Analysis Framework

The 7 HELPFUL Habits of Effective CAMHS are useful and five of them act directly on bottlenecks.

The 7 HELPFUL Habits of Effective CAMHS is a framework of demand and capacity theory, integrated with our clinical and theoretical experiences, in CAMHS language. We wrote this in 2004 after having undertaken separate training on demand and capacity. Then we noticed that although frameworks such as 10 High Impact Changes for Service Improvement (NHS Modernisation Agency, 2004), 10 High Impact Changes for Mental Health Services (CSIP, 2006) and the training and literature available on demand and capacity management were useful, little of the language or examples was easy to translate to CAMHS – it was usually about orthopaedic outpatients! So we translated it!

The 7 HELPFUL habits (an acronym) have 7 areas to focus on. These are:

Handle Demand
Extend Capacity
Let Go
Process Map
Flow Management
Use Care Bundles
Look after Staff

CAPA and the 7 HELPFUL Habits

CAPA integrates many of the HELPFUL Habits into a clinical system that you can use as an off the shelf model. Using all the Habits will further enhance your service. We’ll present them below and then think through a few examples.

Reducing demand:

• HANDLE DEMAND,

• PROCESS MAPPING AND REDESIGN and

• FLOW MANAGEMENT

Increasing Capacity:

• EXTEND CAPACITY,

• PROCESS MAP AND REDESIGN and

• LET GO

In more detail…

Handle Demand

The items under Handle Demand that are particularly relevant in managing bottlenecks, by reducing demand, are:

1. Eligibility Criteria: what is needed to get into this process? Can this be amended? Who makes the decision?

2. Diversion Criteria: who else could do this?

6. Full Booking: no waiting lists…

7. Screen referrals directly: how do you know that all are appropriate? And who decides?

8. Flex capacity: could this help?

(The numbering of the items is as that in the 7-HAT [the 7 HELPFUL Habits
evaluation questionnaire])

Extend Capacity

The Extend Capacity items that can help you wid- en the bottleneck are:

9. Know capacity: how much of this process (Specific intervention/assessment) can be done? Can we plan for the activity or set an activity level (this is the CAPACITY reason of why we plan for Specific work)

10. Follow-up focus: could anything make this process more effective/briefer?

12. Extend clinical roles: KEY TASK… Can the capacity at that step be wider? Can some of the skill be devolved to an earlier step? Are there enough core skills before this Advanced skill? E.g. do you need to train more people up to do Core level CBT?

14. Monitor Activity: how well is this step used? E.g. DNA’s?

Letting Go

Some specific clinical work streams will have spe- cific partnership numbers planned (i.e. how many to start in a set time period). However for others if there is not a set new activity level then take up rates depend on discharge from the Specific com- ponent. Thus sometimes the flow is blocked by an outflow issue and so the Let Go questions are:

16. Closing case variation: reducing variability in the process. This means having ways to be more consistent in the discharge of the pa- tient from this intervention. Having a consist- ent reviewing process. Just carrying on is too easy to do. All the evidence is that it is our var- iation in practice that has the main impact on poor flow (see Variation in the Demand and Capacity Theory www.capa.co.uk). How many surgical patients are discharged on Christmas Eve? How many cases can you close when you are leaving your job? Amazing!

17. Care plans: is the process clear? Are goals clear? How do you know when the work is finished? Are you using routine outcome measures?

Process Mapping

Process Mapping will enable you to identify the steps in the patient pathway:

19. Process Map and Redesign: aim to get rid of those that do not add value to the service user. You will be amazed how many are there for the organisation and not the client.

Flow Management

The Flow Management item that relates directly to bottlenecks is:

29. Something to Do: does this step add value for the client?