SIP 3 Interim Progress Reports

7/27/2019 SIP 3 Interim Progress Reports

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1. SIP (Service Improvement Project) 3 Interim Progress Proforma

Intervention-led SIP

Please detail a brief project plan here

To create an instruction / guidance folder for systems within an out of hours

Emergency Duty Team.

Email team members to inform them of project and to request feedback of

any areas with which they are having difficulties so these can be included in

the instruction folder.

I will write up and produce laminated instruction sheets which will act as

guides for staff to assist with their performance of duties within a busy out of

hours social services team.

In order to keep this project manageable and small I will begin by introducing

approx. 10 sheets for various systems. The project will be Intervention Led as the need has already been identified.

The email to staff will assist with the creation of the instruction folder.

Once in place I will give staff one month to trial the folders

The evaluation will take place via focus group to discuss how useful the

intervention has been and to identify future needs for expanding the folder.

Please detail the extent of your progress here

I have emailed staff to advise re plan for Instruction Folder and request any

further feedback.

I am working with management re implementation of intervention

I am in process of designing instruction sheets

Research question/s: Please detail the question/s your research will answer here

Has the provision of an Instructions Folder improved confidence levels of staff

in the performance of their role within an Emergency Duty Team?

Has the Instructions Folder improved consistency of practice within the team?

Progress on Research input: Please detail your progress in evaluating the intervention here

I have received a positive response to my email advising colleagues of my

planned intervention

Staff are in agreement re need for an Instructions Folder and have offered

ideas for input to the folder.


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General comments: Please place any issues or concerns here

The Team are going through a difficult time at present with many staff

changes, no permanent Team Manager and current staff under muchpressure covering extra shifts and working overtime.

Due to working three times my usual hours I have less time to devote to

study than anticipated so have fallen behind.

I had hoped to trial intervention with new and old staff however new staff will

not be in place till mid to end of April.


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2. SIP 3 Interim Progress proforma

Enquiry-led SIP

Project plan:

March: prepare for and seek permission from County Council and NHS Trust for

completion of focus groups and semi-structured interviews. Have completed:

Focus group structure

Semi-structured interview questions

Information forms

Consent forms.

I have discussed the focus groups in our team meeting. I have also emailed the team,

requesting they keep a provisional date free. Unfortunately this is not until the 1st

May, as I will not have approval from the County prior to the Easter school holidays,

when lots of staff members will be off. However, I am aiming to complete the

interviews during this period.

April:

Distribute information sheets and obtain consent from all participants.

Complete Semi-structured interviews.

May:

Complete focus groups on the 1/05/14.

Complete thematic analysis.

Take steps towards addressing identified problem.

June:

Steps to address problem to have been implemented by 6/06/14.

Write up to begin.

July:

Simple evaluation of change to process to be completed via email by 5/07/14.

Write up to be completed and hand in by 28/07/14.


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Research question/s:

What are the challenges and/or difficulties you have when following these

procedures?

What do you think would improve this for you?

Progress on Research input: As above. Disappointing that I am not able to complete

the focus groups earlier, but this is due to school holidays followed by my own

annual leave, which is taking up a significant chunk of April.

Progress on intervention: N/A as focus groups/interviews have not been completed

yet, cannot expand any more than plan above.

General comments: Still hoping that Im on track! Due to the school holidays being in

April, I think May will be fairly busy. But I still feel that in keeping the project small

and focused, I will be able to implement the change and evaluate within the above

time frame.


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3. SIP 3 interim Progress Proforma

Enquiry-led SIP

Project plan:The aim of the service improvement project is to improve the rate of

compliance with the MCA amongst care coordinators.

Research question/s:Section 2 of the PSIP attempts to define a question which will be

directly related to the project aim. I settled on the following question; How closely do mental

health workers in an Older Adult Community Mental Health Team comply with the Mental

Capacity Act?. Feedback from my tutors included the fact that the questions should focus on

the key issues (or factors) involved in practitioners achieving close compliance with the

MCA. This above question provides a close alignment with my focus group. That is, the

questions presented to my colleagues will be more concerned with the factors they feel aid or

inhibit their compliance with the MCA. This reflection has focused my thinking on what

questions I might present to my colleagues in order to better understand what intervention

might improve their compliance with the MCA.

