Matinum

Taking Charge of Your Health


Quality improvement is a systematic approach
to enhancing patients’ safety, their outcomes and their experience of care. It generally involves applying a method systematically,
but it’s also a way of working that engages everyone working in an organisation; it’s
about a continuous effort to make and test improvements. We’ve seen a growth in the use of quality
improvement approaches in the NHS, and The King’s Fund wanted to learn more about the
opportunities to use those quality improvement approaches in mental health care settings
as well. Two of the case studies featured in our report
are Tees, Esk and Wear Valleys NHS Foundation Trust, and East London NHS Foundation Trust.
And they’ve both been doing this for some time, and we’ve asked them share some of the
key insights into what they’ve learnt along the way. My response to people who ask ‘why should
we be interested’ is always to flip that around and say ‘why wouldn’t you be interested’. So at the moment most services have massive
challenges, unprecedented challenges. How do you maintain quality in the face of rising
demand? I guess the most satisfying bit to see is
that things are getting better for the people we serve. So we have lots of evidence of outcomes
improving: whether that’s a ward being a safer place; whether it’s people being treated at
home rather than in hospital and reducing the need for inpatient admissions; whether
it’s a community team seeing people quicker; making sure that people feel engaged with
the treatment that they’re being offered. There’s so many stories of people receiving
a better experience and outcome of care. Even though over recent years we’ve had increased
demand on services – particularly our children’s services – through our improvement work we’ve
been able to make sure that we continue to make sure that people aren’t waiting for care
and treatment, because we know that waiting really makes people worried and can make things
worse; whereas getting in early can really help people. So we’re really proud that we’ve
been able to do that. I think a lot of the work we’ve done around
sharing of information with patients and their families has been really important, so people
are informed and communicated with about their conditions. The new advent of our recovery
college online – which empowers people to take control of their own recovery journey
through an online resource which is open access, and they can sign up to it as learners on
the online recovery course – and also the sharing of information we’ve done with GPs,
I think has really benefitted service users, their families, and our other partners in
health care. The staff here also, I think, have a different
experience of working here than they maybe did 10 years ago. I think people feel like
they have a way to contribute; they have a bit more control over their workplace; people
probably feel like they are working in stronger teams, rather than in separate disciplines
and silos. All of our improvement work is done in whole teams. I think all of those things make the place a more fun place to be, make it a place where
you actually can change things, and I think that gives people a lot of satisfaction in
their day-to-day work. At the heart of quality improvement is all
about service user and carer involvement. When we’re running quality improvement activities
we provide the same training to experts by experience and service users who would be
part of quality improvement work as we would to staff; and that’s really the joy in all
of this, so when you see a group of staff, service users and their families all working
together on the same project – making improvements together – that’s where you know that things
are really moving and shaping, and that we’re really focusing our quality improvement activity
in the right place. So that’s a must – a big yes for that one. Every single project here, we make sure right
from the very beginning that, first of all, the thing they want to work on is something
that actually matters to the people receiving the service and the people delivering the
service; that’s very important. And from that point onwards there would need
to be a way for people to be part of the work; the people delivering the care, but also the
people receiving the care. And then you need to think about, when you
have work happening at scale, how you spread from one place that’s solved a problem – trying
to take that learning to other places. And again the beauty of the method is it gives
you a way to do this – systematically, and thinking about the core components that are
going to lead to success; spread, from one place to another, to another. It’s not a project; it’s not a piece of work
that’s going to last for two or three years – it’s really something that organisations
need to think about for the long-term. So maybe 10 or 20 years, maybe even 30 years,
for organisations that really take this seriously. So boards do need to buy into that, and believe
it’s the right thing to do for their organisation. We’re trying hard to find ways to make this
work; part of the way that our teams function, not an extra add-on that people do if they
have time, or just the super keen people take part in, but the way that all of our teams
function. And I think the only real way to do that is
to think differently about what you do as a team; rather than add it on to something,
it’s got to be about taking things away as well. So I hope our teams are starting to
now think: do we still need all of our business meetings; do we still our governance meetings
to function in the same way, or can part of that now be about rapid-cycle improvement,
and bringing your team together to solve a complex problem? So our research has shown that quality improvement
is one way to improve the quality of care, and with the right conditions and a commitment
from the leadership, there is scope for quality improvement to be applied across all types
of health care settings.

One thought on “Quality improvement in practice: lessons from mental health

  1. Psychiatry and psychology which are total frauds and forms of social control to uphold and justify the unequal capitalist mode of production. Did you know psychiatrists use to label black slaves with "drapetomania" because they wanted to flee captivity in the 19th century. Today if you can't handle the stress of working for the minimum wage, being constantly tested or bullied at school or any other social problem then you get labelled with a mental illness and drugged to the eyeballs to keep you quiet while the other slaves work for nothing, or immigrants do the job.

