Improving care and support for children and young people with mental health problems

Three Royal Colleges have jointly agreed five shared principles designed to improve care and support for children and young people with mental health problems.

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The Royal College of General Practitioners, The Royal College of Paediatrics and Child Health and The Royal College of Psychiatrists have issued a position statement saying that as well as the commissioning of specialist treatment, an effective child and young people’s (CYP) mental health system required:

  • acknowledgment that CYP mental health is everybody’s business and should be supported by a shared vision for CYP mental health across all government departments
  • a preventative, multi-agency approach to mental health across all ages, incorporating attention to education for young people and families, social determinants, and health promotion
  • a system of national and local accountability for population-level CYP mental health and well-being, delivered via integrated local area systems
  • training and education for the whole children’s workforce in their role and responsibilities for CYP mental health
  • more support, both from specialist services and other sectors, for professionals dealing with CYP who do not meet referral threshold to CAMHS.

Full document: Position statement on children and young peoples’ mental health

A Multifaceted Intervention to Improve Outcomes in Intensive Care

This study examines the effectiveness of a patient-centered care and engagement program in the medical ICU | Critical Care Medicine

Interventions: Structured patient-centered care and engagement training program and web-based technology including ICU safety checklist, tools to develop shared care plan, and messaging platform. Patient and care partner access to online portal to view health information, participate in the care plan, and communicate with providers.

Measurements and Main Results: Primary outcome was aggregate adverse event rate. Secondary outcomes included patient and care partner satisfaction, care plan concordance, and resource utilization. We included 2,105 patient admissions, (1,030 baseline and 1,075 during intervention periods). The aggregate rate of adverse events fell 29%, from 59.0 per 1,000 patient days (95% CI, 51.8-67.2) to 41.9 per 1,000 patient days (95% CI, 36.3-48.3; p < 0.001), during the intervention period. Satisfaction improved markedly from an overall hospital rating of 71.8 (95% CI, 61.1-82.6) to 93.3 (95% CI, 88.2-98.4; p < 0.001) for patients and from 84.3 (95% CI, 81.3-87.3) to 90.0 (95% CI, 88.1-91.9; p < 0.001) for care partners. No change in care plan concordance or resource utilization.

Conclusions: Implementation of a structured team communication and patient engagement program in the ICU was associated with a reduction in adverse events and improved patient and care partner satisfaction.

Full reference: Dykes, P. et al. (2017) Prospective Evaluation of a Multifaceted Intervention to Improve Outcomes in Intensive Care: The Promoting Respect and Ongoing Safety Through Patient Engagement Communication and Technology Study. Critical Care Medicine. Published online: 3rd May 2017

Why UK hospital staff find it difficult to make improvements based on patient feedback

Patients are increasingly being asked for feedback about their healthcare experiences. However, healthcare staff often find it difficult to act on this feedback in order to make improvements to services | Social Science and Medicine

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This paper draws upon notions of legitimacy and readiness to develop a conceptual framework (Patient Feedback Response Framework – PFRF) which outlines why staff may find it problematic to respond to patient feedback.

A large qualitative study was conducted with 17 ward based teams between 2013 and 2014, across three hospital Trusts in the North of England. This was a process evaluation of a wider study where ward staff were encouraged to make action plans based on patient feedback.

Through the development of the PFRF, we found that making changes based on patient feedback is a complex multi-tiered process and not something that ward staff can simply ‘do’.

  • First, staff must exhibit normative legitimacy – the belief that listening to patients is a worthwhile exercise.
  • Second, structural legitimacy has to be in place – ward teams need adequate autonomy, ownership and resource to enact change. Some ward teams are able to make improvements within their immediate control and environment.
  • Third, for those staff who require interdepartmental co-operation or high level assistance to achieve change, organisational readiness must exist at the level of the hospital otherwise improvement will rarely be enacted.

Case studies drawn from our empirical data demonstrate the above. It is only when appropriate levels of individual and organisational capacity to change exist, that patient feedback is likely to be acted upon to improve services.

Full reference: Sheard, L. et al. (2017) The Patient Feedback Response Framework – understanding why UK hospital staff find it difficult to make improvements based on patient feedback: A qualitative study. Social Science & Medicine. 178. pp. 19-27.

 

Clinical audit in commissioning

The Health care Quality Improvement Partnership has published Using Clinical audit in commissioning healthcare services.

This guide outlines how clinical audits can be used by commissioners to assure both quality and drive continuous improvement in patient care. It examines the strengths and limitations of clinical audit outputs for monitoring and assurance as well as considering how clinical audit can drive quality improvement as demonstrated through case studies and practical guidance.

Mental health in primary care

This event hosted by The kings Fund in partnership with the Royal College of Psychiatrists and NHS Clinical Commissioners showcased some of the best practice taking place across England in integrating mental health and primary care, demonstrating the benefits for both the mental health and primary care workforce and providing more joined-up and holistic care for patients and service users.

The presentations are available to view here

New models of care in practice

The NHS Confederation has published briefings on new models of care and how they are working in practice: