10 results
Applying the Principles of Midlands Charter to Improve Well-being of Psychiatry Higher Trainee in BSMHFT
- Nurul Yahya, Amna Mansour, Ruth Scally
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S39-S40
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Aims
The Midlands’ Charter outlines commitment to prioritise the restoration of postgraduate medical education and training impacted during the COVID-19 pandemic . The support provided must be accessible, inclusive, and culturally sensitive, with a greater understanding of current barriers that the trainees face to achieve this goal. This project aims to identify the barrier of receiving well-being support and to enhance psychiatry higher trainee's well-being in the trust by following the principles of Midland's Charter.
MethodsWe designed an anonymous electronic survey, where multiple choice questions and Likert scales were used to quantify respondents’ levels of agreement with a range of statements. Questions were selected to capture baseline characteristic, rating of current well-being score, access to well-being support, barriers, and suggestion of improvement.
The survey was open for one month and was distributed to all psychiatry higher trainees working in BSMHFT.
ResultsWe identified a response rate of 81%.
One of the main themes of the survey that came up repeatedly was that trainees are struggling with clinical workload that sometimes overspilled to their personal time, which means family time is affected. More than half of the trainees reported that they do not know how to access well-being support in the trust. While the result was split in half when the trainees were asked if they have a well-being concern whilst working for the trust. Trainees said that there is very little support given to attend any nonrelated work engagement and they made grievance on the difficulty of accessing the trust occupational health and well-being services.
ConclusionSince the inception of the survey, several recommendations were trialled. This include raising awareness among clinicals supervisors, where a video was uploaded on to the Trust intranet outlining the tips of becoming a good clinical supervisor. A well-being booklet was introduced as part of trainees’ induction, and this was also made available on the intranet. Lastly, an awareness on ST representative role was also highlighted so that they can continue to facilitate an ST forum meeting as platform to raise concerns.
Improving Confidence and Knowledge in Raising Concerns: A Development Half-Day for Representatives of Postgraduate Doctors in Training
- Katie Thomas, Sian Davies, Vicki Ibbett, Shay-Anne Pantall, Ruth Scally
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S18
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Aims
Raising a concern is an integral duty for a doctor. The General Medical Council guidelines on Good Medical Practice state that a culture should be promoted that allows “all staff to raise concerns openly and safely”. Appointment of Postgraduate Doctors in Training to Representative (Rep) positions can be an effective way to allow trainee voices to be heard. Here we present the results of a Development Half-Day created to empower Reps with the knowledge and confidence to represent peers effectively within a large mental health Trust. The training session was identified as a ”change idea” in a wider Quality Improvement Project (QIP) seeking to improve trainee confidence in raising concerns.
Methods16 Postgraduate Doctors in Training Reps were invited to attend a Development Half-Day in November 2022. The day included talks on their roles and responsibilities, respectful challenge and maintaining well-being.
Quantitative and qualitative data were gathered using anonymous questionnaires completed before and after the session. The questionnaire contained 4 questions asking them to rate their knowledge of their role as a rep and confidence in raising trainee concerns. This was quantified using a 1-10 scale for each question with 1 being lowest confidence/knowledge and 10 being highest. Mean scores and standard deviations were calculated. A paired one-tailed t-test was used to assess the statistical significance of the difference in pre- and post-session scores.
Results9 Reps attended the Development Half-Day and completed the pre- and post-session questionnaires.
There was a statistically significant improvement between pre- and post-session scores for all questions (all p values <0.05). Importantly there was a significant increase in the confidence felt by reps in knowing where and who to raise trainee concerns to (p < 0.05).
Qualitative feedback indicated that attendees found the session useful and they appreciated that it was in-person. The only suggestion for improvement was for the session to have been held earlier, closer to when reps were initially appointed; this will be a change that will be implemented in the next “Plan, Do, Study, Act” cycle of the QIP.
ConclusionImplementation of a Development Half-Day for Trainee Reps was shown to have a significantly positive impact on their confidence in their roles and their ability to respectively challenge seniors. The Reps additionally reported being better equipped at knowing where and who to raise concerns to. This will hopefully aid in their ability to signpost and empower other trainees to do the same.
