Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial

Abstract

BackgroundQuality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period.MethodsStandalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization.DiscussionTo our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and service-level outcomes. The study has the potential to help shape future efforts to improve the quality of inpatient care.Trial registrationCurrent Controlled Trials ISRCTN79614916. Retrospectively registered 28 March 2014]

Perspective On Excellence in Forensic Mental Health Services: What We Can Learn From Oncology and Other Medical Services

“…This should be both national and international in order to develop the networks needed to foster multicenter RCTs and data-driven research on outcomes. Some national networks for quality and accreditation already exist, such as the quality networks in the UK (3–4, 5, 9) and the Netherlands (6). Up until now, these have focused on raising the minimum standard and fostering consistency.…”

“…Up until now, these have focused on raising the minimum standard and fostering consistency. We believe such networks can better drive excellence by moving from primarily judging compliance with standards and guidelines to also accrediting quality improvement by services using research-informed outcome measurement and management (9, 133). International networks such as the International Association of Forensic Mental Health Services, European Psychiatric Association, and World Psychiatric Association are also focused on these goals.…”

“…This paper describes how excellence can be recognized from the ability to conduct randomized controlled trials (RCTs) (7) and information-driven research paradigms which may be “hypothesis free” (8) or mix quantitative and qualitative methods so as to continuously improve TAU. This is set out with particular reference to FMHS for persons presenting serious risk to others (9), since FMHSs increasingly provide the main access route to more intensive, more organized, and more sustained pathways through care and treatment (10). In FMHS, TAU has been inadequately defined.…”

Impact of a peer-review network on the quality of inpatient low secure mental health services: cluster randomised control trial

“…Details of the design and methods of the trial are reported elsewhere [28]. In summary, we conducted a single-blind, parallel-group, cluster-randomised controlled trial, of the impact of membership of a peer-review network on the quality of inpatient low secure mental health services.…”

Quality improvement and psychiatric research: Can design thinking bridge the gap?

“…Quality improvement is already closely aligned with audit, training and continuing professional development. 4–6 However, despite many examples of quality improvement initiatives, 7–9 quality improvement methods remain poorly understood and are contested, specifically in relation to the underpinning research into quality improvement processes. The explanation for this disconnect may lie in very different approaches to solve problems found in science (including medical sciences), which relies on empirical observational of data to test hypotheses and to solve a defined problem within a specific setting and context.…”