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My quality improvement experience - Sarah Curtis's blog on Kingsley Ward

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A blog post written by Sarah Curtis, a service user at Southern Health NHS Foundation Trust, who took part in the Quality Improvement workshop week during September 2018 focusing on reducing incidents of violence and aggression on Kingsley Ward at Melbury Lodge. Sarah was detained on a section two of the Mental Health Act during February 2018 and treated on Kingsley Ward. It was felt by the whole group that this would give a unique perspective on how it feels to be a patient on the ward and thus contribute positively to the work undertaken.

January 11, 2018

When Lou first emailed asking me if I’d like to participate in a week-long workshop looking at how to reduce incidents of violence and aggression on Kingsley Ward, to increase the feeling of safety for patients, my first thought was that I didn’t really know what to expect. My second was that actually when I had been a patient on the ward in February 2018, while there had been many frustrations relating to my care, I hadn’t felt unsafe, so although I understood the aims of the project, it wasn’t really a feeling to which I could relate. However, I tentatively said yes and when I met Lou, the ward manager, on the first morning, I got the feeling she didn’t really know what to expect either! Lou also expressed a great deal of cynicism about the project. Having been a veteran of many other initiatives with similar aims, none of which had led to any real significant change for patients on the ward, Lou had real concerns that this project would go the same way. Joining Lou and I on the week were other ward staff including a nurse and a healthcare support worker, occupational therapy staff, a consultant and some carers.

The first day of the week was spent learning about some of the theory behind quality improvement (QI), and although the phrase ‘death by PowerPoint’ was used on more than one occasion(!), it actually proved invaluable in helping us think about what we wanted to achieve by the Friday and, most importantly, why. At the end of the day we were asked to tick on a big sheet of paper stuck to the wall how we felt as we left. The choices ranged from ‘frustrated’ and ‘exhausted’ to ‘excited’ and ‘hopeful.’ Lou felt no shame in sharing that she ticked frustrated and continued to for the rest of the week. That first day I ticked exhausted as I truly was. I really underestimated the mental energy required in taking part.

Tuesday morning was when the real work began (and when the sweets appeared on the tables… honestly as the week continued there was an steady increase in the number of doughnuts, cakes, biscuits etc on offer!) and we started to consider the issues that may have led to incidents of aggression on the ward. What I particularly liked about that, was how the workshop facilitators approached it from a positive stance and basically threw the question open to the group; ‘What’s working already?’ This is where I felt my contribution as a patient was really valued and it gave me the opportunity to express what I thought had been helpful during my admission. It then gave us all the chance to think about how we could make that experience even better and from there, as a group, we were able to identify some key issues that needed addressing.

From Wednesday we started to split into groups, each group looking at the key themes identified and starting to unpick them. The issues felt most important to address, by the whole group, were patient observations, ward rounds and the management of leave. At the same time, we identified ‘quick wins’ which were issues that could be addressed quite easily and quickly (the clue is in the title!) for the benefit of patients. For example, clock radios for patient rooms and the revision of the patient Welcome Pack. At one point it felt like we were being asked to generate almost too many ideas, and although we understood why, it could have been more beneficial to stop and focus on what we had.

To take the example of patient observations, at that time they were neither meaningful or therapeutic. I had described my experience of them as akin to being an animal in a cage at a zoo, being peered at every half hour. As we were asked to think creatively, the ward manager mooted the idea of discontinuing observations altogether and replacing them with a one-to-one contact for the patient with their allocated nurse for both the morning and afternoon shift. This contact would be of so much more value to the patient it definitely seemed like the way forward. Thus plans were formulated around how it would work, the support staff would need and when it could be implemented. It was also agreed that the policy would be based on individual need so that patients who needed a higher level of care would receive that care. There was a great deal of keenness amongst the group to return to the ward and give it a go!

On the Friday afternoon, as a whole group, we gave a short presentation to members of the Trust board on the work we had been doing and on the proposed changes. There was a sort of nervous energy as we lined up and whispers of how we all deal with public speaking which ranged from ‘I’m going to be sick’ to ‘I’ll trip up I know I will’ and ‘Well I’ll just laugh’ but within it all was a real sense of comradery.

After the week ended the real work began. We had set target dates to start the new observation policy and current policies had to be rewritten and the nursing staff had to be consulted and supported in making the changes. In her reflections, Lou repeatedly refers to this as ‘blimmin’ hard work’ and it was. However, it’s always swiftly followed by ‘but it was worth it.’ The patient observation policy is just an example of one issue that has now been approached from a different angle but has made a huge difference to the patients on the ward. Patients feel like nursing staff have time for them and feel valued. Nursing staff repeatedly report, in their supervision sessions, that they’re finally being allowed to do the job they’re trained to do, namely care for patients, and they love it! There’s a new energy about the ward and people are buzzing with excitement. Lou describes herself as ‘evangelical’ about the whole QI process which is a huge turnaround from how she felt at the beginning, and even at the end, of the QI week itself. When Lou talks about the QI experience with others I see the passion in her and it’s genuine, and it’s genuine because it’s made a difference to patient care and that’s what the ward is there to do.

Then there’s me, as the service user in the room, and my final thoughts about the project and I loved it! I loved how right from the beginning there was no sense of ‘them and us’, we were all equal and just together as a group with one purpose. I loved how on the first day Lou persuaded me to <cough cough!> ‘appropriate’ some purple post-it notes because I love purple! I loved how on the first day the consultant who had been my doctor on the ward during my admission and who I’d not been awfully nice to (I was under a section and consequently angry) crept in (slightly late!) and sat opposite me and it was awkward for all of about five seconds and then we just got on with it and her professionalism and kindness just blew me away. I loved how, as the week went on, the room just got messier and messier (I was more tactful at the time and said ‘lived in!’), but it was a reflection of the work going on. I loved being part of something and having that sense of belonging. Then alongside all the ‘loves,’ participating has resulted in some real, meaningful changes for me. I’d written myself off but having managed in that environment, with support, I now see myself returning to some kind of work in the not too distant future, albeit voluntarily to begin with, which is huge.

Most recently Lou, me and a carer spoke to some colleagues from Antelope House about the QI work undertaken on Kingsley Ward with the aim of helping them make some changes to the wards there. At the beginning of the meeting people were sceptical, much like Lou was at the start of the project, but two hours later they were raring to go. It was amazing to see the difference, even if just in their body language and facial expressions.

So, that’s the QI experience! It is really worth participating, if given the opportunity. It’ll be hard work, it’ll be an emotional rollercoaster (you’ll laugh, you’ll cry, you’ll eye up the doughnuts and say ‘oh go on then, just one more!’) but it’ll be worth it for the end result.

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