Improving Trainee Knowledge of Raising Concerns: A Trainee-Led Session at Induction for Postgraduate Doctors in Training
- Sian Davies, Vicki Ibbett, Katherine Hubbard, Ella Kulman, Shay-Anne Pantall, Ruth Scally
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S17-S18
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Aims
As part of a wider Quality Improvement Project aiming to improve trainees’ experiences with ‘Raising Concerns’ in a large mental health trust, we sought to improve induction processes to make information on raising concerns more accessible when starting a new post. Based on change ideas generated from our driver diagram, peer-delivered information was identified as a useful tool, so a trainee-led session was introduced to the induction programme.
MethodsA 60-minute trainee-led session was integrated into the induction programme for Postgraduate Doctors in Training in August 2022. The session included sections on raising concerns, on-call advice and rota information. Following the induction, as part of our “Plan, Do, Study, Act” (PDSA) cycle, we sent a questionnaire to gather data from trainees, which covered quantitative measures, including overall helpfulness of the session and effectiveness of information on ‘raising concerns’, and qualitative feedback for how to improve the session. The session was replicated at both the December 2022 and February 2023 inductions, incorporating the feedback from each previous session.
ResultsOn a 1-5 scale (5 = strongly agree), the average response for how helpful the trainee-led induction session was 4.5 from both the August and December 2022 inductions. 4 out of 6 responders from the August 2022 induction specifically mentioned the information on raising concerns as being particularly helpful. There was also feedback on improvements that could be introduced, such as increasing the amount of time for the session to allow for more questions. When asked to rate the helpfulness of the ‘raising concerns’ section, the average response was 4.83 and 4.50 for August and December 2022 inductions, respectively. Following the feedback from August 2022, we implemented changes to increase the duration to 90 minutes and include trainee reps in a separate ‘Question and Answer’ session. Unfortunately, there were only 2 responders to the December 2022 questionnaire due to a small intake, so we will evaluate data from February 2023 induction to analyse the effectiveness of changes made to the session and assess the need for further improvements.
ConclusionOverall, the response to our trainee-led induction session has been positive, with good feedback both for the whole session and specifically relating to ‘raising concerns’. It has highlighted trainees’ appreciation for peer-delivered information and the need for more time in this session. The questionnaire from February 2023 induction will give more data on whether our improvements have been effective and provide ideas for future PDSA cycles.
Understanding Trainees’ Current Likelihood of Raising Concerns
- Vicki Ibbett, Manjinder Padda, Katie Thomas, Rajendra Harsh, Sian Davies, Tabassum Mirza, Katherine Hubbard, Ainy Gul, Khadija Kulman, Marium Fatima, Amy Shaw, Ella Kulman, Razan Saeed, Shay-Anne Pantall, Ruth Scally
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, p. S96
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Aims
Raising concerns is a duty for all doctors. However, a scoping exercise within a large mental health Trust demonstrated that trainees experience difficulties in raising both patient safety and training concerns. As part of a trainee-led quality improvement (QI) project within this Trust, our aim was to develop a pulse survey to capture the current likelihood of trainees raising concerns and factors influencing this.
MethodsAn online survey was developed using ‘plan do study act’ (PDSA) methodology. The initial draft was informed by data from the Autumn 2021 scoping exercise. The survey was refined using a collaborative trainee-led approach. It was tested by trainees involved in the QI project followed by two other trainees and was revised accordingly.
Trainees across all training grades were invited to complete the survey through various communication channels. The pulse survey will be repeated monthly with a two-week response window.
ResultsTen trainees out of 103 responded to the first pulse survey open from 18th to 31st January 2023 (response rate 9.7%). Seven respondents were core trainees and three were higher trainees.
Respondents were more likely to raise patient safety concerns than training concerns (average score of 3.8 out of 5, where 5 equals ‘very likely’, versus 3.4 out of 5 respectively). Of the three respondents who had experienced a patient safety concern in the past 2 weeks, only two had used any existing process to raise it. These data were replicated for training concerns.
No respondents were confident that effective action would be taken if they raised a training concern, while less than half of respondents were confident that effective action would be taken if it were a patient safety concern.
The reasons for the low response rate are likely varied. However, there may be some similar underlying reasons for low engagement in surveys and low engagement in raising concerns. Given this, a more negative picture of trainees’ likelihood of raising concerns may have been portrayed if more trainees engaged in the survey.
