HIMAA Conference, July 28Th 29Th 2005

HIMAA Conference, July 28th – 29th 2005

Paper Submission

Title of presentation: Quality and Service Development for Mental Health in Rural Western Australia: HIMpossible?

Principal author:

Rachel Wright

Snr Project & Quality Management Officer

Postal address:

Rachel Wright

Snr Project & Quality Management Officer

C/O Community Mental Health

Callistemon House

PO Box 1411, Albany WA 6331

Please mark: Personal staff mail: Private and confidential

Email address:

Phone: (08) 9892 2440

Fax: (08) 9842 1028

Author’s organisation:

Great Southern Mental Health Service

Based in Albany as a part of the Western Australian Country Health Service

Brief background of Author:

As a mature aged student, I graduated in December 2002 receiving a Bachelor of Science (Health Information Management) with distinction from Curtin University, Perth, Western Australia. I developed a passion for rural HIM during university and prior to graduating applied for and was offered a job as a Public Health Project Officer in the Great Southern Health Service’s regional Drink Driving Intervention Program. Since that time I have held other positions in Public Health as a Project Officer working with the aboriginal community in the Great Southern, Release of Information Officer (Albany Hospital) and Relieving Health & Corporate Information Services Manager at Albany Hospital. Drawing from both my student employment as a Clinical Coder in a mental health setting and project experience, I am now in the position of Snr Project & Quality Management Officer for the Great Southern Mental Health Service. In this position I use my HIM skills towards the running of a mental health quality improvement program and project work for a region which spans 86, 0002 kms with a population of 67, 528.

Abstract of ‘Quality and Service Development for Mental Health in Rural Western Australia: HIMpossible?’ paper

As Health Information Managers (HIMs) we have an enormous breadth of knowledge across a whole spectrum of domains, however as professionals we face the conundrum of a limited number of ‘traditional’ medical record department positions based in the acute setting. With a smaller population base in Western Australia, increasing numbers of graduates and fewer traditional HIM positions this is the challenge we appear to be currently facing. Is the HIM profession fully exploring the employment options available to us? Do we use the full range of our skills, or are we reluctant to look outside the comfortable traditional roles? As a HIM working in a non-traditional area of Quality and Service Development in the rural mental health sector, I have found my skills in data collection and analysis, management concepts, knowledge of health information processes and problem solving ability to be an enormous asset. This is a rare position in rural mental health services in Western Australia, which is an exciting extension of the traditional HIM role. The potential for the creation of similar positions in both mental health and other areas such as population health is ever present. Data and health information management skills are at the forefront of demand, with such demand only likely to increase given the escalating trends towards evidence based practice and the role of health information in the allocation of increasing demand for limited resources. In this paper, I will explore the role of HIMs and their potential transition into non-traditional areas through the skills we offer and the rewards, both for the HIM profession by broadening the scope of employment and the personal development opportunities and for individual HIMs. As HIMs we are in a unique position to alter our focus, take up the challenge and reap the rewards.

Paper: Quality and Service Development for Mental Health in Rural Western Australia: HIMpossible?

Introduction:

Working in the area of quality and service development there are two key concepts which I view as being essential to the way in which outcomes are achieved. Firstly, evaluation. For obvious reasons this is one of the essential building blocks of the quality cycle and an element that is crucial to the delivery of evidence based and best practice concepts within the health care setting. Secondly, the word catalytic. The Macquire Dictionary defines a catalyst as being a ‘person or thing that acts as an agent in stimulating or causing change’[1].

I see the need for catalysts within the Australian HIM environment as real, presenting a challenge that both our industry and we face as individuals. As professionals we face the conundrum of a limited number of ‘traditional’ medical record department positions based in the acute setting. With a smaller population base in Western Australia, increasing numbers of graduates and fewer traditional HIM positions this is the challenge we appear to be currently presented with.This environment also harbors fear, but what is so often forgotten is the new opportunities and potential that change brings. I believe these opportunities far outweigh any fear, allowing HIMs to apply their skills to new areas, to grow as individuals, to provide professional visibility and to forge new HIM employment trends.

