Guiding change in mental health services is complex for many reasons. What approaches can engage front line teams and service users in a meaningful way? How do you support services that provide to individuals and families with complex needs, where mental health issues intersect with homelessness, disabilities, and other challenges? While capacity and resources are limited, demand on services is on the increase. Organisational processes and systems are continually evolving. So where do you start?
In 2015 the HSE engaged CES to establish a Programme Management Office in the Mental Health Division. Setting up the PMO was influenced by several factors. A Vision for Change (2006) put forward a patient centred, flexible and community based service, with high levels of service user engagement. In 2014 the HSE Mental Health Division was formally established, as part of a major organisational restructure, and one of many changes within a wider agenda of reform in health services in Ireland. PMOs have been set up across public services in recent years, to manage and sustain change.
CES recruited a small PMO team with a mix of clinical and programme management expertise and located them within the HSE. We worked alongside mental health services staff, in a partnership approach over a three year period. The team developed customised project and change management methodologies, training, tools and templates based on mental health service improvement needs. We provided data and process analysis supports to build capacity in using tools to envisage the future and figure out how to get there.
A Mental Health Change Board was set up to give governance and oversight to all the projects. Service improvement national projects were established and initiated using project management approaches. The team helped build structures which involved service users and family members from the beginning of the change project right through to its delivery.
Three years on, HSE Mental Health have adopted the new governance approach as the preferred way of working and staff have taken ownership of their new work processes. The challenge to engage service users is ongoing, but there has been a shift in organisational culture and behaviour towards one of coproduction with them. Building capacity in new change processes, tools and clear structures ensure that new working approaches are sustainable. Working smart by breaking down large work plans, and dividing change into defined chunks, makes projects, which then become easier to deliver. All of these developments support the professionals who design and deliver services and will ultimately benefit people using services, their families and carers.
One of the projects we worked on involved supporting the HSE to implement the National Mental Health Recovery Framework . This describes recovery as ‘living a life of ones own, having dreams and ambitions, with or without the presence of mental health challenges and regardless of the severity of those challenges.’ In order to deliver recovery oriented services all Community Health Organisations (CHOs) are aligning their local services with the Framework. The PMO team provide them with mentoring, tools and resources and ongoing support.
Our aim was to enhance project and change management capacity in how mental health services were delivered. Like a good coach, we want to leave behind the knowhow after the partnership ends.
The experience of the PMO is now being used to inform integrated working and programme development across HSE community health services.
Both the art and the science are equally important in introducing and managing change, to make sure that it lasts and improves services and the lives of people using them.
Start from an understanding of where you want to go: What will the world look like after the project is completed? What difference will it make? Communicating and agreeing a shared understanding of what will happen because of change is important. If you are working towards change in the long term, then break your aims into programmes and projects with shorter timescales and which are more realistic to achieve.
The citizen is at the centre: Improving the lives of people using services is at the heart of successful change. New structures and work processes offer opportunities to involve service users and their families, for example in steering committees and working groups. This work is challenging but essential to achieve good outcomes. Good communication and feedback practices, and clear roles help engagement to be meaningful.
Collaborative working builds capacity: The partnership used an embedded approach, where our team worked within HSE mental services over a three year period. This brought a mix of skills and expertise, a high level of engagement and good working relationships. The partnership worked side by side, to develop and deliver improvement programmes together. New skills and processes are now routine and can continue to grow after CES has finished.
