Implementing Organisational Change in Adult Acute Psychiatric Inpatient Settings

Systematic review

Objectives
Implementing changes in psychiatric inpatient settings is vital to relieve the pressures of the services and deliver excellent patient care. Adult acute psychiatric inpatient (AAPI) wards have specific challenges. This review aimed to systematically appraise and synthesise research to understand the barriers and facilitators to change in this setting and provide guidance for those seeking to implement effective, lasting change.
Method
Four databases were systematically searched for qualitative, quantitative, and mixed-method studies. Six studies were included. Framework synthesis was undertaken, using the Capability, Opportunity, Motivation, Behaviour (COM-B) model. Barriers and facilitators were categorised into the subcomponents of the COM-B. The Behaviour Change Wheel (BCW) was employed to provide strategies for implementation. The Mixed-Method Appraisal Tool was utilised to appraise quality.
Results
16 themes were found to fit under the COM-B components. No factors were identified for the COM-B subcomponent ‘physical capability’. Additional barriers and facilitators that did not fit the model were staff age and occupational status, themed as ‘staff demographics’. BCW strategies included: training packages for staff, skills modelling for junior staff, and using incentivisation to increase motivation to engage.
Conclusions
The COM-B provided a framework for understanding the complexity of implementing change in AAPI settings. While this review cannot state which component represents the most salient influence on change, multiple barriers and facilitators were identified relating to psychological capability, and physical and social opportunity. When implementing change, relevant strategies should be utilised.

Empirical project

Objectives
A process named Purposeful Inpatient Admissions (PIPA) has been trialled in adult acute psychiatric inpatient (AAPI) settings within the NHS, to improve the efficiency of patient care. However, system pressures impact on services’ ability to embed organisational changes. This study aimed to understand barriers and facilitators of change and investigate whether an updated NHS Change Model tailored to AAPI settings is needed.
Design and Methods
A qualitative realist evaluation design was employed with 17 staff members working across three AAPI wards, who took part in semi-structured interviews and focus groups.
Results
Eight overarching themes were identified: ‘Leadership’, ‘Collaboration’, and ‘“Buy-in”’ supported the existing NHS Change Model. ‘Safety’, ‘Practical resources’, ‘Staffing’, ‘Communication’ and ‘Energy for change and sustainability’ were identified as new themes.
Conclusions
Barriers and facilitators to change in APPI settings were identified, along with the resources required necessary for the wards to implement successful change despite different contexts. The NHS Change Model does explain the processes necessary to embed change within AAPI settings to some extent. However, a revised model is necessary. Clinical Psychologists’ contribution to implementing organisational change is important.