Val Parker, RMN.
Ward ManagerConcerns about the standards and quality of care in acute inpatient psychiatric wards have been well documented (Sainsbury Centre for Mental Health, 1998; Standing Nursing and Midwifery Advisory Committee, 1999; Royal College of Psychiatrists, 1996; Rose, 2000; Moore, 1998).
The clinical area in which we work is a busy 25-bed mixed gender adult acute admission ward that provides inpatient psychiatric treatment for people living within the London Boroughs of Redbridge and of Barking and Dagenham. The ward had been going through a steady period of decline since 1996 when the sole consultant psychiatrist retired. We had staffing and other problems and, due to the large catchment area of 90 000 covered by the ward, the trust decided to create a further two registered medical officer (RMO) posts in line with recommendations from the Royal College of Psychiatry (1996). However, because recruitment of consultant psychiatrists was becoming increasingly difficult at this time, the RMO posts remained vacant for several years.
The team leaders got together and compiled a vision of our expectations for our ward in the future. Our aim was to provide a comprehensive specialised service that addressed and rectified the negative perceptions of acute inpatient care described in numerous studies and articles. We also wanted to provide a service in which our clients would receive the optimum standard of care in a ward of which we clinicians could be proud.
There were five clinical governance delegates heading the project: the ward manager, the deputy manager, two consultant psychiatrists and the psychologist. Our first task was to conduct a thorough review of the current service.
In August 2002 we began the review stage of the RAID model again. The whole concept of the RAID model is based on Continuous Quality Improvement and sustaining and embedding the improvements within the system. The method our team has adopted to implement change allows us to focus on the needs and opinions of the people not the organisation. This results in change being generated from the bottom up.
Until we embarked on this improvement project we had little understanding of the term clinical governance and believed it to be yet another paper exercise. This project has brought clinical governance alive in our work environment. Our standards are improving, but our process of change is ongoing. Our ward has structure and organisation and we now function well as a team.
Cullen, R., Nicholls, S., Halligan, A. (2000) NHS Support Team: reviewing a service - discovering the unwritten rules. British Journal of Clinical Governance 5: 4, 233-239.
Cutliffe, J., Jackson, A., Ward, M. et al. (1998/99)Practice development in mental health nursing (part 1). Mental Health Practice 2: 4, 27-31.
Department of Health. (2002)Adult Acute Inpatient Care Provision (Mental Health Policy Implementing Guide). London: DoH.
Harvey, J., Kitson, A. (1996)Achieving improvements through quality: an evaluation of key factors in the implementation process. Journal of Advanced Nursing 24: 185-195.
Jackson, A., Ward, M., Cutliffe, J. et al. (1999)Practice development in mental health nursing (part 2). Mental Health Practice 2: 5, 20-25.
Moore, C. (1998)Acute in-patient care could do better says survey. Nursing Times 94: 3, 54-56.
Moos, R.H. (1974)Ward Atmosphere Scale. Palo Alto, Ca: Consulting Psychologists Press.
Rose, D. (2000)Users' Voices. London: The Sainsbury Centre for Mental Health.
Royal College of Psychiatrists. (1996)Wish You Were Here? Ethical considerations in the admission of patients to substandard psychiatric units. (Council Report CR50). London: Royal College of Psychiatrists.
Standing Nursing and Midwifery Advisory Committee. (1999)Mental Health Nursing: Addressing acute concerns. London: Department of Health.
Sainsbury Centre for Mental Health. (1998)Acute Problems: A survey of the quality of care in acute psychiatric wards (Executive Summary). London: Sainsbury Centre for Mental Health.
Sainsbury Centre for Mental Health. (2001a)Acute Solutions. London: Sainsbury Centre for Mental Health.
Sainsbury Centre for Mental Health. (2001b)Acute Inpatient Care. London: Sainsbury Centre for Mental Health.