Background
AIMS (Accreditation for Inpatient Mental
Health Services) is a network of inpatient ward staff, similarly
QNFMHS (Quality Network for Forensic Mental Health Services) is a
network of forensic ward staff. Both set standards and assist
member wards to follow self and peer-review processes to improve
the quality of their services and share good practice.
The Closing the Gap (CTG)
team worked with both networks to identify an area where wards were
facing challenges in meeting recommendations.
AIMS topic:
to improve access and range of
‘non-therapeutic’[1] activities for
patients
The AIMS team recommended
this topic as it was highlighted as an area of concern in their
first national report (2009): a lower proportion of patients
(65%) than staff (85%) reported that ward activities were developed
and reviewed in consultation with patients. In addition, the
extent to which activities were provided varied greatly over the
week – from 96% of the time during office hours on weekdays, to 63%
at weekends and 61% in the evenings. This tallied with
another theme that emerged from the patient survey, that of
boredom.
QNFMHS topic:
to provide and evidence a minimum of 25 hours structured
activity per patient per week (Department of Health (2007) Best
Practice Guidelines: Specification for adult medium-secure
services)
The QNFMHS Cycle 4 report (2010) identified
this as an area of challenge for nearly half of their member
units. While many units facilitated a range of therapies and
activities it was often reported that the provision of the full 25
hours of activity could vary between patients, as well as between
wards. The development of robust systems to record the amount
of structured activity offered, as well as the amount of activities
engaged in, was also highlighted as an area for improvement.
Although staff at a number of units reported there to be a large
and varied activity timetable in place, it was noted that there are
not formal systems in place to evidence this. In addition,
the ambiguity of what constitutes a structured activity was also
noted to pose a challenge in the collection of consistent and
accurate audit data.
This term
is used to refer to any activity that is not a formally recognised
‘therapy’
The Improvement Project
The CTG team needed to
recruit between four and six teams to come together as a
collaborative to tackle these topics.
The AIMS and QNFMHS teams
assisted by advertising the project among their members and
forwarding the details of those interested to the CTG team for
short listing.
Four teams were shortlisted
from AIMS with an additional two from QNFMHS.
A ‘Project Management Pack’ was developed and sent to teams
giving them detailed information and guidance about what the work
would entail, including advice about the composition of their local
CTG project team.
The CTG team visited the potential participating teams during
October and November 2010. These visits were designed to meet
the teams and get an idea of their local context, introduce the
improvement approach that was
being used, and get formal ‘sign up’ to the 10-month project.
After our visit to one of the teams, they approached their board
for funding to enable them to attend the four learning events.
Unfortunately, this was turned down and the team was unable
to continue with the project. This left three adult inpatient
wards and two forensic wards taking part in the collaborative.
The teams were brought together into a collaborative that worked
together on the chosen topics between December 2010 and September
2011. During this 10-month period, the teams came together
for four learning events. Each learning event was followed by
a 3-month action period where teams carried out small ‘Plan Do
Study Act’ (PDSA) cycles and collected simple on-going progress
measures. During the action periods, the CTG team hosted
monthly teleconferences to review progress, discuss challenges, and
agree ways forward. Additional on-site support visits by a
member of the CTG team were also available by
arrangement.
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