Telepsychiatry: Use of the Donabedian Model

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Table of Contents

Background of the Practice Issue
John Kotter’s Change Model
Failure Modes and Effects Analysis (FMEA)
Six Sigma and Quality Improvement
Budget
Donabedian’s Quality Framework
Measures of Effectiveness
Means of Visual Reporting
Conclusion
References

The advent of technology in healthcare provided medical workers with numerous benefits that quickly reshaped the process of care provision while bringing several disadvantages to the care environment as well. As one of the elements of telehealth, telepsychiatry represents a complex set of services that are provided to patients with no direct face-to-face contact. It may be suggested that the ability to evade any frontal interactions provides patients with more care options and facilitates medication management and patient education (Shore et al., 2020; Spivak et al., 2020). The purpose of the current project is to validate the benefits of telepsychiatry and pave the way for further updates through the interface of Kotter’s change model and quality improvement initiatives supported by Six Sigma methods. The author of the paper expects to establish a positive experience across the local facility and appeal to a larger number of potential patients who could benefit from telepsychiatry from the comfort of their homes.

Background of the Practice Issue

The core local practice concern that has to be addressed is an increasingly high level of reluctance among workers that has to be addressed if the team is looking forward to reaping most of the benefits of telehealth. Accordingly, the problem that the author offers to resolve is a larger-scale implementation of telepsychiatry in an attempt to appeal to both local care providers and patients, especially with the (a) increased costs of healthcare services forced by the pandemic and (b) an exceptionally quick spread of technology across most spheres of human lives. The aim of the project is to implement Kotter’s Change Model and Six Sigma to validate the need for transformation and lay the foundation for further quality improvements. According to Reinhardt et al. (2019) and Freeman et al. (2020), some of the workers and patients could remain reluctant to telepsychiatry, so the idea should be to make the experience much more relaxed and focused on comfort and high-quality services. The increasing popularity of various technologies makes it safe to say that no contemporary initiative can become a reality without a digitalized intervention.

Despite the lack of interpersonal contact, the author considers telepsychiatry a reasonable means of addressing current issues in mental health care because remote psychiatric sessions give a feeling of privacy and safety to every patient.

John Kotter’s Change Model

Table 1. John Kotter’s Change Model in telepsychiatry.

Create Urgency

During this step, the management will be required to observe the team and see how the potential change will be sustained. The feeling of urgency itself will be established through the interface of discussing the impact of the pandemic on healthcare and the growing need to implement technologies.

Form a Powerful Coalition

The management will then be required to pick the most knowledgeable and experienced individuals to promote the benefits of telepsychiatry among team members. Without an accentuated authority, the team will not be able to achieve effective results and attain sponsorships to promote telehealth across the local community.

Create a Vision for Change

The vision that the healthcare facility at hand should aim to achieve is a more positive outlook on telepsychiatry and improved patient engagement. The latter should be the central focus of the current project if the team is willing to promote the core advantages of telepsychiatry and expect patients to provide their timely feedback.

Communicating the Vision

After shaping the vision, the management will be required to develop a strategy for communicating and maintaining change. As a result, a variety of leadership qualities will be expected to help the management address the majority of concerns and anxieties related to telepsychiatry and experienced by patients and team members.

Empower Action

The introduction of telepsychiatry would require the team to promote additional training sessions in order to execute change properly and remove obsolete obstacles to digitalized care. Team members will become aware of the potential barriers to the implementation of telehealth and engage in surveys and discussions to share their insight into how telehealth could improve the existing state of affairs across the facility.

Create Quick Wins

Due to the transition from offline to online psychiatry, the team will have to plan thoroughly and deploy telehealth solutions only when it has gained enough momentum to move forward. It may be proposed to establish a list of milestones to be achieved by the team in order to motivate providers to engage in the process and personally contribute to organizational success.

Build on the Change

As soon as telepsychiatry is implemented, the team should exert even more effort to nurture success and improve the quality of services provided to patients. The core mindset that the team should equip is that there is always something to improve. Telepsychiatry is a relatively young concept, but the team should not be afraid to pursue the desired state of the organization and promote a culture of continuous improvement. Every stakeholder, employee, and patient will have the possibility to contribute to the project via feedback or any other form of investment.

