Katherine M Dollar PhD and Margaret Dundon PhD Center for Integrated Healthcare Objectives Provide an overview of the function purpose and structure of service agreements Provide recommendations for service agreement development ID: 676818
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Slide1
Service Agreements: How to Develop, How to Utilize
Katherine M. Dollar, PhD and
Margaret Dundon, PhD
Center for Integrated HealthcareSlide2
Objectives
Provide an overview of the function, purpose, and structure of service agreements
Provide recommendations for service agreement development
Discuss recommendations for service agreement implementationDescribe the process of development and implementation of the VISN 2 PC-MH service agreementDiscuss lessons learned
2Slide3
The Big Picture: What are Service Agreements?
A broad term and concept used in most industries and markets in some form.
“A contract between two businesses where one agrees to provide a specified service to the other, such as cleaning or running a staff canteen, or between a landlord and a tenant where the landlord is going to provide services, e.g. heating and lift maintenance, to the tenant. “ (Wiktionary
, 2011 January)
“..A negotiated agreement designed to create a common understanding about services, priorities and responsibilities.”
(Karten, 2008)
3Slide4
The Smaller Picture: What do we Mean by Service Agreements?
Formal, written document between separate services within one medical system
Developed
by consensus from multiple stakeholders representing each serviceDetails the specific expectations, roles, functions, and services to be provided by each entity (i.e., who does what)Describes roles and parameters of clinical services
4
(
Iacobelli
, & Lawrence, 1991;
Karten
, 2008; Schiller et al., 1994) Slide5
The WHY: Why are Service Agreements Needed?
Think about the challenges in your system
Is there an on-going dialogue across services?
Are providers unclear about (or misinterpreting) their roles and the roles of other health care professionals?Could services be provided more efficiently?
Is there duplication of service?
Are inappropriate consults placed or inappropriately cancelled?
5Slide6
Service Agreements Can..
Start much needed discussions across services
Get everyone on the same page
Serve as a platform to provide education about the system and services available (Karten, 2008)Provides guideline (e.g., describes expectations for PCPs to prescribe frontline antidepressants)
6Slide7
What Else Can Service Agreements Do?
Reinforce clinical practice guidelines
Set standards
Avoid confusion Avoid duplication of services or failure to provide needed services
7
(
Iacobelli
, & Lawrence, 1991;
Karten
, 2008; Schiller et al., 1994) Slide8
Purpose of Service Agreement
(From VISN 2)
Purpose:
To develop a seamless consultation process in the VA Healthcare Network Upstate New York (VISN 2) system to ensure appropriate referrals, delivery of safe, effective and timely care to Veteran patients, and to improve clinic efficiency. The overall goal of this agreement is to decrease referral delay from primary care (PC) to specialty mental health (MH) services, to enhance co-located, collaborative healthcare delivery, to increase specialty MH capacity, and to increase the graduation rate of Veterans back to primary care from specialty mental health services. This agreement will improve efficiency and access to care, thereby improving overall health outcomes in our Veteran population.
8Slide9
Functions of a Service Agreement (VISN 2 PC-MH)
Describes PCP and PACT team roles and functions
May describe other available resources
Describes the roles and functions of PC-MHI team providers (CCC, CM, and prescribing/consulting provider)Describes roles and functions of specialty MH services
9Slide10
Functions (cont.)
Describes levels of care and which Veterans are appropriate for which level of care
Describes what MH services are available, provided by whom, and how to refer patients to these services
Describes criteria for return from specialty MH services to PC
10
(
Iacobelli
, & Lawrence, 1991;
Karten
, 2008)Slide11
VISN 2 PC-MH Service Agreement
Utilizing the stepped-care approach, there are several options for the treatment of mental health symptoms, ranging from least intensive and restrictive to highly intensive specialty services. Each level is further detailed below in individual sections.
Level 1:
Primary care provider with as needed (curbside) consultation from a psychiatric prescriber or the CCC BHP either in-person, via telephone, or though chart review consult process.
Level 2:
Co-located, Collaborative Care Behavioral Health Provider (CCC BHP): Typically a non-prescriber (social worker or psychologist) embedded within primary care clinics in collaboration with PC team. Listing of CCC BHPs for VISN 2 can be found at:
Listing of VISN 2 CCC BHPs.
11Slide12
Stepped Care
Level 3:
Veteran appointment with a psychiatric prescriber in the primary care environment, in person or via telemedicine. (
Telemental Health is defined as the use of telecommunications technology to provide mental health services to individuals. Link to TMH site: http://vaww.carecoordination.va.gov/general-telehealth/telemental/).
Level 4:
Intensive specialty care (e.g., mental health providers within specialty behavioral health services).