    This is why people are labelled with a mental illness, their personality is incompatible with our heartless exploitative capitalist environment and rather than change the environment to meet your needs YOU have to change. Because people with mental illness can't change psychiatrists need to do research in to why and how you can change in the future but all they need to do is accept that our environment is the cause of peoples misery and change the environment.

    Well if it's that simple why don't they change the social environment? Because our environment is based on inequality, someone become rich and someone becomes poor, the minimum wage goes up then so do your bills and food so you're always stuck in poverty. If they give people with Autism and ADHD a job in the community and help it goes against the principles of our capitalist environment which isn't about help and caring for each other. Then there's another problem, if they give a job and help to people with Autism what about all the people who have depression because of their low paid jobs, people in prison with mental illness who need help and everyone else. The capitalist system would collapse so it's imperative that people with mental illness are dependent on mental health services which creates jobs for psychiatrists, psychologists, therapists and neuroscience research teams. They uphold and justify the capitalist mode of production which is why after 200 years of psychiatric research suicide is on the increase and they can't even diagnose properly like real medicine does.

    At the moment the whole premise behind psychiatry is that if you're mentally ill its due to a biological problem like a brain disease which is a lie. This means society can carry on screwing people over and making them ill because if it's a brain problem then nothing needs to change and those who do thrive in this environment will continue to do so. Most of the illnesses in the DSM are voted into existence by the American Psychiatric Association, none are discovered in the laboratory. In fact most mental illnesses are diagnosed through an interview. Can you imagine a normal doctor giving someone insulin, chemotherapy, drugs to treat cancer etc on the basis of an interview? If I'm going to have chemotherapy or be put on a life long drug treatment plan then I want a test to prove it especially when psychiatric drugs can causes liver, kidney damage and other health problems.

    But isn't capitalism the best social environment? Well for some people it might be like a business man but because different environments effect different people differently it doesn't work for everyone. Also we're told at school to think about ourselves, get good grades, go to Uni and get a good job but we don't look over our shoulder to see how these stresses affect other people. We're not told that it's an unequal exploitative, capitalist system where employers mainly care about money and will screw you over. In Business Studies we are taught about the differences between sole trader, partnerships and limited companies when discussing business but we are conveniently kept in the dark about the dark side of business.

    What do you mean? Take the slave trade for example, slavery expanded to satisfy European consumers and enrich merchants and bankers. in the 1700's the British were the main consumers of these goods. ports like Liverpool and Bristol became rich during the slave trade and lots of people depended on it including boat builders, sail makers, rope makers, carpenters, sailors and shopkeepers who sold the products. Slavery was seen as normal and even shopkeepers with savings to invest would finance slave voyages and the economy would boom. Sir Francis Baring founder of Barings Bank was one of the many bankers in the city of London who made fortunes out of the investments in the slave voyages without seeing any of the suffering inflicted on the Africans. Lloyds of London ( the insurer) has its roots in the slave trade. It was founded by Edward Lloyd in the 17th century in Tower Street and became a major insurer of slave ships during the Atlantic slave trade. it was originally called Lloyds Coffee House. A bronze statue on a pedestal of Portland stone was unveiled in Bristol city centre (in 1895) showing a deep thinking Edward Colton leaning on a stick, its inscription reads "Erected by the citizens of Bristol as a memorial of one of the most virtuous and wise sons of their city". Not mentioned are the thousands of slave victims that Colston and his family trampled over to obtain much of their wealth.

    Ok but slavery ended now business is a good thing? No business exists to make money and screw you over that's why there's always been a conflict between employer and employee, like in 1823 The Master & Servants Act was a law which required obedience and loyalty from the workers to their contracted employer, with punishment enforced by jail or hard labour. It was used against workers organizing for better working conditions until the Trade Union Act of 1871 was implemented and secured the legal status of Trade Unions. Even today workers go on strike asking for better pay and conditions because their employers are taking advantage of them. Also think about all the cheap clothes and products we can buy, somebody somewhere must be getting screwed over. In April 2013 an eight storey building the Rana Plaza collapsed in Savar in Bangladesh, over 900 people died. The building contained clothing factories for companies like Benetton, Primark and Monsoon. The workers were worried about the state of the building because cracks appeared in the walls but they were forced to return to work and threatened with loss of pay if they didn't. It doesn't end there there's also corruption.

    What do you mean about corruption? Well business exists to make money and that's all they care about. Take Libor for example (the global benchmark for interest rates) was manipulated during the financial crisis of 2007 so Banks could carry on doing business. Also in 2012 an investigation by the US authorities found that HSBC the UK Bank was failing to stop criminals using the banking system. Mexican drug traffickers like the Sinaloa Narco Cartel laundered hundreds of millions of dollars with the bank. The New York Times reported that Federal Authorities would not prosecute HSBC in case a criminal prosecution would topple the entire capitalist system.

    Please look up "psychiatry fraud" on YouTube and do some of your own research before they destroy your life with psychiatric drugs Link: https://www.youtube.com/watch?v=atsCp2SErog&t=

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