tOTal Improvement

Published 17 April 2019. Last updated 7 May 2019.

tOTal Improvement is designed to improve communication within the multidisciplinary team at Morisset Hospital and to better direct consumers’ support needs within the clinical rehabilitation program.

A process-driven system was established, requiring occupational therapy staff to reflect on regular consumer reviews, as part of their functional reports. Functional occupational therapy reports are written every 13 weeks to reflect on a consumer’s ability to function and complete everyday living tasks, as well as establish new goals for the upcoming 13 week period. These reports form part of a wider consumer care review.

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The aim was to increase the occupational therapists’ completion rate of functional therapy reports.


  • Increased efficiency of reports being completed and submitted between clinical services, such as the clinical rehabilitation unit and community managed organisations.
  • Reduced length of a consumer’s stay, to allow for a faster transition into community based living.
  • Improved communication and handover processes within the multidisciplinary team, to help identify occupational therapy recommendations.
  • More regular updates into the consumer’s function when completing everyday living skills, which helps to track improvements or a decline.


In March 2018, 25.8% of functional occupational therapy reports were completed in the last 13 weeks. This meant that while consumers were admitted to the clinical rehabilitation program at Morisset Hospital, a significant percentage remained there without receiving a completed or updated report.

Before the project started, in February 2018:

  • 50% of consumers sampled had not received a functional occupational therapy report during their admission to the hospital
  • 44% had received one report during their admission to the hospital
  • 6% of the consumer sample size had received two reports during their admission to the hospital.

However between February to October 2018:

  • 80% of involuntary and voluntary consumers from Morisset Hospital’s psychiatric rehabilitation service received an updated functional report, in line with the 13 week consumer care reviews.

N.B. These consumers were involuntary and voluntary consumers who all spent 13 or more weeks in the clinical rehabilitation unit.


Driver diagram mapping identified the following issues and solutions.1

  • Issue: Occupational therapy support for consumers required more inclusion in consumer care plans. In particular, there is a section on the care plan that identifies which consumer and/or health professional is responsible for achieving a task.
  • Solution: This was achieved by occupational therapy staff speaking up more during meetings, ensuring they are appropriately allocated to a task and the consumer was informed.
  • Issue: The creation of an allied health team was also required, to enter the clinical rehabilitation units. This would increase access to allied health staff and overcome staff shortages.
  • Solution: Using a two up risk management approach – such as combination of two or more allied health representatives from occupational therapy, a social worker or psychologist – the allied health team could safely enter the units and improve communication between the disciplines.
  • Issue: Consumer and carer confusion over the roles in the clinical rehabilitation unit.
  • Solution: The distribution of a consumer-focused occupational therapy booklet that outlines the role of the occupational therapy/occupational therapy assistants in the clinical rehabilitation unit at Morisset Hospital.
  • Issue: Incomplete consumer functional reports.
  • Solution: The creation of a flow chart to track the current process used to complete consumer functional reports. By identifying any issues, the team could fill in the gaps to create a systematic process that would help sustain the tOTal Improvement project.


Sustained - The project has been implemented, is sustained in standard business.

Implementation sites

This project was implemented at Morisset Hospital, which is part of the psychiatric rehabilitation service within the Hunter New England Local Health District in NSW.

Team members

This project would not have been possible without the hard work of key members of the multidisciplinary team at Morisset Hospital listed below.

Emily Price (OT Team Leader), Helen Whear (NUM2), Alan Johnson (OT), Nicola Bourke (OT), Carly Blackford, Kiri Osborne (OT), Sarah Duncan (Psychologist), Dr Leesa Brown (Psychiatrist), Karen Webster (SW), Emma Lukaszewicz (OTA), Kodie Sales (OTA), Pamela Morton-Caldwell (OTA), Jennifer Long (RN) and Vickie O’Connor (RN).


Evaluation was completed over eight months, using various methods. These included:

  • monthly data was accessed through these reports which identified the specific role of the occupational therapist in care plans.
  • weekly data was collected to count how many times per week the allied health team accessed the clinical rehabilitation units
  • more occupational therapist were allocated to specific goals listed on the consumers’ care plans
  • more visits were made by the allied health teams to the facilities.

Overall, the mean screening rate for up-to-date occupational therapy functional reports increased from 32.2% in January to February 2018 to 95.6% between May to November 2018. This reflects an average increase of 64.4% more functional reports issued over the course of the project.

Lessons learnt

  • To always follow the Clinical Leadership Program’s framework, as it supports sustainability. This framework helped to guide the process from being a concept , through to becoming embedded in every day practice.
  • This framework helped to support team dynamics when shifting from a largely individualised approach to a team approach. Relationships within the multidisciplinary team improved, and the project leader felt supported by others when they were given the opportunity to lead.


  1. Clinical Excellence Commission. Driver Diagrams.


Darby Ward
Occupational Therapist
Morisset Hospital
Hunter New England Local Health District
Phone: 0432 532 201


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