Leading Better Care
Sharing Good Practice
NHS Board:NHS Lothian
Ward / department / team:
West Lothian Child and Adolescent Mental Health Service (CAMHS) Day Programme at Willowgrove House
Details of Improvement:
What was the particular problem that this case study is about?
To support Service User involvement in service improvement inthe West Lothian CAMHS day programme provision. NHS Lothian has fully supported the Senior Charge Nurse (SCN) modern role and theNHS Education Scotland (NES)SCN Education and Development Framework in alignment with clinical placement with Edinburgh Napier University (ENU)undergraduate nursing programme. This is expected to be of the highest professional standard and is regularly reviewed to ensure the relationship between clinical practice and student experience is maintained.
The Better Together Programme strongly promotes Service User involvement in service delivery and improvement. Furthermore, NES Generic Guiding Principles for Those Supporting Learning in the Work Place along side the SCN role to champion the four key areas of responsibility; To enhance the Patient experience, To ensure safe and effective clinical practice, To manage and develop the performance of the team andTo ensure effective contribution to the delivery of the organisation’s objectives were at the forefront of my thinking when considering ‘what next?’ in my service improvement planning.
How was this identified?
In the role of SCN my dilemma was how all of this can be achieved within my area of clinical responsibility in a child friendly wayin 2012-2013 within a CAMHS service in NHS Lothian. I was also mindful that Third Year Student Nurses at ENU as part of their clinical placement are expected to evidence Service User feed back.
In my Role as SCN I promote reflective practice and maintain best practice by being visible, accessible and approachable at key times in the therapeutic day, one way of achieving this is through the promotion of a team debrief at the end of the day.It was during this debrief it became clear to me that there was an acute reduction in staff and student confidence, levels of high expressed emotion and a sense of hopelessness in relation to the problem solving of the task of Service User involvement. I had found my leadership challenge: ‘How do I support the academic outcome and best practice development for Service User involvement in Service Improvement?’
We agreed that Service User Questionnaires in current practice were good enough and informative but we wanted to be more engaging, imaginative and produce a piece work that reflected the dilemma this case study refers to. To promote Service User engagement supported by clinical leadership it was agreed that a visual tool could provide the answer. Service User confidentiality and consent were reflected upon and through facilitated discussion it was agreed the NHS Lothian Using Patient Stories information and consent form would be used.
Once this was in place the consultation process began which waslead by a Third Year Student Nurseunder my clinical leadership, support and reassurance.
We explored and discussed how we would manage feed back and provide areas for development, being mindful of consolidation and celebrating successes.
The young people of the CAMHS day programme and the Student Nurse began on a journey that produced a Service User involvement poster. They believed this would champion their service and reassure others to the person centred care that was available within this service.
This process took several weeks which included one to one interviews and small group workings using art as a forum. The outcome of which was fed back to staff and young people and was a great source of pride for those involved and of course for myself as clinical leader.
What were the implemented improvements (whattools/techniques did you use)?
In the role of SCNas defined in the NES Education and Development Framework for SCNsthe change agent, developing clinically effective practice through the effective utilisation and integration of evidence,setting, implementation and monitoring evidence based policies, procedures and protocols.
Also incorporatingmy skills, experience and knowledge gained whilst a Leading Better Care (LBC) Facilitator and as a SCN thus taking the opportunity to promote and encourage developments which meet the challenges that face nursing.
Through Plan, Do Study, Act cycles offered timescales and challenges that were met, built upon and achieved. This was backed by the Nursing and Midwifery Council, Code of Professional Conduct which states that models of reflection should be promoted in NHS Settings.
What is the situation now?
The situation now is that reflective practice is at the heart of daily work practice in this placement andclinical area.
We have quarterly user/young people involvement in feed back using art and discussion forums to guide best practice and improvements.
Plan, Do, Study, Act Methodology is used in day to day practice to promote rapid cycle change to new issues as they arise from daily community meetings.
The Willowgrove House Placement satisfaction audit feed back from ENU remains about 98% with comments valid and praise worthy.
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How is the change sustainable?
With continued inspiringExecutive Nurse leadership from within NHS LothianI feel well support to pursue best clinical practice and with the improvements afforded to us through the integration of other national and local work streams including Releasing Time to Care and Scottish Patient Safety Programme will continue to review reflect, celebrate and improve service user feedback.
It is now embedded in day to day practice.
There was team engagement from theoutset.
There is continued access to the support of a LBC Facilitator through the LBC programme.
Improvement methodology is used part of day to day practice.
Clinical Supervisionand Coaching conversations remain available to SCNsand are vital to sustain the energy.
Measurable outcomes
What are the patient benefits?
Poster devised (as attached) and the young people benefits are highlighted on this which include
- “When you listen to me. It boosts my confidence and I feel I can be myself”
- “I like being here as I feel I am taken seriously and I don’t get dismissed just because of my age”
- “When you listen to my concerns and answer questions about my care plan, I feel more confident about making decisions for myself”
The young people fed back of feeling safe, listened to and at the centre of their personal recovery focused care planning.
What are the staff benefits?
Staffs have an improved knowledge of relevant best practice.
It allows staff to welcome young people, families and systemic professional networks in to a transparent and inspiring clinical environment.
How did staff feel before the improvement/during theimprovement and after the improvement?
Before- Acute reduction in staff and student confidence, levels of high expressed emotion and a sense of hopelessness in relation to the problem solving of the task of Service User involvement.
During–Staff was engaging and there was an eagerness to drive forward service user development.
After- Staff have pride in their work, improved moral and positive interface with a significant increase in staff confidence in relation to user feedback.
What are the lessons learnt and what would you dodifferently next time?
Lessons learned are to build on current practice, build momentum and best practice and once set in motion it should happen systematically.
Requires being a rolling programme.
What plans are there to spread the improvement?
Poster and narrative were shared throughout NHS Lothian and received good feedback.
Student Nurse invited and encouraged to spend time with the Chief Nurse to reflect on user involvement and poster creation.
Contact information for case study
Fiona Bonnar
Senior Charge Nurse
West Lothian CAMHS
Willowgrove House
01506 434274