ConclusionEngaging trainees to provide insight into their likelihood of raising concerns is challenging. Despite the low response rate, this initial pulse survey demonstrated that trainees continue to experience barriers to raising concerns. PDSA methodology will continue to be used to optimise the monthly pulse survey response rate. The key QI outcome measures will also be integrated into pre and post intervention surveys as a pragmatic approach to evaluate specific change ideas.
Improving Access and Confidence in Learning Lessons From Serious Incidents: A Quality Improvement Project Aimed at Junior Doctors
- Cornelia Beyers, Eleanor Parkinson, Rajendra Harsh, Sameer Nardeosingh, Dolapo Oseji, Alice Packham, Nick Conway, Renarta Rowe, Ruth Scally, Joshua Rochelle-Bates, Onaiza Awais, Farhaana Surti
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S87
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Aims
Birmingham and Solihull Mental Health Foundation Trust (BSMHFT) previously developed some methods of learning lessons following serious incidents. However, despite various systems available, frontline junior doctors were not regularly exposed to important learning opportunities. This potentially resulted in doctors not being aware of learning from serious incidents, and not feeling embedded within the organisation, with potential effects on their training experience. As we identified an unmet need within the Trust in learning lessons from serious incidents amongst junior doctors, we aimed to improve access and confidence in learning from serious incidents by starting a Quality Improvement project on this theme.
MethodsThe current approach involved a comprehensive quarterly bulletin circulated by email to staff. An initial survey confirmed that this was not very effective in delivering learning lessons information to junior doctors.
Using a QI driver diagram, we identified potential areas for change. Selected change ideas were sequentially trialled including shortened email bulletins, supervision templates and remote learning lessons sessions. Initial PDSAs highlighted difficulties with communication via email, with many trainees failing to read/engage with this format.
ResultsThe use of remote interactive learning sessions yielded positive results, with improvement in the confidence in learning from Serious incidents. We therefore continued to refine this method to wider groups.
During the COVID-19 pandemic we experienced multiple setbacks and created a timeline tosupport team morale, maintain team energy, visualise progress and motivate the team. We therefore managed to persevere and strengthened the group by recruiting members to the team and complete the project.
ConclusionThe team have been able to create a sustainable, effective and interactive short teaching session which has shown to be effective in engaging trainees in this vital area and help us meet our aim. This format further has the potential to be refined and implemented locally and nationally.
Raising Concerns and Trainee Well-being: What Are the Issues?
- Sabrina Hasnaoui, Vicki Ibbett, Sambavi Navaratnarajah, Rajendra Harsh, Shay-Anne Pantall, Ruth Scally
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S24
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Aims
Raising concerns is an important part of being a doctor and part of the GMC ‘Good Medical Practice’ guidelines, however as a trainee it often comes with specific challenges. Historically trainees are often left feeling that their concerns are not taken seriously and there is no resolution to problems raised. Here we present the findings of a scoping exercise undertaken as part of a Quality Improvement project exploring these issues within a large mental health Trust.
MethodsTrainees across all training grades from Foundation doctors to higher trainees were invited to engage in virtual focus groups specific to their training programme. Contributions were analysed anonymously using a thematic analysis approach by two independent coders. Quantitative data were also gathered using an online survey to capture trainees who had been unable to attend a focus group.
ResultsKey results included:
• A total of 6 focus groups were attended by more than 35 trainees, with high turnout particularly within Foundation trainees and CT1 doctors.
• Three key themes were identified from the qualitative data: difficulties with the process of raising concerns, fear of the consequences and challenging the culture of the organisation.
• It was noted that senior trainees felt more comfortable with the process of raising concerns compared with junior colleagues but were more apathetic about the impact of doing so.
• 12 trainees completed the online survey. Of these, 6 (50%) reported having had patient safety concerns and 7 (58%) had had concerns about their training.
• The most common reported barriers to raising concerns were the impact on working relationships (67%), lack of support (50%) and fear of repercussions on their training (50%). 42% of respondents were unsure of how to raise concerns.
• Trainee suggestions for change included improved information for trainees and trainers about the process for raising concerns, sharing of feedback about concerns raised more widely and regular opportunity to meet with key stakeholders.
