An evaluation of a managed clinical network for personality disorder: breaking new ground or top dressing?

Hogard, Elaine; Ellis, Roger

doi:10.1111/j.1365-2753.2009.01284.x

Cited by 7 publications

(5 citation statements)

References 19 publications

(18 reference statements)

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“…The studies noted that success was dependent on a combination of these factors being present rather than just a few isolated features. In particular, commitment to a set of shared values and objectives was necessary but insufficient for clinical effectiveness in the absence of other factors [ 38 ].…”

Section: Resultsmentioning

confidence: 99%

The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies

Brown

Patel

McInnes

et al. 2016

BMC Health Serv Res

136

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BackgroundReorganisation of healthcare services into networks of clinical experts is increasing as a strategy to promote the uptake of evidence based practice and to improve patient care. This is reflected in significant financial investment in clinical networks. However, there is still some question as to whether clinical networks are effective vehicles for quality improvement. The aim of this systematic review was to ascertain the effectiveness of clinical networks and identify how successful networks improve quality of care and patient outcomes.MethodsA systematic search was undertaken in accordance with the PRISMA approach in Medline, Embase, CINAHL and PubMed for relevant papers between 1 January 1996 and 30 September 2014. Established protocols were used separately to examine and assess the evidence from quantitative and qualitative primary studies and then integrate findings.ResultsA total of 22 eligible studies (9 quantitative; 13 qualitative) were included. Of the quantitative studies, seven focused on improving quality of care and two focused on improving patient outcomes. Quantitative studies were limited by a lack of rigorous experimental design. The evidence indicates that clinical networks can be effective vehicles for quality improvement in service delivery and patient outcomes across a range of clinical disciplines. However, there was variability in the networks’ ability to make meaningful network- or system-wide change in more complex processes such as those requiring intensive professional education or more comprehensive redesign of care pathways. Findings from qualitative studies indicated networks that had a positive impact on quality of care and patients outcomes were those that had adequate resources, credible leadership and efficient management coupled with effective communication strategies and collaborative trusting relationships.ConclusionsThere is evidence that clinical networks can improve the delivery of healthcare though there are few high quality quantitative studies of their effectiveness. Our findings can provide policymakers with some insight into how to successfully plan and implement clinical networks by ensuring strong clinical leadership, an inclusive organisational culture, adequate resourcing and localised decision-making authority.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1615-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies

Brown

Patel

McInnes

et al. 2016

BMC Health Serv Res

136

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“…It appeared to the referring bodies that the network was unable to cope with the scale of need. "(Hogard and Ellis, 2010) (51) "Training alone was perceived as insufficient for practice, but a combination of training and hands-on experience was useful to build confidence. One participant stated 'that could perhaps be a good thing if it was-if everyone saw at least one person through it … they felt comfortable in it, they felt that they could relax … they could actually engage better with the person.…”

Section: Table 3 Table Of Quotes 199mentioning

confidence: 99%

“…Understanding community mental health administrators' perspectives on dialectical behavior therapy implementation. (51). An evaluation of a managed clinical network for personality disorder: breaking new ground or top dressing?Network staff from across multiple agencies with diverse backgrounds, including psychotherapy, occupational therapy, and advocacy N = All staff from network Semi-structured interviews A managed clinical network for 'PD', England People with a diagnosis of 'PD' NA…”

mentioning

confidence: 99%

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Troup

Lever-Taylor

et al. 2020

Preprint

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Introduction The need to improve the quality of community mental health services for people with Complex Emotional Needs (CEN) is recognised internationally and has become a renewed policy priority in England. Such improvement requires positive engagement from clinicians across the service system, and their perspectives on achieving good practice need to be understood. Aim To synthesise qualitative evidence on clinician perspectives on what constitutes good practice, and what helps or prevents it being achieved, in community mental health services for people with CEN. Methods Six bibliographic databases were searched for studies published since 2003 and supplementary citation tracking was conducted. Studies that used any recognised qualitative method and reported clinician experiences and perspectives on community-based mental health services for adults with CEN were eligible for this review, including generic and specialist settings. Meta-synthesis was used to generate and synthesise over-arching themes across included studies. Results Twenty-nine papers were eligible for inclusion. Six over-arching themes were identified: 1. The use and misuse of diagnosis; 2. The patient journey into services: nowhere to go; 3. Therapeutic relationships: connection and distance; 4. The nature of treatment: not doing too much or too little; 5. Managing safety issues and crises: being measured and proactive; 6. Clinician and wider service needs: whose needs are they anyway? The overall quality of the evidence was moderate. Discussion Through summarising the literature on clinician perspectives on good practice for people with CEN, over-arching priorities were identified on which there appears to be substantial consensus. In their focus on needs such as for a long-term perspective on treatment journeys, high quality and consistent therapeutic relationships, and a balanced approach to safety, clinician priorities are mainly congruent with those found in studies on service user views. They also identify clinician needs that should be met for good care to be provided, including for supervision, joint working and organisational support.

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“…One tertiary psychiatric service, designed around the assertive outreach model offering both individual and group therapy to patients with personality disorder, showed a reduction in hospital stays following treatment and a small but significant improvement in psychometric parameters (Pretorius et al , 2010). Another study of managed clinical networks, which help service users link into other services (Department of Health, 2009), showed improved communication and good staff commitment, but it was not clear whether there was an improvement in clinical services (Hogard and Ellis, 2010).…”

Section: Resultsmentioning

confidence: 99%

Personality disorder service provision: a review of the recent literature

Evans

Sethi²,

Dale

et al. 2017

MHRJ

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Purpose The purpose of this paper is to describe the evolution of the field of personality disorder since the publication of “Personality disorder: no longer a diagnosis of exclusion” in 2003. Design/methodology/approach A review of both the academic literature contained within relevant databases alongside manual searches of policy literature and guidance from the key stakeholders was undertaken. Findings The academic and policy literature concentrates on treating borderline and antisocial personality disorders. It seems unlikely that evidence will resolutely support any one treatment modality over another. Criticism has arisen that comparison between modalities misses inter and intra patient heterogeneity and the measurement of intervention has become conflated with overall service design and the need for robust care pathways. Apparent inconsistency in service availability remains, despite a wealth of evidence demonstrating the availability of cost-effective interventions and the significant inequality of social and health outcomes for this population. Research limitations/implications The inclusion of heterogeneous sources required pragmatic compromises in methodological rigour. Originality/value This paper charts the recent developments in the field with a wealth of wide-ranging evidence and robust guidance from institutions such as NICE. The policy literature has supported the findings of this evidence but current clinical practice and what patients and carers can expect from services remains at odds. This paper lays bare the disparity between what we know and what is being delivered. The authors argue for the need for greater research into current practice to inform the setting of minimum standards for the treatment of personality disorder.

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An evaluation of a managed clinical network for personality disorder: breaking new ground or top dressing?

Abstract: On the basis of this evaluation and at this stage of one network's development it is concluded that the benefits of a managed clinical network remain theoretical rather than proven.

Cited by 7 publications

References 19 publications

The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies

The effectiveness of clinical networks in improving quality of care and patient outcomes: a systematic review of quantitative and qualitative studies

Clinician perspectives on what constitutes good practice in community services for people with Complex Emotional Needs: A qualitative thematic meta-synthesis

Personality disorder service provision: a review of the recent literature

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