Posted by: ayrshirehealth | March 12, 2014

Reflections of an Improvement Advisor by @samh_mcewan

Scottish Patient Safety Programme for Mental Health

There have been several blogs on Ayrshire Health over the years that have examined the nature, meaning and importance of person centred care. SPSP MHI wanted to blog on this topic too and thought it would be a good opportunity to do so from the point of view of my current involvement in the Scottish Programme for Mental Health (SPSPMH) locally and recent “graduation” as an Improvement Advisor, courtesy of the Institute for Healthcare Improvement in USA.

Last year @SimonSRN wrote for Ayrshirehealth on the Scottish Recovery Indicator (SRI2) and national priorities of SPSP and NHS Quality Strategy, reminding services to bear in mind Person Centred Care as well as Safety and Effectiveness. He also highlighted the usefulness of Kotter’s stepped model for change management to influence service change successfully.Kotter

SPSPMH aligns well with the SRI2’s 10 indicators of recovery focused practice that are enshrined in person centred principles. Indeed evidence suggests that actively engaging service users in their health care may influence positive outcomes and reduce harm. Aren’t we all more likely to be involved in meeting our health or lifestyle needs if we are part of the process of identifying them ourselves and putting in place a plan to meet them that suits us, or are at least given the tools that we can grow to believe will work for us?

Personal views and preferences

NHS Ayrshire and Arran Mental Health Services have focused activities on improving engagement to try and reduce potential harm to service users in our care. This has included ensuring that each service user in our SPSPMH test sites are involved in discussion and decision making about choice of medicine; their views on personal safety issues are sought and responded to on a daily basis; personal daily goals are set based on whatever the individual decides is important to them – the same principles are followed for individual or group based therapies. Personal views and preferences influence care planning and service users are also debriefed following any difficult events on the ward. Debriefing doesn’t only introduce a sense of transparency and openness to scrutiny of the more difficult aspects of nursing practice but hopefully also engenders a real partnership approach to ensuring a service user oriented therapeutic environment and care.

Use of the Patient Safety Climate Survey, developed with service users in NHS Scotland, helps services reality check their safety orientation from the point of view of those who use them. We  may intuitively think that safety briefings, safety huddles and risk assessments improve patient safety, and they may do so, and staff may feel their ward is “safe” but the crux of our success will be based on the difference our changes to practice makes for the people who use our services. We may ensure people are safe but do they feel safe in our care? This is important from a trauma informed care perspective. NHSaaaPeople can be traumatised from a stay in hospital long after “symptoms” have been treated if we haven’t been given the information we need, or things don’t happen in the way we expect or we are not communicated with – these basics of care affect our sense of safety and security. This reminds us that it is the person that’s important, not a set of symptoms.

In NHS Ayrshire and Arran our use of the Patient Safety Climate survey finds that the attitudes of staff towards collaborative approaches to care; time spent with a nurse; information sharing; and involvement in treatment influences individuals’ perception of safety.

Underlying Kotter’s model for change management is the need for services to be able to critically reflect on their processes and outcomes and to be able to actively seek out, listen and respond to the views of service users and their families. Front line services need to be enabled to be active generators of vision and change rather than adapters to it in order to create and sustain their own future. Imposing change on services, such as a perceived “new” approach like SPSPMH, without communication or involvement can lead to resistance. Or it may lead to change but not engaged change.

Resistance to change

We often talk about resistance to change, and coping with change.

Change 1People tend to change, do something different or recover when they are listened to, and supported or equipped with the tools that they know are going to help them move in the direction they want to go.  Change is resisted when people feel part of the problem rather than a part of the solution, or uninvolved, or they can’t identify what the benefit will be for them, which creates defensiveness. Resistance also happens when change is sold as a list of tasks added to an existing burden rather than emerging from within as an alternative to what they are currently doing.This is equally relevant for service users as services.


Successful change will happen if services (and people – as we are all the one) are supported to develop their own vision of the change they want to see through reflection and learning.

Embracing the vision and values held by those who are part of our services leads to more than just coming up with “good ideas” for change – it encourages the spiritual reflection and growth necessary for wider and sustainable change. This arguably exemplifies the element of vocation or “calling” within healthcare professions and highlights the difference any of us can make when we attend to our true purpose, in a way that a list of competencies or skills does not.

This week’s blogger is @samh_mcewan (Samantha McEwan) who is the SPSPMH Programme Lead and a Clinical Improvement Practitioner & Improvement Advisor in NHS Ayrshire & Arran.


  1. Haven’t seen the 8 steps to successful change before – really useful stuff!

    – Dyfrig

  2. Reblogged this on saleswatchdog.

  3. Great blog Sam…very insightful. Highlights the importance of taking people (whether it be service users or staff) along with you on the improvement journey…only way for sustainability.

  4. […] care at the centre of their care, asking them what they think about medicine and safety issues, in Reflections of an Improvement Advisor on the Ayrshirehealth blog. Gordon Hay, writing Education and Revalidation for the dghealth […]

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