NHS Board:NHS Greater Glasgow and Clyde Health Board

Leading Better Care

Sharing Good Practice

NHS Board:NHS Greater Glasgow and Clyde Health Board

Ward / department / team:Directorate of Forensic Mental Health & Learning Disabilities

Details of Improvement:

What was the particular problem that this case study isabout?

Lack of service users’ involvement and understanding of treatment outcomes and goals within their care plans.

How was this identified?

The problem was identified and highlighted by a mental welfare commission visit.

What were the implemented improvements (whattools/techniques did you use)?

A short life working group was developed to examine this issue. They initially completed a literature review and sourced other examples of user friendly care plans that had been utilised in other areas. The group identified a care plan that was being used in NHS Fife which would cover the main issues raised in the mental welfare commission report. These issues included;

That information from CPA meeting and in careplans was in a language and format that was non-user friendly.

There was also insufficient evidence that service users were fully involved in planning and evaluating their care.

The NHSFife care plan was distributed to the clinical teams and the clinical governance group for comment and discussion. After this initial consultation some of the text and clipart from the original careplan was altered to meet the specific needs of our service users. This was completed by liaising with colleagues in the occupational therapy department who changed the clipart by using specialised software (Widgit) and colleagues in speech and language department who ensured that the language used in the careplan was appropriate for the needs of our service users. Then the new draft careplan was sent to advocacy for comment and further changes were made in regards to some of the language in the text. Advocacy then took the careplan around each individual patient council meeting. Feedback was given back to the Senior Charge Nurse leading the improvement; on the whole the service users were very positive about the new user friendly care plan.

What is the situation now?

The user friendly care plan was fully implemented across the directorate.Exemplars of both versions were given to all nursing staff along with guidelines on how and when to complete the careplans. It has been reviewed and some alterations have been made to the mental health version to bring in closer alignment to the categories within the CPA careplan. The LD version has been back to advocacy and patient council for further comments and they are satisfied with the current version and implementation.

How is the change sustainable?

The user friendly care plan is now part of the initial assessment documentation and the CPA process.

Measurable outcomes

What are the patient benefits?

1. The patients are now fully involved in planning and evaluating their care in a format which is tailored to their specific communication requirements.
2. That they now feel more engaged and empowered in regards to their care.

What are the staff benefits?

1. The staff now work in partnership with the service users.
2. The staff can now demonstrate through practice that they are implementing the ethos and principles of recovery.
3. Named nurses now have an easy format to regularly engage with their service users.

What are the organisational benefits?

1. The most recent mental welfare commission report flagged up the user friendly care plan as good practice.
2. The directorate can highlight user friendly careplans as evidence on meeting outcomes around promoting recovery, providing service user centred care and working in partnership.

How did staff feel before the improvement/during theimprovement and after the improvement?

Before the improvement staff felt that they were engaging sufficiently well with service users. However the issue was ensuring written evidence of this engagement and the level of understanding of health needs from the service user.

During the improvement the staff felt that some of the criticism from the mental welfare commission was unjustified. However they fully engaged with the process and supported the implementation of this new user friendly careplan.

After the improvement they still feel engaged and believe that the user friendly careplans have created a more equal partnership with their service users.

What are the lessons learnt and what would you dodifferently next time?

During the consultation period I should have pushed for more comments to come back from specific groups i.e. Consultant Psychiatrists. This would have prevented changes being made shortly after the implementation of the mental health version.

What plans are there to spread the improvement?

The careplans have been implemented across the directorate and I hope to present the users friendly careplan at a national conference.

Contact information for case study

SCN Kevin Tolland

Holly Ward

Rowanbank Clinic

133 Balornock Road

Springburn

Glasgow, G21 3UL

0141 232 6400