Evaluation and quality improvement in mental health service delivery

The provision of mental health care throughout the world is both extremely complex and there exists a diverse set of systems of delivering clinical care. Despite advances in diagnosis and technology, most systems are plagued by limited resources and inefficiencies. From 1992 to 2002, for example, expenditure for serious mental disorders increased from $63 billion to $100 billion (Insel, 2008). Yet, despite this increase in expenditure on mental health care, clinical practices were unable to demonstrate improved outcomes or cost savings and waitlists became longer. Growing financial pressure within the past decade has brought about a movement among health care institutions and clinical care providers to supply more efficient and cost-effective mental health services focusing on clinical outcomes, client satisfaction and efficiency. With the turn of the new millennium, health care institutions began to look to private corporations for insight and inspiration in solving the problem of efficiency and improving outcomes. Two efficiency methods emerged from this process, which were adopted readily: Lean Manufacturing and Six Sigma. Both methods have been adopted by many large public and private health care providers throughout the world, but the first to be documented was Britain’s National Health Service (NHS). Other countries have followed suit, including Canada and the USA, as well as Australia and New Zealand. Only recently did other parts of Europe and Asia begin to investigate and integrate Six Sigma and Lean into their respective health care service providers (Brandao de Souza, 2009).