Action six: Consider sustainability from the outset

In Cheshire and Wirral, the team’s project aim was to improve the experience and safety of mental health patients as well as the wellbeing and effectiveness of staff while waiting in the emergency department. The team used the fishbone improvement tool early on in the programme to visually represent how the drivers of the problem and change ideas interact across the ED system and to plan for sustainability upfront.

It highlighted that improving experience is about multiple continuous interventions; reinforcing changes across environment, people and processes while recognising the importance of sustainability beyond the programme and prioritising building the foundations during the improvement programme phase.This has enabled the team to sustain their activities beyond the programme.

Next steps for the team include:

• supporting the permanent position of role of the mental health matron
• developing a shared data dashboard 
• continuing and developing staff training and further staff surveys.

In Bedfordshire and Luton, the aim of the project was to reduce unnecessary waits on a medical ward for people assessed as needing a mental health inpatient bed. The team prioritised ideas based on what was realistic to test and deliver change within the period of the project, while ensuring ideas that would take longer or needed a business case were built into sustainability plans.

The team implemented a number of ideas during the testing phase of the programme:

• Care plans developed by patient liaison service for patients on one-to-one observations. 
• Activity equipment designed to be used on the wards to improve the environment and experience for people who are waiting for a bed.
• Change to bed prioritisation where environment and length of time waiting are a factor.
• Voluntary sector support: Mind BLMK and Samaritans support NHS staff through training and information sessions enabling vulnerable patients in ED and acute wards to obtain emotional and mental wellbeing support.

Some early improvements showed an increase in patients transferred within 72 hours of a bed being requested, with the team looking to monitor these as part of ongoing work to measure change and implement ideas. They are also keeping project meetings ongoing but broadening the scope of the work to consider the impact of other initiatives which will contribute to improvement including the building of a mental health crisis house.