Progress on Research input:Consent form, focus group interview guide and information

sheet are all completed. The pilot group was held on 21/03/2014 and provided some very

helpful learning points to consider when planning and facilitating my focus group.

Housekeeping: Remembering to ask the participants to switch their phones off and ensure that

they are not obstructing any cars in our car park (an ongoing problem on our site).

Ethics of the participation of workers with line management relationships: Prospectiveparticipants feel that there would be a more candid exchange if their line managers were not

present. The initial idea was for all care coordinators (including the lead social worker and

lead occupational therapist) to be invited to participate. I will now negotiate the removal of

these colleagues from the list of participants invited.

Language: Dont use jargonistic language during the focus group; use language which is

accessible to all.

Sound quality: All participants could be clearly heard on the digital recording from a one and

a half meter range. My humming in agreement with the statements of the participants seemed

to interfere with the clarity of the sound. This would be an issue if I attempted to transcribe.


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Progress on intervention: From preliminary indications from colleagues and my initial

findings from my pilot group, I have begun to think about what form my intervention would

take.

General comments:PlanFull Focus group to be held on 4thApril 2014, 10:00h.

Intervention to be designed by mid April and implemented throughout May. Evaluation will

be carried on in mid-June, with the majority of the analysis completed by then.


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4. SIP 3 Interim Progress Proforma

Intervention-led SIP

Project plan:

My SIP is intervention led because it is concerned with change management which is

a well recognized and theorized discipline. My SIP focuses on transition, which is the

term used to describe the process by which people adapt emotionally to new

situations. I am applying this knowledge to my particular service change

circumstance. I will be using an established change management tool, the Personal

Transition Curve (PTC), to capture a snapshot of how my staff are feeling about the

work place changes they are experiencing. The PTC self-assessments will then

inform a response strategy which will also constitute my SIP intervention. After 3

months of exposure to this intervention staff will be asked to complete a repeat

evaluation of their feelings about change and a comparison will be made with theoriginal assessment results. This will enable me to assess the progress of staff

towards adoption of the new service structures and to draw conclusions regarding

the impact of my intervention.

Progress on intervention:

Following BU ethics approval; project information sheets, participant consent forms

and the initial personal transition curve response sheets were distributed in

November 2013. 19 curves were sent out and 16 were returned. The responses were

mapped on to the companion curve in the NHS Change Management Navigating

Change toolkit. The majority of the responses (9) fell in the third quadrant of the

companion curve which indicates that regular and reliable information about what is

happening during the change is required to enable the team to process and

internalize the changes, feel involved and encouraged, and to move forward on the

PTC. The remaining 6 respondents were further forward in their assimilation of the

changes and required clear direction to enable them to establish themselves in their

new environment. Overall both these objectives, namely provision of reliable

information and provision of a clear direction, could be met by increasing the

frequency of communication between me and my team.

The nineteen members of my team are spread the length and breadth of Dorset. I

felt that it was important that everybody got the same information at the same time.

This meant that a face to face verbal communication strategy was impractical and

that the medium for communication had to be email.

Since 3rdJanuary 2014 I have been writing a weekly newsletter which has covered 4

key areas of change in our service namely general non specific change, technological

change, clinical change and management change. I have also added in an end of the

month 15 min CPD section where I attach some articles which relate to an

information strand which has been in the Newsletter previously. I hope that this

draws attention up from the shop floor for a moment of respite whilst still being, inmy view, relevant!


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I recognise that I am only using this one vehicle for my communication intervention.

This will be open to scrutiny in my SIP final evaluation.

Research question:

Does the use of change management techniques help staff in the Community Adult

Speech and Language Therapy Team cope with change?

Progress on Research input:

I have yet to collect my second set of transition curve data so have done no analysis.

I have noted that if I ask for information in response to content it is largely

unsuccessful. I therefore am not sure whether this means that the newsletter is not

read or that staff dont see the newsletter as an appropriate medium for two way

communication! It may alternatively be that the items I include are not thought to be

of interest or benefit. I choose the items because I consider them to be of value in

setting context or explaining purpose and so contributing to the establishment of a

common understanding of context. I do see that this is in my opinion only and it may

be the wrong approach. These are issues to consider in the evaluation of the SIP.

