NSW Mental Health
Improving the planning and development of mental healthcare facilities in NSW
Jbara Innovation was contracted by NSW Health Infrastructure (HI), Australia, to examine the evidence and develop a coherent, evidence-based clinical input approach for improving the planning and development of mental healthcare facilities in NSW and inform Health Infrastructure of strengths and opportunities for improvement.
The goals of the project were to:
• Identify evidence-based best practices in mental health facility design, in regard to fitness-for-purpose and effectiveness in delivering care.
• Identify the perceived role and impact of Health Infrastructure (HI) on the efficiency and effectiveness of mental healthcare facilities procurement in NSW.
• Consult with Mental Health Units in New South Wales, the NSW Ministry of Health (MOH), and planning & design professionals about their experience with Health Infrastructure.
• Examine staff attitudes and organizational policies in regard to the current planning and procurement process in NSW.
• Prepare an environmental scan of current practices to identify issues and gaps in the planning process, deficiencies in current roles and responsibilities, and options for improvement and change.
This Report includes an extensive literature review, key informant interviews, site visits, a review of project documentation and reports focused on the process of mental health facility procurement in NSW. The literature suggests that the built and natural environments exert a range of impacts on patients and staff. The data indicates that change should target both the systemic and cultural levels, with a particular emphasis on improving professional and business alignments that lead to project delays, budget overruns and political remonstrations. Effective redesign and improvement of the HI service model will involve bringing the voices of the many stakeholders into a shared dialogue with HI.
The data in the report indicate that Health Infrastructure’s work and leadership is perceived in a positive manner, and it is particularly noted for:
• being a learning organization, actively changing procedures and methods on the basis of experience and reflection
• a strong reputation for leadership
• a recognized track record for innovation and pioneering health facility procurement techniques
• high levels of staff loyalty and pride in achievements
• a strong culture of continuous improvement and change readiness
The data also indicate scope for HI to more effectively refine its governance model, manage its risks, and appreciate the impact of its decisions on the level and type of clinical risks in the system.4 Upstream ‘latent factors’ enable, condition, or exacerbate the potential for ‘active errors’ and patient harm. Understanding the characteristics of a safe, resilient and high performing system requires research to optimize the relationship between people, tasks and dynamic environments.5 The socio-technical perspective incorporates the concept of latent conditions whereby the cascading nature of human error is understood as beginning with the decisions and actions of management; including decisions made during planning, design and procurement of health facilities. Identified risks were particularly associated with: the rapid churn in the formal membership of decision making bodies; frequently disrupted communication processes; an overly lengthy time horizon between development of the Clinical Services Plan (CSP) and Procurement Implementation (PI); fast tracking of service planning processes to meet dominant stakeholder agendas; limited health facility planning expertise inside the organization; and use of negotiated guidelines as project control tools, instead of tools to engage users and providers in a structured dialogue during planning and design.