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WP7 (PCSP) – Getting Going: Designing and Conducting a Stocktake

Getting Going: Designing & Conducting a Stocktake

Introduction

At this stage of the project, you will be analysing the ‘as is’ state of the current culture, processes, practices and people before implementing the new PCSP standard for mental health. In order to obtain a clear understanding of the gaps between where you are and where you are going, you must first ‘take stock’ of the current situation. In this section you will learn what a stocktake is, how to conduct them, who needs to be involved and how to encourage participation.

What are the key features of a good stocktake?

  • To provide a vehicle for telling people about your transformation objective and getting them on board with the idea
  • To understand the 'problem' you are trying to fix
  • To better appreciate how your sense of the situation differs from that of the other stakeholders
  • An opportunity to bring people from different stakeholder and professional groups together to collectively reflect on differing approaches, culture and language
  • Designed to reflect that the implementation of the PCSP standard is a people-based cultural endeavour as much as a technology project.

Read more on key features of a stocktake here and click here to read ‘What to take into consideration’ before embarking on your stocktake.

Community Mental Health Care Planning Toolkit:

Getting Going

Designing your own stocktake

In designing your own Stocktake it is helpful to consider what range of evidence you want to generate from the workshops or elsewhere. 

The conducting workshops matrix (opens in new tab) sets out what items, examples, and evidence to consider collating before and during a Stocktake. This resource is downloadable from the resources page.

For the Stocktake to effectively contribute to your PCSP standard implementation initiative the workshops need to be designed to elicit the appropriate information and intelligence for you to really understand where you are starting. You need to:

• Be prepared to hear what you don’t want to hear

• Have your assumptions about your readiness for the initiative to be challenged

By populating the matrix iteratively before and after the stocktake you will be able to ask the most helpful questions, actively invite contributions of items and examples from your participants and log your learning through the Outcomes of the workshops.

How to conduct a good stocktake

Traditional models of engagement and training have relatively limited impact on culture change or multi-disciplinary practice transformation. ‘Change Laboratories’ have been developed from a strand of Cultural Historical Activity Theory (CHAT) and have a good track record in supporting improvements in health and social care.

Click the link to read more about CHAT theory on the resources page.

Explore the key elements established by Change Laboratories for conducting a successful stocktake.

Conducting the stocktake workshops

The Stocktake is comprised of iterative cycles of workshops. There are two possible approaches to the cycles to suit different local circumstances and staff availability.

Regardless of which model of stocktake you adopt, it is recommended that learning sets, communities of practice or change laboratories be established across all areas expected to implement the PCSP standard so that the learning can be consolidated and the widest range of stakeholders can feel ownership and commitment to the shared ambition of improving care plans and planning through adoption of the PCSP standards. The Change Laboratory method has been well tried and tested specifically in health and social care settings. 

During our work on the PCSP Standard Implementation project we have observed a significant and detrimental gap between the strategic assumptions of transformation specialist/ strategists and the lived experience of point-of-care stakeholders. Bridging the gap is fundamentally important to successful implementation of the PCSP standard and the resulting improvements in care plans/care planning.

Click each button below to explore the two types of stocktake workshops;

  • Consider the features of a stocktake
  • Conduct workshops
  • Consider CHAT theory
  • Take considerations
  • Initiate discussion
Workshop Cycle Variation 1
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Workshop Cycle Variation 2
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How to initiate discussion in a stocktake workshop

To initiate discussions in the workshop, use ‘stimulus material’. You can use text-based clinical scenarios, audio, visuals, video, performance, or objects as stimulus. Each subsequent iteration uses a refined stimulus to reflect the previous discussion.

There will be a wealth of materials already existing that you could use as stimulus material for your conversations. Choosing the right stimulus material to reflect your own situation will help with the implementation of the PCSP standard. During the pilot with early implementers clinical scenarios were used and workshop discussion was collected cumulatively in real time using Padlet. An anonymised example of a CMH care planning project can be viewed here: [Have your say: CMH Care planning project]

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Personalised care and support planning for people with severe mental illness

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides more detailed explanations about each element of the plan, including advice on how the planning process might be best conducted.
These questions might form a checklist for current plans to be compared with. 

