Improving the quality of the admission process in a French psychiatric hospital: impact on the expertise of the professional team.

INTRODUCTION: A 20-month quality improvement project was undertaken in order to improve the patient admission process at a 350-bed French public psychiatric hospital. In addition to improving the quality of patient admissions, the project was expected to increase the expertise of quality improvement team members.
METHODS: The project team consisted of two physicians, three heads of nursing, one senior manager, one member of the admissions staff and one secretary. A pharmacist acted as internal facilitator. The team used problem-solving methodology to identify and correct any shortcomings in the existing admission process. Validated data were collected before and after implementation of corrective actions. The team was trained to become more effective on the basis of a published how-to manual for building an effective work team. Team effectiveness was compared before and after the project.
RESULTS: Changes in relevant variables were as follows: (i) patients going through the admissions department (40% after corrective action, versus 20% before); (ii) no delay in admission formalities for patients entering hospital by long-standing arrangement (100% versus 20%); and (iii) no delay in admission formalities for patients whose hospitalisation was not predetermined but foreseen (45% versus 0%). The expertise of team members improved in terms of the four tested items: meeting customers' needs and expectations (P< 2 x 10(-6)); contribution of the team to the internal quality improvement strategy (P< 0.01); understanding of the methodology (P< 0.04) and accountability (P< 2 x 10(-5)). Improvements in adherence to the mission statement were also observed. A total of 728 hours were spent on project management. DISCUSSION: Objective improvements were achieved; in particular, the team was shown to have become more effective. The extent to which the lessons learned here can be extrapolated may depend on the openness to change of members of other project teams.
CONCLUSION: This project demonstrated that it is possible to put theory into action and thereby make progress. In order to advance further, a second quality improvement project is planned.