Improving emergency care for people in mental health crisis: actions for change
Action three: Define the problem and establish shared ownership from the outset
Why this matters
Lack of clarity on the problem and ownership leads to duplication, slow progress and over-reliance on individual leads. Effective improvement starts with a shared, system-wide view.
What works in practice
Clear problem definition and shared ownership were repeatedly identified as critical success factors. Where this was lacking, teams experienced delays, duplication and over-reliance on individual project leads.
“We have commenced a weekly multi-agency huddle… reducing waste of clinical time of clinicians chasing across organisations.”
Tips from the teams
- Invest time early on to define the problem clearly, using data and staff insight to agree what you are trying to change.
- Develop a shared aim statement that reflects the priorities of all partners, not just one organisation.
- Secure multi‑agency ownership, ensuring responsibility does not sit solely with the project lead or improvement team.
- Regularly revisit the agreed problem and aim as learning emerges.
Improvement work in progress
Surrey Heartlands
In Surrey Heartlands, the team used an existing multi-agency programme called the Mind and Body. The programme was part of the trust provider collaborative and had a clear aim to better integrate mental and physical health, by using collaborative expertise, resources and creativity to strengthen and wrap the right support around acute trusts and into Surrey and Borders Partnership Trust.
While the programme had already delivered several strategic changes across Surrey, ED attendances had remained a significant challenge across the five acute trusts.
By incorporating a new improvement project as part of this existing agency programme, the team was able to accelerate activities and learnings through established relationships, shared understanding and existing processes.
Coventry and Warwickshire
In Coventry and Warwickshire, the interface team prioritised establishing a clear, shared understanding of the problem and collective ownership from the outset. A structured, bi weekly multi agency task and finish group was introduced, providing a consistent forum for partners to review progress, update actions and maintain focus on agreed priorities. A driver diagram and action log were used as shared reference points, helping teams align around a common aim and track delivery.
Early work focused on defining key areas for improvement, including developing standard operating procedures (SOPs) for escalation and exploring the role of mental health crisis centres within ED. A large-scale stakeholder engagement event brought together partners from across the system, including ED, mental health services, police, and social care to build a shared view of the challenges, explore effective approaches, and agree how organisations would work together to develop and implement solutions.
This approach strengthened shared ownership and reduced fragmentation by ensuring all partners were involved in both problem definition and solution design. To support this, the team co-developed a patient experience questionnaire across the MH–ED interface, providing insight into current experiences and helping to shape improvement priorities. Clear outcome measures were agreed early, spanning patient safety, experience and flow. These included monitoring waiting times, length of stay, staff experience and feedback from patients, families and carers.
By investing time upfront to align partners, define the problem and agree shared measures of success, the team created a strong foundation for coordinated improvement and more effective, joined-up care for patients in crisis.
Key takeaway
Clarity of purpose and shared ownership are prerequisites for system-wide improvement.