A mid-programme evaluation of the mental health and addiction (MHA) quality improvement programme was carried out by Francis Health and Kahui Consulting in 2020. Thank you to all those who took part – we really appreciate your considered and thoughtful feedback. The findings provide valuable insights for the programme approach and areas of future focus.
A mixed-methods approach that incorporated a Māori-centred research methodology was used to gather and analyse data. It included a literature scan; review of documents and the measurement framework; interviews and focus groups; and a stakeholder survey. The evaluation team engaged with over 130 people during May to June 2020, who generously offered their time.
They included district health board (DHB) quality improvement project team members and their sponsors, consumer advisors and the consumer advisory group, Māori advisory group members, leadership and stakeholder group members, DHB and Health Quality & Safety Commission managers, and members of the MHA quality improvement programme team.
What’s working well
The evaluation identified a number of areas where stakeholders felt the programme was working well, including the focus on involving frontline staff in quality improvement, having respected leaders on the programme team, and useful regional and national collaboration and sharing. The five priority areas selected as improvement projects were endorsed.
It was felt there has been a concerted effort to address Māori health inequities, and there was strong support for the implicit bias work initiated by the MHA quality improvement programme team.
All project teams spoken to reported that consumers and whānau were involved in their project teams and that expectation had been established by the MHA quality improvement programme team. However, there was considerable variation between the DHBs in how the consumer voice was incorporated into the project.
Areas of improvement suggested in the evaluation included:
- the programme being more responsive to sector feedback with reference to the Ngā Poutama consumer, family and whānau survey, and the naming of the zero seclusion project
- more clarity around programme governance and the purpose and role of the consumer and Māori advisory groups, and the stakeholder group
- clearer messaging about when projects end and how success is measured
- clearer communication channels.
Challenges identified within DHBs included:
- competing priorities and budget constraints
- the need for more engagement between the DHB project team and the DHB sponsor, operational managers, frontline clinicians and clinical leaders
- inconsistent understanding of quality improvement at management level.
The evaluation suggests the following areas for future focus:
- programme governance and stakeholder relationships
- project set up, end point and stakeholder engagement
- a clear and feasible measurement strategy
- clarity of programme timelines and endpoints
- enhanced Māori health equity focus
- a more strategic communications approach.
The MHA quality improvement programme is taking time to consider the evaluation findings, and how to make changes in response to suggested areas of improvement.