A Day of Celebration for Forensics Team
By William Diaz, Improvement Advisor
On May 1, 2024, staff, service users (SU) and guests arrived promptly for the 10th Anniversary Celebration in Forensics Directorate with the Institute for Healthcare Improvement (IHI) in Wolfson House, our low-secure mental health unit in Green Lanes, London. It kickstarted with a festive lunch of jollof rice, curry and roast chicken wings, assortment of salads and healthy wraps, and a basket of fruits. This was kindly prepared by Wolfson House service users with Diana Adu, our resident occupational therapy assistant. Opening remarks was given by Dr Sian Llewellyn-Jones, Associate Clinical Director, and Quality Improvement (QI) Lead for Forensics Directorate who set the focus on broader organisational challenges such as patient flow, safe observations, and challenging racism.
Photo 1. Patti Harvey and Tonderai Kasambira, Head of Nursing, chairing the discussion around service user participation in QI
QI teams presented their project progress and challenges, where we have Patti Harvey, representative from the IHI, to support us on our discussions around these. Lorna Hayes and Dr Paula Murphy, project leads for the patient flow project, showed us the four workstreams working on this complex issue: admission, inpatient, discharge, and community. They identified change ideas to include establishment of complex and flow panels, use of an app to optimise recovery, discharge-focused peer support networks, strengthening of links between the John Howard Centre and Wolfson House, creation of Forensic Pathway Handbook, increase support to timely discharge, establishing collaborative working relationship with the local boroughs and the community team, and a multidisciplinary team (MDT) approach to tackle bottlenecks and barriers to discharge.
We affirmed that community collaboration, which is about connecting with others within and outside our organisation, can unlock multitude of benefits for us all especially with complex issues such as patient flow. Key decision points should also be examined as well as ensuring that we establish clear expectations from other stakeholders that we work closely with such as our local borough partners. Another team presented their project in tackling staff to staff racism by testing change ideas such as inclusion of this topic in the local monthly staff induction, creating a communication tool for staff to report racism, and exploring other means to increase awareness and reporting of incidents. Patti encouraged us to work with 3 ground rules at work: trust, respect, and vulnerability, without such, racism, amongst other equity issues, may not be addressed well. This starts from ensuring we have a fair hiring process, continually reinforcing our values as seen in our leadership and management practices, and hold each other accountable. Lastly, Matekenya presented us a summary of the observations and therapeutic engagement works, which showed an increase in the percentage of general observations completed and a decrease in verbal aggression incidents in the directorates as seen on Figure 1 and 2.
Figure 1. P’ Chart showing the percentage of general observations completed in Forensic wards.
Figure 2. U Chart showing the incidents of verbal aggression across all wards in Forensics.
We had a fantastic interaction around blockers and enablers in our QI projects using the 1-2-4-All approach, one of the Liberating Structures approaches, which aims to engage everyone to simultaneously generate ideas, ask clarifying questions and identify suggestions in a large group discussion. More information can be found here. We all reflected on these and made a commitment to nurture enablers and limit the blockers on achieving momentum and sustain our QI projects through to the end of the Sequence of Improvement as summarised through Force Field Analysis as shown in Figure 3.
Figure 3. Force Field Analysis of how to sustain momentum & ensure project through completion.
Finally, we had some of our service users sharing with us their heartwarming and inspirational accounts of their personal journeys as active contributors to QI projects. One of them mentioned how immensely grateful he was as he found his voice within the system that he was long part of – thanks to QI! We concluded with the question – how did it feel today? We responded that we felt a positive and overwhelming pride of what we have achieved and will be doing for the next year and reaffirmed our commitment for another year and more to improve our areas of work and the quality of service we all provide for our service users and the whole community.
Lipmanowicz, H. & McCandless, K. (2014). The Surprising Power of Liberating Structures: Simple Rules to Unleash a Culture of Innovation. Seattle: Liberating Structures Press.