General comments:

I have also been keeping a reflective diary. The set of questions which I answer alsocome from the Navigating Change toolkit and provide a fixed framework within

which I can capture my feelings and observations about what has been happening

during each of my working days. This was a late in the day decision and not part of

my original plan but I thought it would be interesting to capture my own progress

through the SIP period as a counterpoint.


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Enquiry-led SIP

Project plan:

I plan to interview local faith group leaders to gather information relating to faith and

dementia. It is hoped that these structured interviews will provide themes and issues

which will inform better knowledge and working links on both sides between the

local Community Mental Health Team (CMHT) and faith groups. I plan to digitally

audio record the interviews and fully transcribe them.


I currently have not formulated a specific research question. However, my aim is to

gather information with regard to faith and dementia locally, in order to improve

knowledge and links between the CMHT and faith groups in both parties.


As I have not started interviewing people, I have not yet gathered this information.

However, I feel that it is likely that some good work (from both CMHT and faith

groups locally) is being already done. It is possible that some form of information

exchange or training on either side may be of help to both parties.


As outlined above, I am yet to start the interview process. I have some questions for

interview formulated and have contact details for local faith groups. At this point, I

need to complete question formulation, get critical feedback on them and then

commence with interviews. I would like to commence interviews early in April 2014

in order to complete (including the transcribing and coding of them) before the end of

May 2014. This should provide a minimum of 2 months for evaluation of data, the

intervention and final essay writing.

General comments:


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I feel very motivated and interested in this study and am really looking forward to

commencing interviews. I am aware that I need to be conscious of time, in order not

to let things slip! My only other concern at present is to ensure I have clear aims and

objectives. In addition to this, I may require some assistance to ensure my interview

questions are robust, non-ambiguous and relevant to the information I want to gather.


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Enquiry-led SIPlone working of AMHPs

Project plan: Please detail a brief project plan here

Complete Participation Information Sheet and Informed Consent form

Inform local research governance department of my intended activity

Audit MH1s Data gathered from MH1s completed from June/Sept 2013

Feb 2014 (dependent on the amount of assessments undertaken looking for

approximately 60). Analysing data that relates to risk incidents/near misses,

timescales in completing assessments, ambulance delays, length of time lone

working and demographic characteristics (gender, experience and the areaeach AMHP is working in).

From information gathered above I will develop my research questionnaire

and disseminate to AMHPs in the HTT, AOT and 2 x CMHTs Total

approximately 12 along with Participation and consent forms via email. The

questionnaire will be a mixture of closed and open questions to gain the best

evidence of AMHPs experiences of lone working. Utilising exact responses to

gain demographic data and a mixture of ordinal and semantic responsestogether with space for personal experiences to be recorded. This will provide

me with information on the safety and risk management/assessment,

systems/processes used by AMHPs in their practice. I intend to allow a

timescale of 3-4 weeks for return of questionnaires.

The gathering and analysis of risk management tools and procedures used

out of county by AMHPs carrying out assessments.

I intend to follow the process of the lone working policy and procedures within

my own workplace to switchboard protocol, to evaluate whether this is being

adhered to and how robust the policy is in relation to the safety and lone

working of AMHPs.

Evaluate all information gathered and begin write up of findings and

implement proposed intervention.

Evaluate implementation and include recommendations into research projectassignment.


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Research question/s: Please detail the question/s your research willanswer/has answered here

My research will highlight any problems experienced by AMHPs when lone working

and will provide best practice used to overcome and manage the risk and safety

issues experienced

Progress on Research input: Please detail the extent of your progress inclearly defining the problem/issue and in the design of potential interventionshere

The identified problem of AMHPs lone working is the risk management once a

MHAA is completed and the Doctors leave. The AMHP is left to coordinate

conveyance and risk manage the patient and their family independently.

Potential interventions include:

A change in policy that indicates the care coordinator for the patient

must be in attendance at MHAA, for their patients to provide support

and risk management to patients, their families and AMHPs. This is a

potentially very difficult and lengthy intervention to implement and

ensure adherence.

