Mental Health System Transformation: Drivers for Change, Organizational Preparation, Engaging Partners and Outcomes.

St. Joseph's Health Care London (hereafter referred to as St. Joseph's) is a publicly funded hospital that has led mental health (MH) service system transformation in south west Ontario following directives from the Health Services Restructuring Commission (HSRC) (Sinclair 2000). This paper documents how provincial policy; HSRC directives; use of change management activities; organizational planning; and partnerships with other hospitals, community agencies and LHINs drove, shaped and accomplished the transformational change. The transformation included divestment of beds and related ambulatory services to four other hospitals, closure of beds and employment services and the construction of two state-of-the-art facilities. This paper documents the tracking of system performance measures and the outcomes that resulted.

A process improvement strategy for patient safety.

Most change processes fail. Success requires a systematic approach based on the best practices performed within a setting of significant commitment by the organization and its leaders and staff. The Institute for Healthcare Improvement (IHI) framework for improvement was used along with cascading organization-wide performance indicators with specific targets and the implementation of performance reporting. This approach successfully improved the two patient safety practices of acute myocardial infarction and medication reconciliation.

Application of evidence-based practice through a float project.

Evidence-based practice must become a common, acceptable process for the bedside nurse. This paper demonstrates a process for engaging nurses in the use of evidence for direct practice. An example using the revision of a float policy is provided as a model for staff nurses to incorporate evidence in a mechanism to elicit change.