Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial.

BACKGROUND: We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention. METHOD: We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy. RESULTS: The intervention was accepted by staff. However, the skills gained, and changes to the unit's processes and structures that were agreed with the intervention team were not sustained after they left. The main reasons for this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of senior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period; reinforcement of skills). CONCLUSION: This study illustrates some of the inter-related factors which operate at different levels within and outside of NHS organisations that may impact on the success of complex interventions. These factors need to be considered when designing interventions to ensure adequate buy-in from senior staff. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010)

Explaining Citizen Surveys Non-Adoption in Local Governmen

In order to measure the outcomes of service delivery activities public administrators often relies on citizen surveys. At the same time citizen surveys have been severely criticized and labelled ad useless and unreliable. Drawing on available literature, the aim of this paper is to explore the antecedents of the decision to adopt those tools from the decision maker point of view. Data were collected through questionnaires sent to a sample of Italian town mayors. Results particularly emphasize public officials\u2019 perception that surveys are often useless for their decision process. On the other side findings do not support the hypothesis that surveys are not conducted because they are believed to be as not reliable as objective indicators. Results are discussed and managerial implications are drawn

Through the Looking Glass: What does strategic planning reveal in French local governments?

International audienc