Ensure reading, understanding and adherence to Lone working policy

and procedures both within the CMHT and Switchboard protocol after

working hours, which would ensure AMHPs had support and advice

available to them whilst lone working to enhance their safety within the

community.

The development of a risk management tool to be used to identify and

manage risk whilst carrying out assessments.

Analysis of evidence may highlight best practice that could be

implemented to all teams via Senior Practitioners.

Progress on intervention: Please detail your plans for the intervention and itsevaluation here

I have no current plans for the intervention until I have gathered all the evidence

which will identify the best course of action and the most suitable intervention.

To date I have:


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Made contact with IT and awaiting MH1 information for analysis.

Drafted a Participation Information Sheet and Informed Consent form

Emailed AMHPs from out of county for risk management tools used within

their practice

General comments: Please place any issues or concerns here

Timescale in gathering all evidence required.

Too much information to gather? Have I gone to big/wide? Could I get the

answers I need to decide on the best intervention in a simpler way?

Who do I need to contact regarding Ethics approval? Will the Head of social

work for NHS trust suffice or do I need to contact the research data office forapproval?


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Enquiry-led study - Research Question (s)

The question my research will aim to answer is whether an intervention, during the

facilitation of the Hospital at Night system, during out of hour periods within an acutehospital trust, would be beneficial to increase patient care and safety. The research carried

out would highlight appropriate interventions which would increase the amount of

deteriorating patients seen by the clinical site nurse practitioner. It is clear from carrying out

my psip that the intervention would not be a designable pathway or assessment sheet or a

new way in which the Hospital at Night would be facilitated.

Progress on Research input.

Approached the ethics committee and presented my proposed study and awaiting approval.

Discussed with the audit department to assist with designing the online questionnaire and

have a meeting with them to do this on March 28th

2014.

I have been able to contact members of the clinical database to formulate facts and figures

over a four month period on the following;

Pre Intervention. Research criteria

1. Number of H@N calls that the CST have answered in relation to carrying basic

nursing tasks such as venepuncture, cannulation, ECG recordings, female andmale urinary catheterization.

2. Number of Amber and Red calls that the doctors have seen and compare the

calls to which the CST could have answered if not requested to carryout basic

nursing skills.

3. Number of Amber and Red calls on H@N that the CST has answered and what

were the calls regarding.

4. Number of Adverse Incident Reports relating to delayed patient assessment or

care delivery due to delayed responses from the H@N Doctor / CST.

All the above I have obtained and am currently formulating an analysis of thisdata in excel.

Proposed interventions which are apparent and those discussed with my line

manager include:

1. Removing basic nursing task from H@N which would mean that the

ownership and responsibility falls back on the ward nurses.-

Problem- this would cause patients to have further delays in treatment.


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2. The facilitation of H@N will produce a name and shame to which senior

nurses and clinical leaders have to justify why their staff are not being

appropriately trained to care for their patients adequately.

Problem: although this highlights breakdown in training and skill mix on a ward,

the clinical leaders and senior nurses may add further stress upon the wardnurses which is unnecessary.

3. To employ a Health care assistant to be part of the H@N team in which they

are already trained and competent to complete basic invasive nursing tasks.

Problem: obtaining funding might be an issue due to current economic climate

however from carrying out my psip all the research conducted on this topic

highlighted how vital a HCA is to the H@N.

Progress on Intervention;

A trial is currently underway to ascertain the effectiveness of using a H@N HCA

during a period from 17:00 hours to 02:00 hours. I will contact the clinical data

base people to send me data highlighted above, by using the same criteria to

ensure reliability and validity.

I will also gain feedback from the CST to see if they feel that by having a HCA on

the H@N team aids in increasing patients assessments.

General Comments.

I am concerned that I have not heard anything from RBH ethics committee and

will be chasing this on 30th

March 2014.

I am having difficulty in designing the questionnaire but hopefully my meeting

with the audit department will clear thing up.


