1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
Header line 1
Header line 2
Header line 3
Advancing Recovery in Adult Mental Health Inpatient Services in Ireland
Jennie Synnott
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.

2. Introduction & Background Organisational Impact
Advancing Recovery in Adult Mental Health Inpatient Services in Ireland
Jennie Synnott
Introduction & Background
Methodology
Evaluation
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.
PEST and SWOT completed to analyse drivers, stakeholder analysis also completed. National and international drive to ensure service-users 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
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.
PoRSAT baseline measured, Re-admission rates measured. recovery discharge pack introduced and staff member and service-user trained. The change agents priority is to maintain both momentum and communication .
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 service-user has led to this being delayed. On reflection funding for this should be secured during initiation phase.
It is vital to gather data to prove change is an improvement (1).
Re-admission rate in intervention group significantly lower. 35% increase in the recovery orientation of the service.
Figure 1: HSE Change Model (5)
Initiation
Aims & Objectives
67%
PoRSAT post
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
32%
PoRSAT pre
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
Planning
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 .
Implementation
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).
References
Mainstreaming
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 quasi-experimental mixed methods study. BMC Psychiatry ;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.