Title: Developing a service user centred co-designed patient safety intervention for acute mental health wards: A mixed methods process evaluation.
Funder: Department of Health and Social Care

Abstract: Acute mental health wards are not safe places. This project will develop and test a system to measure how safe service users on mental health wards are feeling in real-time, and make this information available to ward staff to help them manage safety. The measure and how the information is presented to staff will be designed with service users and staff. We will test it on wards, to see whether it makes wards safer. _x000D_ We know there are large numbers of safety issues on acute mental health wards. Where safety data is collected (e.g. about incidents), it is collected afterwards and service users’ viewpoints are rarely collected. Research has shown patients are happy to report safety issues in general hospitals but this has not been tried on acute mental health wards. We think a system that allows the collection of safety data from service users that can be fed back to staff on a daily basis can be developed and change practice._x000D_ The project will have three phases. Phase 1 will develop the system (service user measure and how to present this information to staff). Firstly, we will review the evidence about collecting safety data from people in hospitals and carry out interviews with service users and staff. Secondly, we will hold workshops with service users and staff to co-design the system. In Phase 2 we will carry out some small-scale testing on two wards for eight weeks. We will interview service users and staff about how they use the system and collect other routine data about incidents, safety and staffing to explore relationships between these data. We will then modify the system if required. Phase 3 will be a more indepth study for nine months on six wards. We will collect data from the system and the wards as before, we will interview staff and service users about how they have found using the system, and we will observe how staff use the information. This will tell us how useful the system is and, this will be used to inform the design of a randomised controlled trial. _x000D_ The project has been designed as a result of our previous research and speaking with service users and staff. One of our co-applicants has lived experience of using mental health services and the system will be co-designed with service users to ensure it collects information important to them. The project will have service users on the Project Management Group as well as being guided by a Lived Experienced Advisory Group of people with experience of using mental health services._x000D_ The output of the research will be a co-designed system for service users to record how safe they are feeling in real-time, and a way for this information to be used by staff to help them manage safety on wards. We will publicise our findings through academic journal articles as well as accessible reports, and audio/video/blog summaries using animation, or interviews with service users or staff that we will share on social media e.g. twitter. Our publicity will target mental health services; health service commissioners and practitioners; policy makers; and academic researchers. We will present our findings at conferences or other events to different audiences. The resulting system will have the potential to the improve safety and wellbeing of service users and staff and could reduce NHS costs by reducing incidents, physical and psychological harms and complaints. It has the potential to be translated and tested across the NHS and as such may benefit thousands of service users and staff.

Lay abstract: Evidence shows there are large numbers of safety issues on acute mental health wards, frequently involving violence and self harm, associated with increased costs, physical and psychological harm. Safety data is currently only collected retrospectively and very little is collected from the service user perspective. This project aims to co-design with service users and staff a technological intervention that collects data about the perception of safety from service users, in order to support staff to anticipate and avoid developing incidents. _x000D_ The project has three phases and uses different methods during each phase. Phase 1 uses a co-design approach to developing the intervention, supported by an ‘environmental scan’ consisting of a scoping review and the collection and qualitative analysis of interview data. Phase 2 will test and refine the intervention, examine available NHS data, and conduct further qualitative interviews. Phase 3 will be a mixed-methods process evaluation. We will collect routine data including incidents, NHS mental health safety thermometer, workforce and ward occupancy. Measures of safety culture, ward atmosphere and health related quality of life will be completed at six time points pre and post intervention. A focused ethnography pre and post intervention will explore how staff communicate and use safety data supported by interviews with service users and staff to further understand feasibility and acceptability. The synthesis of these data will assess the impact of the intervention on outcome measures; enhanced understanding of feasibility and acceptability and result in a draft pilot trial protocol._x000D_ Stakeholder and lay input has informed the development of this project, specifically through discussions with service users and co-applicant representation. A Lived Experience Advisory Group of service users will support the project. The key outputs of the research will be a new intervention in the form of a licensed product to enable the collection of and response to real-time service user generated safety data and improved economic understanding of acute mental health wards. The research will produce traditional and non-traditional publications in a variety of media. Dissemination will target key stakeholders: mental health service providers, commissioners, regulators, practitioners, policy makers, and academic researchers and make effective use of social media. We will publish in high-impact open access academic journals and present and discuss our findings at conferences to a wide range of practitioners, academics, service users. We will also devise and host a digitally supported dissemination event and invite representation from all stakeholders. The resulting product has the potential to improve safety and well-being for service users and staff on acute mental health wards, a key concern of the Care Quality Commission and an NHS priority.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: MENTAL HEALTH