Title
of1 the
Change
Project
Header
line
Advancing
Recovery
in Adult
Mental Health
Header
line Services
2
Inpatient
inID.Ireland
Student
Jennie Synnott
Header
line MSc
3 in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
Abstract
HSE Change Model (2008) was used to improve the delivery of recovery-orientated care in an adult mental health
inpatient service. The areas of education on recovery and maintaining recovery on discharge were selected for
improvement. A literature review was conducted and found that recovery had common themes and that with training
these themes could be translated into practice. Regarding discharge the evidence suggests that when certain
interventions are used they can have a dramatic effect on supporting a service-users recovery.
During initiation stage, a PEST and SWOT were used to explore the drivers for the change and then a stakeholder
analysis was conducted. Mandate was sought from stakeholders which provided buy-in and credibility for the
change.
During the planning stage focus groups were used to engage staff and put forward a case for change. A working
group was recruited and a recovery discharge package was created. The package has been implemented but
ongoing communication and engagement remains a priority. A staff member and a service user were recruited and
trained to deliver the training to all staff.
During mainstreaming the re-admission rate of the people who have been involved in developing their package was
measured to demonstrating a reduction in re-admission rates. The PoRSAT was re-measured to demonstrate a 35%
increase in the recovery orientation of the service. The education packages are ready to go however funding for
service-user input has been a barrier to implantation. The HSE Change model served as a template to introduce a
successful change and an improvement in the recovery orientation of a mental health service.
Advancing Recovery in Adult Mental Health
Inpatient Services in Ireland
Jennie Synnott
Introduction & Background
Methodology
Modern mental health services are
expected to be built on a recovery
philosophy (1). This change sought to
advance the recovery orientated care
of an adult mental health inpatient
service in Ireland. The area was
identified as an Advancing Recovery in
Ireland (ARI) pilot site. The Pillars of
Recovery Audit Tool (PoRSAT) (2) was
used to establish a baseline, identify
areas for improvement then reapplied
to measure if the change had improved
the delivery of recovery orientated
care.
The HSE model (5) was chosen due to
familiarity with the model, it is practical
and easy to use.
Aims & Objectives
Aim:
To increase and enhance
organisational compliance with the
PoRSAT (2) audit within seven months.
Two target areas were identified to
implement change.
Objectives:
5 focus groups used to engage
stakeholders and consider their views
on recovery and discharge.
A
Recovery
discharge
pack
developed
Service-user and staff member
education on recovery for all adult
inpatient staff.
PoRSAT reapplied to evaluate the
impact of the interventions on the
recovery orientation of the service
Literature review
This change project seeks to improve
two areas of service delivery.
Maintaining recovery on discharge and
improving the understanding of
recovery by staff through training. The
evidence suggests,
Recovery has common themes and
is transferable internationally (1).
Staff should convey hope for
recovery for service users (1,3).
Training in recovery principals for
staff improves recovery orientated
care (3).
Recovery can be maintained on
discharge by service users and staff
working together (4).
Evaluation
It is vital to gather data to prove
change is an improvement (1).
Recovery Discharge Planning
8% readmissnion
Intervention
group at 55
days
65% Post
intervention
68.5% Pre
intervention
Figure 1: HSE Change Model (5)
Initiation
PEST and SWOT completed to
analyse drivers, stakeholder analysis
also
completed.
National
and
international drive to ensure serviceusers receive recovery care. Local
quality improvement group identified
need for discharge planning to improve
and ARI lead supported need to
develop
recovery
orientation
of
inpatient service
Planning
Building commitment and sharing the
vision for the service. Staff engaged
through the use of focus groups.
working group recruited, staff member
and service-user identified to be
prepared to deliver recovery training.
Implementation
PoRSAT baseline measured, Readmission rates measured. recovery
discharge pack introduced and staff
member and service-user trained. The
change agents priority is to maintain
both momentum and communication
.
Mainstreaming
Sustaining changes now (1) . Recovery
discharge packs are being used.
Service users report they are useful.
Education sessions are ready to go
however funding to pay the serviceuser has led to this being delayed. On
reflection funding for this should be
secured during initiation phase.
0
20
40
60
80
Re-admission rate in intervention
group significantly lower. 35% increase
in the recovery orientation of the
service.
32%
PoRSAT pre
67%
PoRSAT post
Organisational Impact
Demonstrates the organisation is
providing recovery orientated care.
Future development of procedure
and policy for discharge planning
Education sessions due to begin for
all staff on recovery
Further areas identified for change,
for example outpatients
Conclusion
This change was initiated to improve
the recovery focus of a service. ThThis
change has demonstrated that through
change an organisation can improve.
The experience has been a valuable
opportunity to improve mental health
services for people who use them and
for the people who work in them .
References
1. Cleary, M., Horsfall, J., O’Hara-Aarons, M., Hunt GE. Mental
Health Nurses views of recovery within an acute setting. Int J
Ment Health Nurs. 2013;(22):205–12.
2. The Mental Health Commission. A Recovery Approach
within Irish Mental Health Services: a framework or
development. Dublin: MHC; 2008.
3. Gilburt, H. Slade, M. Bird, V. Oduola, S and Craig. Promoting
recovery orientated practice in mental health services: a quasiexperimental mixed methods study. BMC Psychiatry.
2013;13(167).
4. Vigod, S. N. Kurdyak, P.A. Dennis, CL. Leszcz, T. Taylor,
V.H. Blumberger, D.M. and Seitz. Transitional interventions to
reduce early psychiatric discharge in adults: a systematic
review. Br J Psychiatry. 2013;(16):539–45.
5. Health Service Executive. Improving our Services: A users
guide to managing change in the HSE. Dublin: HSE; 2008.