Quality and Service Development

I would like to share with you how HIM has been a catalyst for my career. I am employed in the non-traditional area of Quality and Service Development for a mental health service in rural Western Australia. As a Snr Project & Quality Management Officer I form part of the management team working within the Great Southern Mental Health Service (GSMHS), an area which spans 86, 0002 kms and encompasses a population of 67, 528 individuals[2]. The GSMHS incorporates both the Great Southern and Wheatbelt health regions, including a total of 28 local government authorities and 31 towns. The GSMHS provides both acute and community based mental health services across the streams of Children and Adolescents, Adults and Seniors. The three main sites where staff are permanently based are Albany, Narrogin and Katanning. The incumbent of this position is traditionally based at the Albany site, which is located 409 kms from Perth being the southern most city in Western Australia. The towns of Narrogin and Katanning are located to the North of Albany, with Narrogin at 260kms being the furthest northern staff base of GSMHS. Katanning is located 106 kms from Narrogin in a Southerly direction.

The position of Senior Project and Quality Manager is responsible for the coordination of the GSMHS Quality Management Program using both the Australian Council of Healthcare Standards (ACHS) and the National Mental Health Standards (NMHS). The position is also responsible for the identification of service development opportunities and the implementation of initiatives to meet the overall objectives of the GSMHS. In this position my role is also to provide research, data collection and analysis skills as well as other supportive skills to the Management Team. In conjunction with the Manager, I am responsible for coordinating the development of strategic plans, annual business and operational plans and policies and procedures including community and consumer input. A considerable aspect of my position is to write business cases on behalf of the service which, when successful bring additional resources that allow clinical staff to provide core services in areas of need.

This position allows me to use my HIM skills of data collection systems, analysis and reporting in areas which can directly affect service development and as you may expect my HIM skills receive a daily workout. I can honestly say that, although stressful and at times frustrating, I enjoy the challenges and personal development opportunities my current position offers me.

Rural Employment

Working in the rural health sector has distinct disadvantages but also comes with equally satisfying advantages. I graduated from Curtin University, Perth in 2002, and therefore still consider myself a ‘new grad’ with a great deal to learn, however one definite aspect of employment within the rural sector is the provision of a steep learning curve. Providing HIM professional support to other HIMs working in rural Western Australia is challenging for many reasons, with distances to Perth often vast and work demands strenuous. Personally, I have found my horizons have been broadened in line with the multi-disciplinary environment in which I operate. I believe such an environment promotes learning on a deeper level, which has provided me with the advantages of enhanced strategic thinking, project management skills, leadership and the direct application of health information to service development in new ways. I no longer see HIM as a ‘silo’ profession, but a profession which has a plethora of applications and skills to offer the multi-disciplinary environment.

Opportunistic growth

As a HIM profession we are presented with an increasing number of graduates, but a limited number of traditional medical record department positions based in the acute setting. As HIMs, do we fully explore the application of our skills across the full health care environment? Are we reluctant to look outside of the traditional roles? Do we fear change? I freely admit I was fearful of taking a non-traditional position. Fearful that my HIM skills would not be enough to meet both my personal and employers expectations.

What I have discovered and would like to reiterate, is that HIM data management skills are the unique mix that have allowed me to exceeded expectations and at times strengthen the delivery of service development. HIM skills are relatively unique and highly transferable. Rural HIMs often have extensive and varied responsibilities and therefore tend to become generalists across a wider variety of jobs due to the adaptability of their skills. Employment positions for rural non traditional areas are freely available, however they are not titled with the traditional HIM title, and sometimes often don’t even call for a HIM degree, rather a ‘relevant tertiary qualification’. Because of recruiting and retention issues in the rural sector of Western Australia it is unfortunate that we have difficulty recruiting to health positions in general, hence the ‘relevant tertiary qualification’ criteria. However, it is within this opportunistic environment where HIMs can thrive and reap the benefits.