Make Change Stick

After implementing telepsychiatry, the team will be required to put telehealth on the list of key organizational assets since digitalization precedes a sustainable care environment. The team should never stop reinforcing the value behind information technology instruments since there are diverse rewards linked to one’s ability to adapt to the digital world. To sustain changes, the administration will be required to collect data on telepsychiatry in a consistent manner and compare pre- and post-implementation outcomes.

Failure Modes and Effects Analysis (FMEA)

Table 2. FMEA for telepsychiatry

Steps in the Process	Failure Mode and Causes
Defining whether the patient has to be seen virtually or in-person	Telepsychiatry could affect the care process and contribute to treatment delays; An exceptional willingness to switch to remote consultations is not beneficial; Exclusively virtual meetings avert the provider from acquiring visual evidence (Guinart et al., 2021). Bottom Line: There have to be clinical guidelines regulating the utilization of telehealth since virtual care cannot be non-standardized. All patients should be asked to fill in questionnaires and surveys to provide care specialists with lots of additional information related to their personal state or any other important characteristic that could affect the process of remote treatment.
Patient Health Screening	There are going to be missed opportunities and services that have not been provided to the patient at the right time; Patients will be rather likely to remain reluctant to telepsychiatry due to long-standing concerns and prejudiced thinking (Cerimele et al., 2020). Bottom Line: Without preventive screening, telepsychiatry will remain an underdeveloped treatment method that has to be reinvented time after time due to providers’ inattentiveness to detail.
Utilizing Patient Health Records to Improve the State of Affairs	An essential missed opportunity to conduct preventive screening may lead to issues associated with the inability to investigate the correct complaint; Despite a high level of digitalization, the organization still risks exposing itself to the lack of interoperability; A superficial approach to patients’ health records will decrease the effectiveness of telepsychiatry and deteriorate further health encounters for both providers and patients (Saeed, 2018). Bottom Line: Providers have to communicate with patients more often, even if through the interface of telehealth instruments. The team could benefit from recurrent virtual visits and closer attention being paid to encouragement and empowerment activities.

Six Sigma and Quality Improvement

Table 3. Six Sigma for telepsychiatry

Defining the Problem	Team members have to realize the impact of digital solutions and exert enough efforts to maintain telepsychiatry and achieve positive patient outcomes
Measuring the Current Process	Data regarding patient engagement and successful interventions have to be collected in order to be aligned against the new findings after the deployment of telepsychiatric solutions
Analyzing the Cause of Issues	The team will be required to collect evidence throughout the process in order to investigate the advantages and disadvantages of telehealth and apply them to the case of telepsychiatry
Improving the Process	Quality improvement initiatives will be focused on looking into how more patients could be attracted to telepsychiatry without a substantial increase in the cost of respective services
Controlling the State of Affairs	Constant feedback collection will help the administration see how the existing findings could improve the care environment and leave fewer employees and patients reluctant to utilization of telehealth-based interventions

Budget

Table 4. Budget for the implementation of telepsychiatry.

Salaries for New Staff	—
Indirect Expense for New Staff	—
Salary Cost	$30,000
Supplies	$3,000
Software Changes or Additions	$2,000
Cost for Space Construction or Leasing	$2,000
Project Earnings	$45,000
Project Return on Investment	$8,000

Donabedian’s Quality Framework

Table 5. Donabedian’s quality framework for telepsychiatry.

Structure	Telehealth initiatives can be utilized to protect patients from negative health outcomes and optimize the general process of care provision (Nilson et al., 2017).
Process	When care providers get to interact with patients within the framework of telepsychiatric interventions, they are expected to provide them with all necessary equipment and background information (Binder et al., 2021).
Outcomes	Patient assessment can be completed with the help of digital assistants purchased by the administration, with team members being responsible for starting the treatment as soon as possible and having all the knowledge required to provide care to respective patients (Lew, 2020).

Measures of Effectiveness

The most appropriate qualitative measure of effectiveness for the proposed quality improvement initiative will be feedback collection. While gaining insight into team members’ and patients’ concerns, the administration will also have the opportunity to map future activities and evaluate their perceived benefits in association with the key strengths of telepsychiatry. Patient feedback is exceptional because it will broaden the facility’s horizons in terms of how the existing assets could be utilized to appeal to patients and improve the quality of remote care.

