New ways of working in acute inpatient care: a case for change

This position paper focuses on the current tensions and challenges of aligning inpatient care with innovations in mental health services. It argues that a cultural shift is required within inpatient services. Obstacles to change including traditional perceptions of the role and responsibilities of the psychiatrist are discussed. The paper urges all staff working in acute care to reflect on the service that they provide, and to consider how the adoption of new ways of working might revolutionise the organisational culture. This cultural shift offers inpatient staff the opportunity to fully utilise their expertise. New ways of working may be perceived as a threat to existing roles and responsibilities or as an exciting opportunity for professional development with increased job satisfaction. Above all, the move to new ways of working, which is gathering pace throughout the UK, could offer service users1 a quality of care that meets their needs and expectations

An Assessment of Mental Health Services for Veterans in the State of Texas

This report describes the complex challenges faced by veterans and their families in seeking, navigating, and attaining adequate mental health care in Texas. There are 1.7 million veterans in Texas, comprising 8.6 percent of the adult population. According to the U.S. Department of Veteran Affairs (VA), the number of veterans requiring mental health services has grown dramatically and will continue to increase, making veterans’ mental health care an urgent issue in Texas. The federal agencies responsible for military and veterans mental health care, the U.S. Department of Defense (DoD) and the VA, have created new programs and invested significant financial and staff resources. Despite barriers to addressing veterans mental health needs. Texas state agencies have increased funding and instituted new mental health programs supporting returning veterans. Nonprofit agencies focused on veteran’s mental health have multiplied across Texas and the U.S. over the past decade to fill gaps in care. While these organizations provide a growing and increasingly diverse set of resources for veterans to extend the scope of support, volunteer efforts can suffer from fragmentation and overlap. The report identifies current practices, challenges, and opportunities within and across each group of service providers. The report draws on government reports, scholarly literature, and agency websites, as well as interviews with counselors, Veteran Service Officers, nonprofit providers, state officials, and veterans themselves. This report offers five recommendations toward the goal that veterans’ mental health care in Texas become comprehensive, inclusive, effective, and efficient. First, there is a need for greater inter-agency communication across organizations, improved outreach efforts, and increased services for hard-to-reach populations, such as homeless veterans. Second, federal agencies ought to address staff shortages, improve the transition from DoD to VA care, and increase feedback. Third, at the state level, specialized services are needed to address unique veterans’ needs concentrated in cities across Texas as well as those dispersed in rural areas. Fourth, providers can improve mental health care by integrating social services and law enforcement. Fifth, both veterans and providers can benefit if they recognize opportunities for cooperation and coordination and work towards long-term goals that emphasize outcomes that improve the lives of returning veterans. This research was funded in part by the Jack S. Blanton Research Fellowship and the George A. Roberts Research Fellowship of the IC² Institute.IC2 Institut

Culture of Wellness Toward Resiliency

Stress and burnout are increasingly prevalent amongst law enforcement officers and civilian staff due to job demands and job-related traumas. A culture of wellness planning is how administrations can build resiliency against stress and burnout. A wellness plan should emphasize organizational responsibility, officer responsibility, formal and informal leadership, and external collaborations. Agencies can also utilize the same cognitive behavioral therapies that supervised release agents find beneficial for clients. There are great similarities between the utilization of cognitive behavioral interventions, evidence-based models, and thought behavioral links between supervised release clients and law enforcement staff members. Often, cognitive behavioral therapies are used to help supervised release clients change their thought processes to change their criminal behaviors. For law enforcement officers and staff members, these same techniques can be used for those struggling with mental health particularly relating to stress or burnout accumulated on the job. If left untreated stress and burnout have a negative impact on how officers and civilian staff carry out their duties. This leads to ethical and moral failures. Agencies can foster staff to have a personal moral compass through external mental health resources, developing clear and concise ethics policies, having leaders who model strong ethical values, and changing the culture within the agency to be mental-health focused first. Searching methods for this literature review focused on law enforcement and civilian staff stress and trauma. An emphasis was placed on how law enforcement agencies could help staff build resiliency towards stress and burnout and what resources were beneficial

The Experiences of Gay, Lesbian, Bisexual and Transgender People around End-of-Life Care

All States and Territories in Australia have implemented legislation relating to end-of-life decision-making and substitute judgment. However, reports to relevant legal and community services indicate that many gay, lesbian, bisexual and transgender (GLBT) people in NSW -- estimated to be about four to five percent of the population -- are being denied their legal rights in the end-of-life care of their partners and other important people in their lives