HIMs as Catalysts

The current economic climate of health sees escalating trends towards both evidence based practice, and health information management in the allocation of limited resources to ever increasing demand. As HIMs we have the knowledge of data collection systems, processes and analysis skills that see us ideally placed for employment in these new areas. These skills combined with project management, strategic, conceptual, problem solving skills and knowledge of management principles see HIMs as far better placed for these roles than several of the more traditional clinical professions. The employment arena for HIMs is rapidly expanding. With this expansion comes opportunities for personal and professional growth particularly in non-traditional areas. It is my aim to deliver a challenge to delegates attending this conference. The challenge is to be a catalyst. As HIMs we are in a unique position to alter our focus, take up the challenge and reap the rewards.

The expansion of HIMs into non traditional areas is not a concept - it’s an attitude. This new attitude not only adopts new concepts, but also has the innovation to create new visions. It is the recognition of opportunity and the associated rewards. HIMs have the skills to thrive in new employment environments and to establish themselves as experts in new fields. If we fail to establish ourselves in these new fields, other health professionals will.

We are not alone in recognizing the need for change, The American Health Information Management Association (AHIMA) in June 2004 published a study of interviews of over 100 employees (HIMs, executives and managers) from nine HIM employers[3]. The article focused on the changes employers perceive as being required by the American HIM profession in order to survive into the next decade and included the following quote;

‘Increasingly, healthcare organizations are moving from silos of practice to continuums of care. They are structured as matrices, teams, and project-orientated work groups. As organizations change, the professional roles within them also change. Health Information Managers increasingly are found in a variety of organizational units in a variety of roles as HIM becomes less centralized and less departmentalized’.

In January 2005, Mervat Abdelhak published an article that focused precisely on the issues of opportunistic change faced by the American Health Information Management Association (AHIMA)[4] in response to the Electronic Health Record. The article was titled ‘Maintaining Momentum: Breakthroughs Abundant for 2005’ and outlined an analogy of change through cumulative effort. Abdelhak asked his readers to imagine a heavy flywheel fitted to an axle, then set readers with the task of creating enough momentum to spin the wheel on that axle with as much speed as they could, for the longest duration they could manage. Initial efforts to rotate the wheel come at great effort and seem almost impossible, with movement barely visible. As the wheel gains speed, rotations become faster, but we still need to push in order to keep the wheel turning. Suddenly, momentum kicks in and the weight of the wheel causes the rotations to accelerate rapidly. You exert no additional effort than before, however momentum now causes the wheel to spin with an energy that is unstoppable.

We can use this analogy to view the new opportunities available to HIMs in Australia. As an individual where do you stand in respect of the wheel? Do you have the attitude of change that motivates you enough to move forward and exert all your effort in a non-traditional or new area? And when you step forward, are there others at the wheel exerting effort, or is it just you? How do you feel we are progressing towards change as a HIM profession? You may be a HIM employed in a traditional role, and have no desire to raise a sweat to gain wheel momentum. Think about how you can support those actively seeking new opportunities. It may be something as simple as mentoring a student, or lobbying a HIM degree as criterion for a new position.

A collective effort for all HIMs is required and once momentum is gained, we will all reap the rewards. I’d like to think we are slowly gaining momentum as a profession and actively seeking new opportunities for the expansion of the HIM employment arena. The opportunities for HIM in the future has the potential to be an exciting roadmap, with our skills being the vehicle allowing us to reach any destination. Who’s creating momentum by turning the wheel and what destination are you driving towards?

1

[1] Blair, D. (Ed.). (1984).The Pocket Macquarie Dictionary. Suffolk: The Chaucer Press.

[2] Australian Bureau of Statistics. CDATA 2001 – Full GIS. Commonwealth of Australia 2002.

[3] Wing, P & Langalier M.H. (2004) The Future of HIM: Employer Insights into the Coming Decade of Rapid Change. Journal of AHIMA, 75 (6), 28-32.

[4] Abdelhak, M. (2005) Maintaining Momentum: Breakthroughs Abundant for 2005. Journal of AHIMA, 76 (1):8.