As for the quantitative measures, it may be recommended to pay closer attention to the number of patients engaging in telepsychiatry and the amount of time one spends communicating inside a telehealth application. These two numbers would signify the presence of particular tendencies connected to telepsychiatry, as patient engagement does not have to be viewed only through the prism of qualitative information. Based on the number of telepsychiatry patients and the amount of time spent in sessions, the management will be able to predict revenue on investment and conclude whether the telehealth initiative was financially successful or not.

Means of Visual Reporting

The selected practice issue may be best presented with the help of (1) a bar graph for the number of patients engaging in telepsychiatry and (2) a pie chart for the distribution of time spent in session. The first will be required to establish a graphic representation of how the administration was able to appeal to the potential pool of customers while the latter would display the most popular durations of telepsychiatric sessions. Both these measures could also be offered to the audience in the form of a histogram so as to highlight the dynamics of the proposed telepsychiatry solutions.

Conclusion

Within the framework of the current project, the researcher pointed out the main reasons why telepsychiatry has a future and also has to be viewed as an essential addition to the existing field of healthcare. John Kotter’s Change Model, Failure Modes and Effects Analysis, and Six Sigma can be successfully implemented to enhance the quality of care and ensure that most of the benefits of telemedicine will be turned into monetary profit and patient satisfaction. It is proposed to quantify the number of patients and the amount of time spent in psychiatric sessions to assess the strength of the proposed program. In terms of qualitative data, the researcher would like to rely on patient, stakeholder, and care providers’ feedback in order to be able to collect the latest insights into potential problems affecting the given healthcare facility.

References

Binder, C., Torres, R. E., & Elwell, D. (2021). Use of the Donabedian Model as a framework for COVID-19 response at a hospital in suburban Westchester County, New York: A facility-level case report. Journal of Emergency Nursing, 47(2), 239-255. Web.

Cerimele, J. M., LePoire, E., Fortney, J. C., Hawrilenko, M., Unützer, J., & Bauer, A. M. (2020). Bipolar disorder and PTSD screening and telepsychiatry diagnoses in primary care.General Hospital Psychiatry, 65, 28-32. Web.

Freeman, R. E., Boggs, K. M., Zachrison, K. S., Freid, R. D., Sullivan, A. F., Espinola, J. A., & Camargo Jr, C. A. (2020). National study of telepsychiatry use in US emergency departments. Psychiatric Services, 71(6), 540-546. Web.

Guinart, D., Marcy, P., Hauser, M., Dwyer, M., & Kane, J. M. (2021). Mental health care providers’ attitudes toward telepsychiatry: A systemwide, multisite survey during the COVID-19 pandemic. Psychiatric Services, 72(6), 704-707. Web.

Lew, S. Q. (2020). Measuring quality and impact of telehealth services in home dialysis patients.International Journal for Quality in Health Care, 32(3), 173-176. Web.

Nilson, L. G., Dolny, L. L., Natal, S., de Lacerda, J. T., & Calvo, M. C. M. (2017). Telehealth centers: A proposal of a theoretical model for evaluation.Telemedicine and e-Health, 23(11), 905-912. Web.

Reinhardt, I., Gouzoulis-Mayfrank, E., & Zielasek, J. (2019). Use of telepsychiatry in emergency and crisis intervention: Current evidence.Current Psychiatry Reports, 21(8), 1-8. Web.

Saeed, S. A. (2018). Successfully navigating multiple electronic health records when using telepsychiatry: The NC-STeP experience.Psychiatric Services, 69(9), 948-951. Web.

Shore, J. H., Schneck, C. D., & Mishkind, M. C. (2020). Telepsychiatry and the coronavirus disease 2019 pandemic — current and future outcomes of the rapid virtualization of psychiatric care. JAMA Psychiatry, 77(12), 1211-1212. Web.

Spivak, S., Spivak, A., Cullen, B., Meuchel, J., Johnston, D., Chernow, R.,… & Mojtabai, R. (2020). Telepsychiatry use in US mental health facilities, 2010–2017. Psychiatric Services, 71(2), 121-127. Web.

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