A safer place for patients: learning to improve patient safety

1 Every day over one million people are treated successfully by National Health Service (NHS) acute, ambulance and mental health trusts. However, healthcare relies on a range of complex interactions of people, skills, technologies and drugs, and sometimes things do go wrong. For most countries, patient safety is now the key issue in healthcare quality and risk management. The Department of Health (the Department) estimates that one in ten patients admitted to NHS hospitals will be unintentionally harmed, a rate similar to other developed countries. Around 50 per cent of these patient safety incidentsa could have been avoided, if only lessons from previous incidents had been learned. 2 There are numerous stakeholders with a role in keeping patients safe in the NHS, many of whom require trusts to report details of patient safety incidents and near misses to them (Figure 2). However, a number of previous National Audit Office reports have highlighted concerns that the NHS has limited information on the extent and impact of clinical and non-clinical incidents and trusts need to learn from these incidents and share good practice across the NHS more effectively (Appendix 1). 3 In 2000, the Chief Medical Officer’s report An organisation with a memory 1 , identified that the key barriers to reducing the number of patient safety incidents were an organisational culture that inhibited reporting and the lack of a cohesive national system for identifying and sharing lessons learnt. 4 In response, the Department published Building a safer NHS for patients3 detailing plans and a timetable for promoting patient safety. The goal was to encourage improvements in reporting and learning through the development of a new mandatory national reporting scheme for patient safety incidents and near misses. Central to the plan was establishing the National Patient Safety Agency to improve patient safety by reducing the risk of harm through error. The National Patient Safety Agency was expected to: collect and analyse information; assimilate other safety-related information from a variety of existing reporting systems; learn lessons and produce solutions. 5 We therefore examined whether the NHS has been successful in improving the patient safety culture, encouraging reporting and learning from patient safety incidents. Key parts of our approach were a census of 267 NHS acute, ambulance and mental health trusts in Autumn 2004, followed by a re-survey in August 2005 and an omnibus survey of patients (Appendix 2). We also reviewed practices in other industries (Appendix 3) and international healthcare systems (Appendix 4), and the National Patient Safety Agency’s progress in developing its National Reporting and Learning System (Appendix 5) and other related activities (Appendix 6). 6 An organisation with a memory1 was an important milestone in the NHS’s patient safety agenda and marked the drive to improve reporting and learning. At the local level the vast majority of trusts have developed a predominantly open and fair reporting culture but with pockets of blame and scope to improve their strategies for sharing good practice. Indeed in our re-survey we found that local performance had continued to improve with more trusts reporting having an open and fair reporting culture, more trusts with open reporting systems and improvements in perceptions of the levels of under-reporting. At the national level, progress on developing the national reporting system for learning has been slower than set out in the Department’s strategy of 2001 3 and there is a need to improve evaluation and sharing of lessons and solutions by all organisations with a stake in patient safety. There is also no clear system for monitoring that lessons are learned at the local level. Specifically: a The safety culture within trusts is improving, driven largely by the Department’s clinical governance initiative 4 and the development of more effective risk management systems in response to incentives under initiatives such as the NHS Litigation Authority’s Clinical Negligence Scheme for Trusts (Appendix 7). However, trusts are still predominantly reactive in their response to patient safety issues and parts of some organisations still operate a blame culture. b All trusts have established effective reporting systems at the local level, although under-reporting remains a problem within some groups of staff, types of incidents and near misses. The National Patient Safety Agency did not develop and roll out the National Reporting and Learning System by December 2002 as originally envisaged. All trusts were linked to the system by 31 December 2004. By August 2005, at least 35 trusts still had not submitted any data to the National Reporting and Learning System. c Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these are still not widely promulgated, either within or between trusts. The National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system. It published its first feedback report from the Patient Safety Observatory in July 2005

Health Care Leader Strategies for Cultural Diversity in the Workplace

Health care leaders who lack strategies to manage workers from diverse ethnic and cultural backgrounds face high employee turnover. High employee turnover can jeopardize the health of patients and the financial stability of their organization. Grounded in the cognitive diversity theory, the purpose of this qualitative multiple case study was to explore strategies eight health care leaders in Iowa use to manage diverse employees. Data sources were semistructured interviews, researcher notes, and a review of the diversity policies of each facility. Five themes identified through thematic analysis included leaders using recruitment strategies to promote diversity, leaders encouraging and using communication/feedback, leaders conducting diversity training to encourage diversity, leaders providing suitable working conditions to promote diversity, and leaders encouraging and engaging in teamwork and collaboration. A key recommendation for health care leaders is to conduct diversity training that encourages teamwork and collaboration amongst employees with diverse cultures and backgrounds. The implications for positive social change include the potential for health care leaders to build a more inclusive culture that can lead to lower turnover in staff and improve the quality of healthcare for patients