ConclusionThe majority of trainees had experienced concerns about either patient safety or training issues. It will be necessary to address the multiple barriers highlighted to enable trainees to feel more confident and able to raise concerns. Increasing awareness of escalation processes, improving the processes themselves and fostering a supportive environment which encourages and supports trainees to raise concerns will be important given the implications for patient safety and trainee well-being.
Perception of junior doctors about local induction in Birmingham and Solihull Mental Health Foundation Trust - A quality improvement project
- Saima Jehanzeb, Kozara Nader, Ruth Scally
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S198
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Aims
A quality improvement project was undertaken to understand the perception of trainees about the quality of the local induction delivered by Birmingham and Solihull Mental Health Foundation Trust (BSMHFT). The primary aim was to evaluate the current local induction programme, following concerns raised by previous trainees in National Training Survey (General Medical Council) and local inspection. Our secondary aim was to devise a revised induction programme based on the trainees’ identified needs.
MethodTwo anonymised questionnaire surveys were emailed to all Foundation Year Trainees, Core Psychiatry Trainees and General Practice Speciality Trainees working in BSMHFT, in December 2019 and March 2020, using trust survey monkey.
ResultThe overall response to survey was 60 percent. 44.44 percent of the responses came from Core Psychiatry Trainees, with 27.78 percent responses each from Foundation Year Trainees and GP Speciality Trainees. Local induction was defined as induction specific to place of work (47.06%), trust based induction (41.18%) or all of the above options (11.76%) by trainees. 83.33% of all trainees had received local induction, whereas 16.67% did not have any local induction at the start of their post. 11.12% trainees were very satisfied and 44.44% were satisfied with local induction. 72.22 percent of the trainees were informed about of the local induction, prior to starting the post.
33.3% trainees had a paper version, 22.22% had an electronic version of local induction pack, whereas 44.44% had no induction pack. 55.55% of those trainees who had an induction pack, 43.75% found it very helpful and 56.25% did not find it helpful.88.89% thought having a local induction would be helpful, whereas 11.11 percent did not feel it would help. 94.44% of the trainees completed a local orientation checklist with their consultants. Some of the trainees experienced difficulty in gaining access to electronic prescribing, electronic patient record system (RIO), and identity badges (ID) at the beginning of their post.
Conclusion11.12% trainees were very satisfied, 44.44% were satisfied, 22.22 % were neither satisfied nor dissatisfied and 22 % were dissatisfied, with local induction. 88.89% of the trainees thought having a local induction pack would be helpful. Based on the trainees identified needs we developed a template for local induction pack for each post. Clinical supervisors have agreed to take the lead in preparing the local induction pack specific to their post with trainees.We aim to repeat the survey after implementing the changes identified by trainees based on their training needs.
A service evaluation of the healthy lifestyle groups in a female medium secure unit- what do our patients know about nutrition?
- Lauren Shipperbottom, Ruth Scally
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S350
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Aims
To assess whether patients have a good knowledge of basic nutrition compared to a group of staff. We hypothesise that the patient's knowledge will show deficits compared to the staff despite the group interventions.
BackgroundThe Royal College of Psychiatrist's core standards for inpatient physical health outlines that patients should be engaged in healthy lifestyle groups. The women's secure service at Ardenleigh has developed healthy lifestyles groups to promote a better understanding of nutrition.
MethodAn adapted University College London general knowledge nutrition questionnaire was used to investigate nutritional knowledge.
All 22 inpatients and a random selection of staff were offered the chance to complete the questionnaire. As the groups run on a regular basis, it was presumed all patients had attended at least one group session. The staff are the comparator group.
18 staff responses and 12 inpatient responses were obtained (54.5% response rate for inpatients).
ResultNo participant in either group scored 100%. Both groups had a good awareness of what foods they should be eating more and less of. 83.3% of patients were aware that they should be eating breakfast everyday as opposed to 100% of staff.
Poor areas of knowledge included knowledge of the number of oily fish servings per week. Staff and patients also performed poorly when estimating their recommended daily salt intake. 1/3 of patients were unable to provide an example of a serving of fruit and vegetables.
The knowledge of the structure of the Eat-Well plate was poor in both groups. Only 16% of patients and 22% of staff were aware that starchy foods should make up 1/3 of the Eat-well plate. Knowledge of protein sources was poor. 25% of patients and 16.6% of staff thought that fruit and butter were good sources of protein
Furthermore, only 50% of patients were able to choose the healthiest evening meal choice from a list of 3 options compared to 100% of staff.