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Month Project Plan

Date December January February March April May June July Review date

01.12.13

Obtain information regarding H@N Data

Pre intervention. 18.02.14

01.03.14 Obtain Ethics Approval from RBH

17.03.14 +

15.04.14

01.12.13

Start Consent Forms and

Info Sheets

Complete Consent forms

and Info Sheets 28.03.14

01.02.14 Design Questionnaires 01.04.14

01.03.14

Dw Audit department Re

questionnaires 20.04.14

01.04.14

Send out and collect

questionnaires from both

teams 01.06.14

21.02.14

send appendix 2 by 25th

March 20.03.14

01.05.14

Obtain information regarding H@N

Data Post Intervention.01.07.14

01.01.14

start converting data into graphs, review data and questionnaire analysis and by May start writing SIP prepare to hand

in 01.07.14

Other considerations


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Enquiry-led SIP

Project plan:

February March April May June July

Contact ResearchGovernance to explain that

I am doing a project whichis non-research based.

DONE

Plan focus Group questions

Get a few designs that arealready in place

Critically Evaluatethemes from focus

group

See if you could havedone anythingelse/different.

Implement

Intervention

Send email to allAMHPs to gain

feedback ofintervention

Reference

Design Consent Form andInformation Form

COMPLETED

FOCUS GROUP TO TAKEPLACE ON 27thMARCH:

Tap recorder

ALL AMHPS have signedconsent form

Plan ready to take in

Other examples areavailable

NR policy

4-6thOFF FORBIRTHDAY!

Conclude andmakerecommendations


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Identify Focus Group inMarch or VERY early April-27thMarch 2014

Email the group onceidentified with consentforms etc- Emailed 1stMarch 2014.

20th-21st- STUDY DAYS- MeetPK at Bournemouth Uni Library.

Design Interventionand send to R to belooked through forfeedback.

ThirdPerson toreadthrough

Assignment

Contact H about plans andidentify who can sign off-Met with H and agreedRF will sign off.

Transcribe Focus Group

Must be clear

Summarise what people havesaid

Get third person to read andlisten to summarise

18th-22NDHOLIDAY

Start ESSAY- getplan done andcontents by end ofmonth

Have draft essaycompleted.

Have finaldraftcompletedand handedin by 25thJuly 2014.

Re-Read Literature Review 26-28THWEDDING

28th HANDIN DATE!!!!

Research question/s: From completing my PSIP I have been able to see how other authorities have supported AMHPs when applying to

court to appoint a nearest relative for a patient. This highlighted a variety of interventions currently in place which I am aware my authority donot have. There are a variety of questions that I want to pose to AMHPs within the Focus Group they include:

Introductory Questions:

1. Has anyone looked or used the Appointing a Nearest Relative Policy? If so what did you think of it?


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2. If you have identified that a patient had no nearest relative, how confident do you feel with what you need to do next and whosresponsibility it is to follow this process through?

3. If you were asked to identify a nearest relative for a patient that you detained, how would you start this process?4. If you identified that a patient had no nearest relative and had to apply to court how confident would you feel with this process? This

includes: legal obligations and writing a report to the courts to appoint the local authority as NR.5. Why do you think that we do not apply to courts on a regular basis?

Key Questions

1. Now we have identified the above (clear the process is unclear and not supportive to AMHPs), within my PSIP I found a variety ofinterventions/tools which support AMHPs within their role. Which ones do you feel are informative, supportive and clear?

Examples given:

How would you like the information given to you e.g. flowchart or diagram?

2. When I have designed the intervention what are the key facts you would like me to include?

Example:

If a patient has capacity where you should go

BOP Solicitors name/details

What we need to write in a court report?

3. Once I have designed the intervention how would you like me to present it? For example in another AMHP Forum with me providing anexplanation or in an email with notes?

Progress on Research input: From my PSIP I have seen a variety of interventions that support AMHPs and their managers.They includeflowcharts to assist AMHPs with a step by step guide from when they identify a patient has no nearest relative to what they have to write in acourt report. These have been clear and precise and what I am wanting to use as examples in the focus group.


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I have also contacted the Research Department within my local authority and they have approved my project.

The AMHP Lead has recently left and he was due to sign my project off. I therefore have met with unit lead and approached my Team Leaderwho is happy to support me within my project.

I have designed my Information and Consent Form.

I have identified when I will be holding my Focus Group however I need to ensure I have the equipment ready.

Progress on intervention: Once I have completed the Focus Group I can start to design the intervention. This should be in April 2014 as thefocus group is planned for the 27thMarch 2014.

