Devon, Plymouth and Torbay: Value Stream Maps for acute care pathway (January 2016)

Click here to download the value stream maps developed as part of Plymouth and Torbay’s work in understanding their current acute care pathway.

The lead for this work was NEW Devon CCG and the work on the analysis of the pathway, development of the VSMs and scenario testing was been undertaken by Alexander Consulting.

To help understand them it is important to know that they represent two pictures:

  1. The ‘As Is’ map describes the current situation, showing waste and vulnerabilities across a pathway that is acknowledged by all partners and people who use the service as being ineffective. The key issue is that the pathway is completely incomprehensible for people trying to navigate it. The analysis of this VSM showed priority areas to address – liaison services, places of safety, street triage, crisis services, training of staff, approaches to managing intoxication, safe environments in ED – but the main task was to make it easy to access the crisis service, preferably at a time prior to a crisis becoming serious.
  2. The ‘To Be’ VSM is a proposed acute care pathway that attempts to address the deficiencies of current arrangements. It rationalises the current pathway but crucially adds new elements. The most significant is the development of a “single unique point of contact” available 24/7 and able to respond at a variety of levels – signposting, booking appointments, offering brief solution focused interventions, offering phone based support according to agreed crisis plans, directing people to access liaison services and sending out crisis team staff. This system is predicated on the idea that people will be able to access this service easily by telephone, will always get a response and that these response will be simpler as people will be able to use the system earlier. There is also a recognition that the whole system will need to become more adept at addressing issues around intoxication.

These system changes have been tested in a scenario testing exercise based on real cases that did not go as well as they could have. This has reshaped the proposed pathway and brought us to the point where we need to implement a pilot programme to test it in the real world.

Click here to download the Devon Mental Health Crisis Pathway ‘To Be’ VSM Scenario Testing Report, Alexander Consulting (December 2015).