In the UK, life expectancy for people living with a serious mental illness, such as schizophrenia and bipolar disorder, is reduced by 15–20 years compared with the general population. In recent years, evidence based guidelines/policies designed to improve their physical health have been published, yet a gap remains between recommendations and practice. This case study describes how guidelines to support physical health were implemented using a quality improvement approach.
A quasi-experimental study explored systems and processes for assessing the physical health of patients admitted to an acute mental health unit. The multi-disciplinary team of healthcare professionals, service users and experts in quality improvement methods developed solutions to improve the assessment of physical health, drawing on existing guidelines/policies as well as professional and lived experience. Three key interventions were developed: a comprehensive physical health assessment; a patient-held physical health booklet; and education and training for staff and patients. Interventions were co-designed by front-line healthcare staff and service users with iterative development and implementation through Plan-Do-Study-Act cycles. Real-time weekly data were reported on five measures over a 15-month implementation period (318 patients) and compared to a 10-month baseline period (247 patients) to gauge the success of the implementation of the physical health assessment. Improvements were seen in the numbers of patients receiving a physical health assessment: 81.3% (201/247) vs 96.9% (308/318), recording of body mass index: 21.55% (53/247) vs 58.6% (204/318) and systolic blood pressure: 22.35% (55/247) vs 75.9% (239/318) but a reduction in the recording of smoking status: 80.1% (198/247) vs 70.9% (225/318). However, 31.7% (118/318) patients had a cardiovascular risk-score documented in the implementation phase, compared to none in the baseline.
This study demonstrates the use of a quality improvement approach to support teams to implement guidelines on physical health in the acute mental health setting. Reflections of the team have identified the need for resources, training, support and leadership to support changes to the way care is delivered. Furthermore, collaborations between service users and frontline clinical staff can co-design interventions to support improvements and raise awareness of the physical health needs of this population.
Health and Social Care Information Centre. Mental Health Bulletin: annual report from MHMDS returns—England 2011–12. Leeds; 2013.
Department of Health. Closing the Gap: priorities for essential change in mental health. 2014; 1–40.
Nash M. Diagnostic overshadowing: a potential barrier to physical health care for mental health service users. Mental Health Pract. 2013;17:22–3. CrossRef
National Institute for Health and Care Excellence. Bipolar disorder: assessment and management (CG185). London; 2014.
National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178). London; 2014.
Royal College of Psychiatrists. Report of the Second Round of the National Audit of Schizophrenia (NAS). London; 2014.
National Institute for Health and Care Excellence. Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services. London; 2011.
Faulkner A, Crepaz-Keay D, Kalathil J, Griffiths R, James N, Perry E, et al. 4Pi-National Involvement Standards. London: National survivor User Network (NSUN); 2015.
Green SA, Evans L, Matthews R, Jayacodi S, Trite J, Manickam A, et al. Service user engagement in quality improvement: applying the national involvement standards. J Mental Health Train Educ Pract. 2016;11:279–85. CrossRef
NHS Institute for Innovation and Improvement. Improvement leaders’ guide: process mapping, analysis and redesign. Coventry: NHS Institute for Innovation and Improvement; 2007.
Mental Health Taskforce. The five year forward view for mental health. London; 2016.
Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The improvement guide: a practical approach to enhancing organizational performance (Google eBook). New York: Wiley; 2009.
Shiers DE, Rafi I, Cooper SJHR. Positive cardiometabolic health resource: an intervention framework for people experiencing psychosis and schizophrenia. 2014 update. London: Royal College of Psychiatrists; 2014.
JBS3 Board. Joint British Societies’ consensus recommendations for the prevention of cardiovascular disease (JBS3). Heart. 2014;100(Suppl 2):ii1–67. CrossRef
Perkins R, Repper J, Rinaldi M, Brown Hl. Recovery colleges. Implementing recovery through organisational change. NHS Centre for Mental Health. 2012.
Langley GL, Nolan KM, Nolan TW, Norman CL, Provost L. The improvement guide: a practical approach to enhancing organizational performance. 2nd ed. San Francisco: Jossey Bass; 2009.
Curcin V, Woodcock TT, Poots AJ, Majeed A, Bell D. Model-driven approach to data collection and reporting for quality improvement. 2013;52:151–62 (in prep).
Wheeler DDJ. Advanced topics in statistical process control. 2nd ed. Knoxville: SPC Press; 2004.
World Health Organization. Bridging the “Know–Do” Gap. Geneva: World Health Organization; 2006.
Kotter JP. Leading change. Boston: Harvard Business School Press; 1996.
Clarke D, Jones F, Harris R, Robert G, on behalf of the Collaborative Rehabilitation Environments in Acute Stroke (CREATE) team. What outcomes are associated with developing and implementing co-produced interventions in acute healthcare settings: a rapid evidence synthesis. BMJ Open. 2016;7:1–25.
Poots AJ, Reed JE, Woodcock T, Bell D, Goldmann D. How to attribute causality in quality improvement: lessons from epidemiology. BMJ Qual Saf. 2017. https://doi.org/10.1136/bmjqs-2017-006756.
- Implementing guidelines on physical health in the acute mental health setting: a quality improvement approach
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