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Blog: Equity and quality improvement

Mental health & addiction quality improvement
05 July 2019

Dr Clive Bensemann is the Counties Manukau Health Clinical Lead Integrated Care Mental Health & Addiction and leads the Health Quality & Safety Commission’s mental health and addiction quality improvement programme. In this blog Dr Bensemann explores how quality improvement methodologies, and the paradigm of unconscious bias, are helping address equity issues for Māori and Pacific peoples.

Our quality improvement programme is about increasing safety, reducing variation, improving the care we provide, and improving tangata whaiora (mental health consumer) experience. Addressing equity issues is central to success.

The quality improvement process is continuous, involves testing change ideas, and measuring change. It empowers frontline teams. Using co-design approaches staff can incorporate consumer and family/whānau expertise into planning and testing change ideas. This recognises that workers, tangata whaiora and whānau each have their own unique experience and are often best placed to develop solutions. Quality improvement is all about innovation.

Eighteen months into our programme it is fantastic to see how readily the sector is embracing the quality improvement approach. Many organisations have already been using quality improvement methodologies, but the training the programme has delivered has really helped spread the understanding and interest in using these methods more in mental health and addiction services.

Māori values are emerging as a key element of change. Services are innovating and it’s often the simplest solutions that work best. Ensuring tangata whaiora are welcomed properly into services, improving the reception area, taking an active and empathetic interest in the lives of tangata whaiora – these things can make a measurable difference. As an example of this, Counties Manukau Health has put manaakitanga at the heart of their quality improvement initiative.

Health equity, and highlighting the needs of Māori and Pacific peoples is emerging as one of our most important areas of focus. We need to challenge ourselves to make equity central and embrace Māori and Pacific knowledge. To reach our goal of zero seclusion we must find ways to specifically eliminate seclusion for Māori who currently are at twice the risk of non-Māori of experiencing seclusion.

Over the recent months, we have facilitated hour-long zoom tutorials on unconscious bias. The tutorials have been well attended with up to 40 participants from mental health and addiction services connecting in from around the country. We propose that unconscious bias contributes to the inequities for Māori and Pacific peoples in seclusion as well as in other outcomes. Unconscious bias challenges us to support one another as we explore our biases and how they influence our work. That approach needs to be collaborative and non-blaming.

We further developed this work with two half-day unconscious bias workshops which we delivered in Auckland and Wellington in May. As well as delivering more in depth content about unconscious bias, we wanted the training to be practical. We are giving some thought to measurement. What changes do we want to see as a result of this training and how will the changes be evidenced? If we have impact through this work then seclusion rates for Maori and Pacific peoples should fall more rapidly.

Developing our equity strategy and approach has been one of the most exciting aspects of our programme. The data has been depressingly consistent for decades with Māori and Pacific peoples over-represented as tangata whaiora in specialist services. As we watch services embrace quality improvement, and explore different paradigms like unconscious bias, we believe change will result, and that this is well within our sphere of influence.

Our areas of focus

  1. Aukatia te noho punanga: E whai ana ki te whakakore i te noho punanga i mua o te 2020 | Zero Seclusion: towards eliminating seclusion by 2020 (minimising restrictive care)
  2. Te tūhono i ngā manaakitanga: te whakapai ake i ngā whakawhitinga ratonga | Connecting Care: improving service transitions
  3. Te ako mai i ngā pāmamaetanga taumaha me te wheako kiritaki | Learning from adverse events and consumer, family and whānau experience 
  4. Te whakanui ake i te hauora ā-tinana | Maximising physical health 
  5. Te whakapai ake i te whakahaere rongoā, i te tūtohu rongoā hoki | Improving medication management and prescribing

Author: Clive Bensemann

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