Authors: Theresa Williams, Geoff Smith
Event: 2019 TheMHS Conference
Subject: Reflections on introducing Joint Crisis Plans into clinical practice.
Type of resource: Conference Presentations and Papers
THERESA WILLIAMS: A Clinical Psychologist with extensive experience as a senior executive in policy and planning within WA Health. She is currently the Director of Research and Strategy, Western Australian Office of the Chief Psychiatrist and currently holds an appointment as Adjunct Associate Professor at the University of Western Australia.
GEOFF SMITH: A Psychiatrist with extensive experience as a clinician and senior executive in health. Currently Senior Psychiatrist, Research, WA Office of the Chief Psychiatrist. Special interests include person-centred care and implementation science. He has an appointment as Associate Professor in the School of Psychiatry, University of WA.
Two metropolitan and two country-based community mental health services were invited to participate in a one-year pilot to implement Joint Crisis Plans (JCPS) with a view to rolling out the program into routine clinical practice across WA.
Extensive training and support was provided to maximize staff engagement. A target of 40 completed JCPs was set for each site. Consumers experienced the process as both empowering and therapeutic and 62% of staff thought that JCPs increased their understanding of consumers’ needs. Despite the overall positive feedback, only 52% of the JCPs were completed. The most striking finding was the marked difference in the number of completed JCPs at the 4 sites; 38, 28, 17 and 0 respectively.
Despite a thorough implementation process, the results of the study highlight the critical importance of addressing context and culture in individual services when new interventions are being introduced. Our results are consistent with the literature showing that many promising improvements have little overall impact when applied more broadly. We argue that change strategies need to take account of variations between services and allow for local iterative adaptation. Quality Improvement provides a promising approach for building a culture that supports practice change.
Learning Objective 1: Gain an understanding of the challenge of introducing a standardised practice model into services and the need to take proper account of local service variations in context and culture.
Learning Objective 2: Gain an understanding of how QI can assist in addressing this challenge by engaging front-line clinicians, consumers and carers in leading clinical practice change.
Williams, T., Smith, G., Lumbus A. (2014) Evaluating the introduction of joint crisis plans into routine clinical practice in four community mental health services. Australasian Psychiatry, 22(5), 476-480.
IHI (2016) Building a Culture of Improvement at East London NHS Foundation Trust. Cambridge, Massachusetts: Institute for Healthcare Improvement. Accessed 6 March 2019 at: file:///C:/Users/he06404/Downloads/BuildingCultureImprovement_EastLondonNHSFoundationTrust%20(2).pdf