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Four key approaches to change SeCtion one
table B2: Key stages of the Assessment & Care Management Process
Stage Details of process
Referral Receiving contact, taking initial details, signposting to other services if appropriate, assessing if a full assessment is required
Assessment Assessing need, identifying personal support networks, consider eligibility and calculating personal budget
Care planning Developing support plan that builds on personal and community support networks
Reviewing Reassessing eligibility, personal budget level and meeting of outcomes
Crisis Assessing presenting need and risk, liaising with relevant services and arranging support package in short timescale
Manager B wanted to engage all the team members in an event to consider how the pathway could improved. The improvement team advised that this would mean too many people would be involved and the event difficult to manage. He therefore asked the senior practitioners to meet with the staff that they supervised and to explore with them their responses to the three questions above and to ask for volunteers to attend the improvement event. They also ideally wanted to involve people who accessed services in the event, but due to the variety of people that the team supports could not see how this could be done in practice. Instead he decided to begin with presentations of the feedback that had been gained from the stakeholder consultation, and summaries of were written on flipcharts around the room. Participants were allocated responsibility for raising the issues from different stakeholder groups at appropriate steps on the pathway.
The improvement event was timetabled to last three days and was facilitated by the mentor from the improvement team. This enabled Manager B to participate in the discussions. Following an overview of the process, it began with the presentations on the feedback from the stakeholders regarding the current service provided. A long roll of paper was then placed around the room and the sticky notes developed in the previous stage were used to illustrate different elements of the current process including the key areas of ‘waste’, ‘potential value’ and ‘ways to improve’.
On the second day they began by discussing the key areas of ‘waste’ that had been identified and trying to understand what the issues were that led to these. To help them explore the underlying reasons behind the waste they used the 5 whys exercise (Table B3).
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