Thinking about starting CAPA? Most of us need to have a good reason to change and enough information to weigh up the pros and cons… A bit like going to see someone for help with a problem!
Why think about starting CAPA?
First of all, you may not need to. Your current system may be working well. But what does ‘well’ mean? We sometimes hear that there is no need to start CAPA, as the service has no waiting list. We do not see CAPA as a waiting list management tool, but having no waiting list is a delightful secondary benefit. CAPA ensures doing the right things with the right people, at the right time, and by people with the right skills. So it is a system that helps you add quality to your service by ensuring client involvement, staff competence and timely interventions that do not involve the service user in unnecessary delays. How could it help?
What is the evidence it works?
At the time of writing (January 2013) we have not been able to collate the entire audit being under- taken by services using CAPA. But we know many teams that use CAPA are evaluating it. Some people are writing PhDs on it. We have included some evaluation and stories in this book and keep an eye on the website for updates. www.capa.co.uk
Evaluation in the UK and New Zealand show that service users are seen quickly, feel listened to and involved. Waits and DNAs are reduced when compared to non-CAPA systems. Staff describe increased job satisfaction, higher morale and improved team working.
None of this is surprising as CAPA is founded on demand and capacity theory and things that are known to improve outcomes for services users. We hear from services that they find it a really useful system on many levels. It gives increased clinician job satisfaction, accessibility and client engagement, clear systems and improved clarity of information for funders and commissioners.
Some quotes from services using CAPA:
‘We have been running the model for two years now and still no waiting list despite staff changes and cuts to the service.’ When we decided to implement the new sys- tem it did seem like a leap of faith, it was a huge amount of work to get the system off the ground but two years down the line the effort was easily worth it! Evaluating has helped us keep on track but as soon as we started CAPA we knew we would never go back to our old ways because the new ways felt so much better for us and for the families. Our service as a whole has started to value CAPA more in the context of dealing with an increase in referrals following the earthquakes.’
What’s in it for…
…the service user?
A focus on what they want to be different, choices of help, clarity in care planning, timely contacts and the service being designed around them. No unnecessary waits.
Clear and manageable workload that is designed around your job plan. Engaging with clients in a more effective way and with improved multi-agency working. Brings the quality and creativity back to work.
…the admin staff?
Admin usually find that they have more time. They know what the team are doing and when and can inform service users. Involvement in full booking at Choice often increases satisfaction for admin staff.
Meeting targets, clarity of service provision and activity makes life easier. Satisfied clinicians with manageable job plans leads to happy managers…
…the funders and commissioners?
Any service running CAPA will be able to demonstrate what they are doing and to whom. They can provide data on their capacity and activity. Pathways will be clear. It is easier to make commissioning choices in light of the transparent processes.
Have a think now… you may want to get a piece of paper and jot your thoughts down…
1. What is your current situation?
Do you have a waiting list? Do you get complaints from other agencies because they see your ser- vice as not very accessible?
Would you like to do something different? Is your organisation or commissioners demanding you do something different?
2. What do you want to be different?
For your clients they may want to be seen in a timely way, be involved in decision making with you and have choices about what happens. For clinicians the focus may be to deliver a higher quality of service. For a manager it may be to meet waiting time targets. For admin staff it may be to know what the clinicians are doing and having smooth processes. Commissioners may want to be clear about what is being provided and its effectiveness.
3. CAPA can give you some clear first steps.
For many teams, the attraction of CAPA is an off- the-shelf model that can be tailored to individual circumstances. The steps to implementation are straightforward and documented. For the things you want to change, do you have a clear plan?
Are there any disadvantages?
It depends what you call disadvantages. One person said ‘[CAPA] does challenge clinicians to work outside their specialist model, as well as tasks they normally had control of are now taken over, i.e. admin booking appointments, generic [Core Partnership] roles alongside other [Specific] work.’
Another challenge is that CAPA is a transparent model. In traditional models once you assess a client and close the door no-one really knows what happens. Some people feel uncomfortable with the frequent multidisciplinary peer supervision, selection of clinician by skills and the monitoring of activity. However, this feeling dissipates once the system gets going. Sharing work and having a learning environment can be very satisfying.
There are a number of myths about CAPA that are often cited as disadvantages. Read about them later in this chapter and see if you recognise any.
Finally, many services find that their referral rate increases as they become increasingly accessible and responsive. You may see this as a disadvantage. But this increase in referrals may not be for ongoing work, Partnership, but for initial contact, Choice. If there is a real increase in demand CAPA enables you to demonstrate this and define your capacity. This helps negotiation with funders and commissioners.
Does it always work?
We have not yet found a service where CAPA fully implemented, has not worked in terms of improving the service to clients and making things better overall for the staff. We do sometimes hear ‘it doesn’t work!’ [Sometimes in the team I work in! But we have always slipped in our processes… Ann]. When we find out what is going on it is invariably that few of the 11 components are in place. Services are sometimes following a CAPA myth or not adapting it within the 11 components to suit their local circumstances.
Common things that increase the experience of ‘it’s not working’ are:
- Full booking not being in place
- No team job plan
- No activity targets
- No monitoring of processes
- Using the words but not changing the system e.g. calling a first appointment Choice but not using a Choice framework nor providing a therapeutic experience in the first contact.
Sometimes people feel that CAPA will always ensure no waits. Whilst you can guarantee that the wait to Choice will be short if you match your capacity to demand, the wait to Partnership will increase if you do not have enough capacity. One clinician in a service and a million accepted referrals a year will obviously not work. Even if using CAPA. But what CAPA can do is enable you to demonstrate your demand and capacity balance.
Smoke and mirrors….
Sometimes we hear people say that CAPA seems to work by magic and they can’t understand why it works…
There is no mystery. It is developed from theory that is known to improve flow and effectiveness, including Lean Thinking combined with factors that increase effectiveness of interventions through enhancing task and therapeutic alliance. The evidence is all those services that find it works for them in practice.