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Refocusing Acute Psychiatry: 10 Years on

Refocusing Acute Psychiatry: 10 Years on. Nick Bowles Consultant Nurse and Freelance Trainer. Refocusing. A “big idea” and an organising framework Model for Practice Development Change Management Programme. Impact. Implemented in 14 NHS Trusts and 7 Irish Hospitals

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Refocusing Acute Psychiatry: 10 Years on

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  1. Refocusing Acute Psychiatry: 10 Years on Nick Bowles Consultant Nurse and Freelance Trainer Contact Nick Bowles on: preferredfutures@gmail.com

  2. Refocusing • A “big idea” and an organising framework • Model for Practice Development • Change Management Programme Contact Nick Bowles on: preferredfutures@gmail.com

  3. Impact • Implemented in 14 NHS Trusts and 7 Irish Hospitals • Significant contributor to DH Acute Policy • Anticipated & popularised key elements of current practice Contact Nick Bowles on: preferredfutures@gmail.com

  4. Refocusing Origins • Field Site: Bradford 1999 to 2002 • Theoretical Basis: Work Strain Theory Appreciative Inquiry Reflexivity (shared environment & dynamics) Contact Nick Bowles on: preferredfutures@gmail.com

  5. Work Strain Theory (Robert Karasek, Univ. Mass.) Contact Nick Bowles on: preferredfutures@gmail.com

  6. Appreciative Inquiry • Solution Focused • Asks “what works” & “how can we do more of it” • Envisions “Preferred Futures” that people really want Contact Nick Bowles on: preferredfutures@gmail.com

  7. Refocusing Elements Contact Nick Bowles on: preferredfutures@gmail.com • Purposeful admission (reduced bed occupancy; length of stay) • Collaboration and co-operation; goal setting and goal matching; shared safety and risk management • Increased engagement; daily one to one; standards for KW role • Solution Focused approaches from nurses & support staff (we train) • Structured day with meaningful activities; “Protected Time” every day • Highly visible nurses (out of the office) • Reduced or stopped formal arms length and intermittent observation • Line management supervision for all staff that is evidence based • Information literacy & performance management culture (“dashboard”) • Leadership Development (incl. 360 degree system)

  8. Refocusing Results • Increased safety, reduced violence, aggression, SUI, AWOL • Reduced LoS, OBD, RA30 • Reduced staff sickness, overtime and bank spending • Reduced risks to all, including litigation • Fitness for purpose, service acceptability Contact Nick Bowles on: preferredfutures@gmail.com

  9. Reflections on Last 10 yrs • All “systems” can change despite pessimism • Whole system and whole team approaches work • Refocusing anticipated national change in in-pt psych and is widely imitated (Star Wards; Lean; Productive Ward) • Acute wards have improved massively (CQC, 2009) and alternatives to admission have come on-stream • Time now for critical re-appraisal of Acute In-Patient role (i.e. what and who is it for, are there better alternatives) Contact Nick Bowles on: preferredfutures@gmail.com

  10. The next 10 Years • Recovery to be the dominant paradigm, not illness • Lost public confidence in pharmaceutical evidence will drive alternatives (substances & services) • Backlash to CTO’s unless there is a paradigm shift • Disinvestment in secondary and centralist services • Increased role for Third Sector and non-psych staff • Increased proportion of generic workers • Increased role for alternatives to admission (could we ever follow the Lille Model? Why not?) Contact Nick Bowles on: preferredfutures@gmail.com

  11. Finally… • Acute Wards have changed… • Now they (staff, prosumers, community) need to evolve Contact Nick Bowles on: preferredfutures@gmail.com

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