Partnering with people: how experts by experience are helping to reduce restrictive practice in acute mental health settings

17 September marks World Patient Safety Day; the theme for 2023 is ’Engaging patients for patient safety’ in recognition of the crucial role patients, families and caregivers play in improving the safety of health and care.

As part of our celebration of World Patient Safety Day, we hear from HIN Project Manager Ayobola Chike-Michael about how her work on the Mental Health Safety Improvement Programme (MHSIP) has helped to bring together patients and professionals with the shared aim of improving outcomes.

It has been amazing to work as a patient safety project manager for the past four years. Looking back, I am grateful for the opportunity to live out my dream to make life better for both patients and staff through my skills as a project manager.

Much of this has been made possible through NHS England and NHS Improvement’s national patient safety improvement programmes, which form the largest safety initiative in the history of the NHS. These programmes have supported safety, continuous learning, and sustainable improvement across the healthcare system.

There are five major improvement programmes focusing on medicine, mental health, deterioration, maternity and adoption/spread. Each area has key ambitions that align with NHS England’s Long Term Plan.  My reflections in this blog centre on the Mental Health Safety Improvement Programme (MHSIP); my colleague Natasha has recently written about our work on the medicines programme (MedSIP).

What is MHSIP?

The aim of the MHSIP is to improve the safety and outcomes of mental health care by reducing unwarranted variations or health inequalities across a number of specifically-targeted topics.

The MHSIP programme began initially with its focus in areas of sexual health, suicide and reducing restrictive practices. These were all significant areas of interest, however it was not feasible to drill into all three areas concurrently. Ultimately Reducing Restrictive Practices (RRP) became the main focus for Patient Safety Collaboratives (PSCs) to lead on nationally. Using quality improvement methodologies and tools, MHSIP leads worked in their local areas but also collaboratively across England, coming together regularly to share best practice and challenges.

The Health Innovation Network (HIN) where I work, is one of 15 PSCs who led on the MHSIP work in their designated local region. The HIN covered South London and it presented a valuable opportunity for me to work with mental health professionals (particularly in inpatient care) across south east and south west London.

Using the patient perspective to Reduce Restrictive Practice

Our core HIN team – made up of project managers, quality improvement experts and in-house clinicians who provide valuable support in helping us interface with clinical colleagues – was hugely bolstered by having experts by experience working in partnership with us during the programme. These experts by experience were recruited to contribute their unique perspective to the programme; working effectively with people and communities throughout our work is one of the main aims of our Involvement Strategy.

The programme exemplified the elevation of patients’ voices through the partnership with six experts by experience. The HIN primarily acted as a convening force, facilitating continuous sharing of knowledge, experiences and learning opportunities through QI collaboratives and the Patient Safety Network. These were attended by a range of healthcare professionals including mental health nurses, QI professionals, psychiatrists, ward managers, project managers, healthcare assistants, doctors, service user involvement representatives, dieticians, psychologists, and senior managers. Our work meant that each of these groups had the chance to learn from the experts by experience, who often brought new ideas or insights to the table.

Sharing spaces and sharing ideas

One of the highlights of this programme for me has been the visits to various inpatient wards. As the project manager, I was accompanied to each ward visit by an expert by experience, who brought valuable perspectives to the conversations we had with staff and service users.

This collaborative approach fostered a well-rounded understanding of the wards’ dynamics and challenges. Discussions during the visits encompassed various aspects, including the ward’s culture, compassionate leadership, staff wellbeing, potential areas for improvement, and specific techniques for reducing restrictive practice such as the utilisation of safety crosses. We also took the opportunity to address challenges unique to each ward and proposed potential solutions, tailored to their circumstances.

Participating wards successfully tested and implemented some change ideas despite often facing significant barriers,  such as staffing issues or complex caseloads. As a team, we observed and supported the implementation of several change ideas aimed at improving patient care and experiences.

Some of the change ideas included:

• Patient involvement in planning schedules;
• Therapeutic and sensory interventions;
• Staff skills training and use of tools;
• Coproduction with patients and families in decision-making processes and jointly developing care plans;
• Visual display of routines, preferences, and staff allocation;
• Improved indoor and outdoor spaces;
• Reduced blanket restrictions and unnecessary rules;
• Negotiation with patients;
• Increased focus on patient preferences and needs;
• Open door polices to build patient relationships.

The work has generated significant improvements across a variety of measures of patient experience and safety. It has been incredibly fulfilling to be a part of sharing practical, patient-focused ideas between services; the input of our experts by experience has been vital for understanding the human context for these interventions and gaining a well-rounded view of how they might impact patients and their families.

We are grateful to work with the six experts by experience who through their partnership with us, elevated patients’ voices. We are also grateful for the full participation and contributions of the following wards across south London – Avery ward, Aquarius ward, Jasmines ward, Lesney ward, Norman ward, and Ruby ward.