ConclusionIn conclusion staff had better knowledge of nutrition than patients but knowledge was poor in areas amongst both groups. We conclude that groups should have more focus around practical applications of nutritional knowledge to everyday life.
Microsoft teams virtual handover system
- Mohit Mohan, Ruth Scally, James Reed, Calin Cavaropol
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S209
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Aims
Accurate and timely handover of clinical information is of great importance to continuity and safety of care. Psychiatry doctors typically cover a number of sites across a catchment when they are on-call. Consequently, handover between on-call teams and day teams in psychiatric hospitals is reliant on using the nursing staff as an intermediary to flag concerns or relying on the day teams proactively checking the notes on daily basis for outstanding tasks.
The key objective of this project was to use Microsoft teams to establish a handover system that is efficient, safe, reliable, easy to use and replicable.
MethodA microsoft teams group was created comprising of all the medical staff members working at inpatient units across three sites that are part of Birmingham and Solihull Mental Health Trust. These members were divided into two groups - the ‘on-call team’ and the ‘day team’. Within the ‘day team’, every consultant was grouped with their junior doctors to form multiple subgroups.
A system was established wherein the two teams could communicate with each other by posting a message and tagging the appropriate team. A provision was made to create a channel for every ward to allow for easy segregation and monitoring of tasks.
Qualitative information about the use of the tool was monitored by monthly focus group meetings. A formal review of the messages was conducted after 8 weeks to assess the following parameters:
Number of messages posted
Number of messages acknowledged
Number of safety-related incidents
ResultInitial evaluation of the results suggests that the new handover system was perceived to be safe, accurate and efficient while being intuitive and hassle-free. This increased the quantity and enhanced the quality of communication between the ‘on-call’ and the ‘day teams’ and allowed for early completion of tasks while reducing the number of safety-related incidents.
ConclusionThe Microsoft teams proved to be a viable alternate tool to create a virtual handover process that is efficient, safe, reliable and user-friendly. It also has the potential to enhance the communication between inpatient and community teams.
53 - Risk assessment: medium-secure unit
- from IV - Record-keeping
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- By Ruth Scally, Birmingham and Solihull Mental Health NHS Foundation Trust
- Edited by Clare Oakley, Floriana Coccia, Neil Masson, Iain McKinnon, Meinou Simmons
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- Book:
- 101 Recipes for Audit in Psychiatry
- Published online:
- 02 January 2018
- Print publication:
- 01 March 2011, pp 131-132
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Summary
Setting
This audit is particularly relevant in forensic settings but also applies to any adult psychiatric service, both in- and out-patient.
Background
An assessment of the risks posed by patients, whether self-harm, absconding or violence to others, should be recorded in the patient's notes. In the trust audited, these assessments are based on the HCR-20 (Historical Clinical Risk),a 20-item structured clinical risk assessment tool that is widely used in forensic settings (Khiroya et al, 2009).
Standards
The National Institute for Health and Clinical Excellence (NICE) has produced a guideline (2005) on the short-term management of disturbed and violent behaviour in in-patient psychiatric settings. It states that ‘there should be an effective risk assessment and risk management plan … in the case notes of each service user at high risk and that this should be reviewed on a regular basis’. For the purposes of this audit, this was interpreted as all patients having an HCR-20 form in their notes, which had been reviewed within the past 12 months.
Method
Data collection
The medical records of all in-patients on one specific day were reviewed and the following data collected:
ᐅ whether an HCR-20 form was present in the notes
ᐅ whether it had been completed
ᐅ whether it had been reviewed in the past 12 months
ᐅ the number of disciplines involved in the risk assessment (i.e. whether it was a multidisciplinary assessment).
In addition the length of stay of each patient was noted.
This audit was conducted in combination with an audit of risk assessment documentation for the care programme approach (CPA) within the trust.
Data analysis
The percentage of sets of case notes meeting the standards was calculated for:
ᐅ those with an HCR-20 form
ᐅ those that were complete
ᐅ those that had been reviewed in the preceding 12 months.
The number (and nature) of disciplines involved was counted and displayed in a bar chart.
Resources required
People
Depending on the size of the population being studied, this audit would be suitable for one or two people, of any discipline.
Time
About 4 hours should be allowed for an audit of 90 patients.