Improving Metabolic Screening and General Physical Health for Rural and Remote Mental Health Consumers Using Lean Practices

Brian Mayahle^1*, Stephen Parnell², Anthony welch³, Jennifer Barr⁴ & Fumiso Muyambo⁵

¹Central Queensland rural and indigenous mental health services Manager
²Director operations and Innovations CQHHS
³Associate professor, Associate Professor Mental Health, Discipline Head, MentalHealth, CQUniversity, Australia
⁴Associate professor, Deputy Dean of Research, Central Queensland University, Australia
⁵PhD student, Disaster Management Training and Education Centre for Africa (DiMTEC) Faculty of Natural and Agricultural Sciences, University of the Free State, Bloemfontein, South Africa

Brian Mayahle, Central Queensland rural and indigenous mental health services Manager.

Keywords: Lean; Rural and Remote Mental Health; Metabolic Screening; Schizophrenia; Bipolar; Antipsychotic Medication

Abstract

Aim
To improve metabolic screening for rural and remote mental health consumers.
Background
Monitoring and treatment for physical health conditions including metabolic syndrome in mental health consumers taking antipsychotics is generally poor in comparison to the general population [1]. Mental health consumers in Central Queensland regional, rural and remote areas have a challenge securing regular and consistent physical health checks, due to the general inaccessibility of health professionals in rural communities. As a result, some mental health teams are now allocating responsibility of Metabolic screening to community mental health nurses to increase compliance. However, this approach creates consumer dependency on secondary mental health care services and additional workload to the already stretched mental health nurses. The impetus of this paper, therefore, is to present the application of Lean to improve the flow of information between secondary and primary health services, for consumers that require metabolic screening and treatment to have their metabolic screening conducted by GPs under a share management plan.
Method A chart audit tool, based on Gearing, et al., (2006) chart audit review framework, was developed [2]. It was used to review consumer records pre- and post-Lean implementation, to ensure that all consumers who had an open episode to the service diagnosed with bipolar, schizophrenia and prescribed antipsychotic medication, were offered an opportunity for metabolic screening through their general practitioners (GPs).
Lean Intervention Lean Intervention included Kaizen (rapid improvement) three-day workshops which were conducted with operational staff to develop standard work instructions, huddles and visual management systems to constantly monitor consumers, who were newly diagnosed with schizophrenia, bipolar disorder and were prescribed antipsychotic medication. A communication plan was developed to ensure effective collaborative working between GPs and rural community mental health teams.
Key results
• Improved awareness for the clinicians to offer consumers an opportunity to participate in metabolic screening.
• Improved recording of the opportunities offered by clinicians to the consumers in the consumer’s electronic charts.
• Clear communication process with GP practices regarding metabolic monitoring.
• Increased participation of rural mental health consumers in metabolic monitoring.
Conclusion The findings are indicative that Lean philosophy can be applied in rural and remote mental health services to improve the participation of mental health consumers in metabolic screening and subsequently improve their general physical health through effective collaborative working between secondary and primary health services.

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