Abstract
BackgroundRecognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. However, actually bringing fully integrated services to life has eluded most health care organizations. Mental health has followed the rule, rather than the exception, when it comes integrating services. The lack of effective mechanisms to evaluate the needs of persons across mental health care services has been an important barrier to communication between professionals involved in care. This study sought to understand communication among inpatient and community-based mental health staff during transfers of care, before and after implementation of compatible assessment instrumentation.MethodsTwo focus groups were held with staff from inpatient (n = 10) and community (n = 10) settings in an urban, specialized psychiatric hospital in Ontario (Canada) – prior to and one year after implementation of compatible instrumentation in the community program. Transcripts were coded and aggregated into themes.ResultsVery different views of current communication patterns during transfers of care emerged. Inpatient mental health staff described a predictable, well-known process, whereas community-based staff emphasized unpredictability. Staff also discussed issues related to trust and the circle of care. All agreed that compatible assessments in inpatient and community mental health settings would facilitate communication through use of a common assessment language. However, no change in communication patterns was reported one year post implementation of compatible instrumentation.ConclusionsThough all participants agreed on the potential for compatible instrumentation to improve communication during transfers of care, this cannot happen overnight. A number of issues related to trust, evidence-based practice, and organizational factors act as barriers to communication. In particular, staff noted the need for the results of comprehensive mental health assessments to be transformed into meaningful, user-friendly clinical summaries to facilitate uptake of assessment information, and consequently use of a common assessment language across mental health settings.
Highlights
Recognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade
Pre-implementation communication and collaboration during transfers of care Very different themes emerged related to current communication patterns during transfers of care
As this study focused on two specific instruments (i.e., Resident Assessment Instrument – Mental Health (RAI-MH) and interRAI CMH), future work should seek opportunities to explore the extent to which other jurisdictions use alternative compatible instrumentation technologies and their impact on staff communication
Summary
Recognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems worldwide for the last decade. Recognition that integrated services can lead to more efficient and effective care has made the principle of integration a priority for health systems for the last decade. Craven and Bland [2] found that several factors are key to successful collaboration in mental health care, including supportive structures, organization re-organization, and buy-in from staff. These authors reported that shared assessment, decision-making, and treatment planning contribute to high levels of collaboration among staff. These findings were reinforced in a review by Lee, Crowther, Keating, and Kulkarni [3] - they reported that communication between staff was enhanced through use of shared assessments and care plans
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