12Slide13
Steps to Develop Written Service Agreements (From Schiller, Miller-Kovach, & Miller, 1994)
Identify the internal customers
Meet with the customers, identify wants and needs
Develop a consensusDocument the agreement, including a beginning and a review date
Obtain signatures
Renegotiate the agreement on review date
13Slide14
Key Steps in Establishing a Service Level Agreement (From
Karten
, 2008)
1. Gather background information2. Ensure agreement about the agreement3. Establish ground rules for working together4. Develop the agreement
5. Generate buy-in
6. Complete pre-implementation tasks
7. Implement and manage the agreement14Slide15
The How
Obtain examples currently being used by other facilities or VISNs
Identify key stakeholders and develop workgroup
Discuss/Assign sectionsDraftReview, discuss, revise (ad nauseum)
Leadership review with comments
Stakeholder review with comments
15Slide16
The Who
Must have leadership from both services
Front line providers and program champions from both services who will be working under the scope of the agreement
Representation from other stakeholders (e.g., careline managers, pharmacy, nursing, administrative officers, PSAs)
16Slide17
VISN 2 Process Begins
February 2009
A few clinics had local agreements in place
Local committee was formed in WNY areaLocal committee informed that a VISN agreement was to be developed and disbandedSmall VISN committee was formed
Drafts of other agreements from within VISN 2 as well as from other VISNs gathered
Committee members reviewed other models and discussed network needs
17Slide18
VISN 2 Process Continues
Draft was developed and revised..and revised..
Once consensus on a draft was established among initial committee members and leadership, the committee was expanded for feedback from multiple stakeholder groups (Pharmacy, Nursing, etc.)
More discussion and revisionDraft distributed widely to leadership and both PC and MH stakeholders
18Slide19
Are we there yet? (process continues)
Meeting for discussion of comments
Revision: Re-sent draft for comments
Final meetingApproval from stakeholders committeeRevision: Re-sent broadly for final comments…..Final approval from both MH and BH leadership and formal signing
August
2010 mplementation
begins19Slide20
Implementation Recommendations
Multi-level Approach
(Kirchner et al., 2010)
Top Down: Must have top level leadership buy in…. butImplementation should come from local leaders, PC-MHI clinicians and champions New VISN workgroup; comprised of champions (PC and MH) from each local site charged with local education and implementation
Education for all staff involved (may need multiple information and education sessions and modes of dissemination)
20Slide21
Why is an Implementation Plan Important?
Successful implementation sets the stage for…
Buy in and utilization
A “living” and meaningful document A powerful documentSuccessful monitoringSuccessful enforcementContinued discussions
21Slide22
Document Specifics (e.g., length, scope)
Will vary from VISN to VISN depending
On local level needs
On services offeredOn leadership prioritiesOn local population Should be monitored, evaluated, and revised as needed (remember it is an on-going discussion/dialogue)
22Slide23
Lessons Learned
Need top level leadership support
Process of collaboration
On-going dialogueConsult with experts and others who have developed and implemented service agreements
23Slide24
More Lessons Learned
Sometimes document must be vague. Cannot provide guidance on every scenario
(
Karten, 2008)Spirit of the agreementDevelop on-going structure and process for monitoring, discussions, and revisionPlan for how to enforce document
24
(
Iacobelli
, & Lawrence, 1991;
Karten
, 2008;Slide25
References
Iacobelli
, L.P., & Lawrence, W. P. (1991). Service agreements: An integral tool for ensuring customer satisfaction.
Journal of Healthcare Material Management, 9; 26-34.Karten, I. (2008). How to Establish Service Level Agreements. Karten
Associates,
Randolf
, MA. Retrieved January, 2011 from http://www.nkarten.com/sla.html#not Kirchner, J., Edlund, N.C., Henderson, K., Daily, L, Parker, L.E., & Fortney, J.C. (2010). Using a multi-level approach to implement a primary care (PCMH) program. Families, Systems, & Health, 28 (2), 161-174.
Schiller, M.R., Miller-Kovach, L., & Miller, M. A. (1994).
Total Quality Management for Hospital Nutrition Services
. Aspen,
Gaithersberg
, MD.
Wiktionary
. (2011, January). Service agreement. Retrieved from http://en.wiktionary.org/wiki/service_agreement
25Slide26
Additional Resources
VISN 2 PC-MH Service Agreement can be found on the CIH
Sharepoint
: https://vaww.visn2.portal.va.gov/sites/natl/cih/default.aspxOffice of PC-MHI Sharepoint: http://vaww4.va.gov/pcmhi/E-mail:
katherine.dollar@va.gov
margaret.dundon@va.gov
26