked in South Africa, then Melbourne, across both the public and private health sectors, as well as as the penal system. She currently heads the psychology department in the Mackay Hospital and Health Service.