General comments: The only difficulty I have seen at present is the fact AMHPs are taking leave as it is the end of the financial

year and also there have been many off sick. I have had 6 confirm that they will be present at the focus group but recognise that this

is the minimum number needed for a focus group. If a limited number attend then I will need to consider doing it on another day.


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Interventionled

Project Plan:

To devise and implement an electronic outreach assessment

proforma that will meet the needs of the outreach service, the

multidisciplinary team and enhance patient care/ safety.


Completed an IT request for change form and this has been

discussed and accepted at their meeting. Recently attended a

IT/ EPR (electronic patient record) meeting where all the future

IT updates and proposals are discussed. Presented my case and

this has been accepted as a priority.

Research questions:

Need to evaluate the implementation of the form to see if it:

highlights the fact that patient has been seen by outreach

to the multidisciplinary team

streamlines assessment documentation

improves time management

enhances patient care

improves multidisciplinary team working


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Minimal, as awaiting for IT to implement the form, however,now have the Critical care Consultant keen to have input and

the Resuscitation team so hoping that this will help to put

pressure on the IT team. The observation sheets that we

currently use are also changing and I am hoping that this will

work in my favour as it is planned that the wards will be using

electronic observations from 01/06/2014 and this will hopefully

be linked in with my assessment proforma.

General comments:

Feel as though I am not in control as having to wait for others

to devise IT programme and put this on the system before I can

do any evaluation. Am aware that this may not be completed

by the due date and that is frustrating me. IT have their own

pressures and whilst I understand this I am finding that I am

constantly waiting for others and there is no sense of urgency.

I am sure that there is more that I can be doing behind the

scenes and even completing some parts of the SIP but I am

becoming a little bit fixated on my form. Maybe we could

discuss on 31/03/2014 the aspects that I could complete whilst

I am waiting for the form to be put on our patient record

system so that I do not leave it all to the last few weeks.


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Enquiry-led SIP

Project plan: Please detail a brief project plan here


Please detail the question/s your research will answer/has answered here.

Due to growing concerns about the impact of substance misuse on psychiatric

hospital admission throughout the UK, few psychiatric hospitals have been subjected

to systemic evaluations in order to reduce admission rates. This is also the case in

the local area where I currently work, despite this effort there is little evidence on how

these evaluations have helped reduce hospital admission and how staff can best be

supported to avoid psychiatric admission for substance misuse patients.

The purpose of this project is to investigate the process and pattern of psychiatric

admission for substance misuse patients and determine why/ how it leads to

increase in hospital admissions, what has been done/ongoing plans to reduce rates

of psychiatric admission.

Progress on Research input, Please detail the extent of your progress inclearly defining the problem / issue and the design of potential interventions

here:

I will focus on and critically analyse a preliminary interview I have already done with a

member of staff as well as PSIP outcomes, which identified several issues in the

process, and patterns of psychiatric hospital admissions of substance misuse

patients. So far my preliminary interview points to the fact that substance misuse is a

general problem that has led to increase psychiatric admission rate. It also raises

common themes which include, defensive practice and risk assessment process,

lack of confidence in decision making, inconsistency in approaches to assessmentsuch as lack of standard assessment forms as well as the potential to over or under

estimate the possible impact of an incident, which can then bias staff decisions about

risk and actions taken to admit.

Progress on intervention:Please detail your plans for the intervention and its

evaluation here:

SIP statement and consent forms nearly concluded, which clearly state the purpose

of the SIP. Organise interview strategy which I have carefully planned in four levels.Level 1- Interview team manager and care coordinator


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Level 2- Interview substance misuse worker in teams

Level 3- Interview Psychiatric liaison nurse and duty senior nurse in my local hospital

Level 4- Interview Nurses on the ward.

Although I am still struggling with Trust Ethical approval, I hope this will resolve soon

so that I can start my interviews in Mid-April. I have already spoken to my team

and all other potential interviewees. I will wait for ethics approval before I send out

the consent form and information sheet. I hope to conclude interviews in May.

General comments: Please place any issues or concerns here:

I hope I am on track. I am also managing personal issues at present that impacts on

my ability to coordinate and organise myself. I also hope that ethical approval will begranted soon.

End.

Documents

SIP 3 Interim Progress Reports