1. Does the plan include an About Me section in which the service user, in their own words, can indicate the information they want to be available about their lives, their values, their interests, and priorities, available for all those who may care for them?
2. Is the approach to developing a care plan patient centred and engaging, allowing plans to be based on patient priorities goals, and aspirations, along with the actions they plan to take and the support that they will receive?
3. Is there space for a “formulation” to be recorded in which the person receiving care and the professionals who provide it, share and record the personal meaning and the origins of the person’s difficulties?
4. Are relevant procedures and therapies recorded?
5. Where relevant, are one or more contingency plans included for anticipatable disruptions, exacerbations, or deterioration, and do they include advice on what to do and points of contact for those called upon to respond?
6. Where relevant are additional supporting plans incorporated, (an example being an “educational and health plan” for someone with a neurodevelopment disorder)
7. Is a version of the plan available to a service user (if they wish to have it) in a form and format that they can understand and find to be of value?
8. How is a version of the plan available to the GP and other key parts of the health and care system?

Work conducted by PRSB and partners recently has looked specifically at the suitability of this approach to the development and documentation of care and support plans for people with Severe Mental Illness. This resulted in an updated version of the standard (v1.4), for use by any service and for any group of service users, but with some modifications to ensure that it meets the needs of this community. The approach to a patient centred process of identifying goals, hopes, and values, and the support needed to achieve them, is fully compatible with and can be conducted using, specific tools in use in mental health, such as DIALOG, DIALOG+, and ReQoL, for example. 

Where analysis indicates the need for improvement in the content and process of personalised care and support planning for patients with Severe Mental Illness, specific improvement projects should be instituted to co-design with service users and their representatives, and the relevant staff groups, new approaches, and documentation that would be of value in delivering improvement. The toolkit includes a range of existing resources that could be used to engage in this improvement work, including signposting to relevant existing approaches informed by patient experience-based design.

Moving to a single holistic plan

A review of a sample of current care plans, and the way they have been developed, may be helpful in identifying the priorities for this improvement. The PRSB Implementation Guide provides A key development, consistent with national policy on support for Personalised Care across all health and care sectors, is the move towards an individual with complex needs having a single, integrated, care plan, rather than a series of plans developed by different parts of the health and social care system in isolation of one another. For a patient with severe mental illness, the related concerns and challenges might form a very prominent part of such an integrated plan; many will also have concurrent health challenges and needs. The intention is that the relevant services work together to plan and wrap support around the patient and their family in an integrated way, rather than as a series of sequential or disconnected encounters in which the service user or their friends and family have to adopt the role of the integrator.

A starting point would be to agree priority groups of service users who may already have more than one care plan because they need care from more than one part of the system of health and social care. This could be initiated by looking at service users registered with some sentinel practices or PCNs. Alternatively, the approach might focus initially on people with defined co-morbidity or risk that entails collaborative care with agencies beyond specialist mental health services.

The focus here is on the process of care planning and agreement on what should be shared, rather than solely on the technology used;

1. What is the process to agree which professional will initiate care planning and act as the “lead point of contact” for the service user?
2. Will initial plans be agreed with the service user in joint consultations or sequentially? Where and how will they be conducted?
3. What will be the process to agree the elements of the plans which should be available to professionals and potential authorised users beyond the immediate care teams, (A&E services, Ambulance Services, Social services, etc.) with the service user’s consent?
4. How will elements of the plan be updated following consultations in a way which is proportionate, to allow contact and progress notes to be maintained by the service conducting the consultation, whilst avoiding unnecessary work for partners in care if there is no significant change to the personalised care and support plan?
5. What are the implications for workload, logistics, and administration arising out of these decisions?

The answers to these questions and others will best be elicited through focused joint working, grounded in real, or at least realistic examples. This will entail process mapping, and co-design with a range of professionals, service users, and families. Resources from the toolkit and outputs from the Simulation element of this project will be valuable. Some organisations would adopt an approach such as a Rapid Process Improvement Workshop, planned over several weeks and conducted over a number of sequential days, to develop prototype ways of working that could be tested in the field.