Elshadai Markin, a QI champion and Willow project lead, shares a story of his and his team’s improvement journey that speaks strongly to the power of co-production to achieve better outcomes for their patients.
Reducing Self-Harm on Willow ward through co-production
Our team wasn’t ready to submit a poster for the Safety Conversation in November 2021, but we’ve come a long way in the short time since then. Now is the time to start sharing some of our story with our colleagues across CNWL.
Willow Ward is a 19 bed In-patient mental health unit for women, located in Milton Keynes. The team has been part of the CNWL Practicum that started in June 2021. Our focus has been in reducing self-harm on the ward – something the team has wanted to work on since 2019. It took us a while to get going, but we are now seeing real improvements in data relating to self-harm, rapid tranquillisation and feedback from both patients and staff on the atmosphere on the ward.
Over the past year we have focused on 2 change ideas:
- Introducing evening activities on the ward;
- Providing 1:1 support for patients before and after ward round
We have now moved from testing these ideas into making them business as usual within our ward.
This has felt like a long journey. Like everyone else in CNWL, we’ve had challenges over the year – Covid outbreaks, challenges with staffing. We’ve also had to do our work while dealing with the challenges that are part of working on an in-patient mental health ward. At times it felt like we were taking a step backwards, or fighting just to stand still. However, we are now starting to see the benefits of our work. Reflecting on this, we feel that there have been two really important factors for this:
- Listening to our patients, and involving them in the changes we made and how we made them;
- Listening to each other, going beyond the core nursing team to involve all of the MDT that support our patients.
When we started our evening activities work, we introduced the idea to patients on the ward, to see if they’d like to ‘do something’ that evening. Over time, this ad hoc approach has become more formal, with regular conversations with patients on the ward as well as discussions at the weekly community meeting. This has helped us to develop a programme of activities that we can deliver several evenings a week. Patient involvement and feedback into whether they’ve enjoyed activities and what they might like to do in the future will continue as we scale up and make this part of normal life on Willow. Our peer support worker is now involved in the project team, and will lead on this aspect of the work. Patient feedback on the 1:1 support, including experience of ward round, has been central from the start of this work. We’re still scaling up our tests with this idea and we’re making progress and starting to normalise the approach across the team.
Over time, we’ve also extended membership of our improvement project team. At first it was made up of nurses and HCAs who were ward based. It now includes colleagues from psychology and occupational therapy. This has made a massive difference to the resources available to us as a team, giving us different perspectives on change ideas, and helping to provide time to test things and feedback even when we are busy. We’ve made a point of meeting together, with our coach, every week as much as we can. Even when we’ve not managed to do very much between meetings, it has allowed us to review progress, chase up missing information and get us going again. Watch out for our poster at the Improvement Academy Awards this month.
Since Elshadai wrote this story, The Improvement Academy is very excited to announce that the Willow ward Practicum project team won best ‘Runner up’ poster at the Improvement Academy awards.
If you would like to know more specific details about this project then please email us at cnw-tr.improvementsupport@nhs.net and we will be very happy to connect you with Elshadai or someone from the improvement team on Willow ward at the Campbell centre.