22 Sep

Wardipedia Introduction

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The Wardipedia section is a set of ideas and examples about providing imaginative, therapeutic inpatient mental health care. Click on one of the following IMAGINE themes to start exploring.

 

Imagination – what’s it like for the patient?

Mindfulness – chilling out

Activities – social, recreational, physical

Generosity – sharing, kindness, giving  

Involvement – influence, information, independence

Neighbours – friends, family, fellow patients

Empathy – for self and others

 

 

More Ideas For Your Star Wards Journey

Mental health inpatient care rocks. This isn’t usually the message that’s out there, for a whole bunch of reasons including the reputational legacy of the asylums, dissatisfied patients being more actively vocal than the very content majority and crass campaigns by some charities. But despite regrettable inconsistencies in quality of care across the country, there’s no question that inpatient care is safe, therapeutic and gentle. In rating the quality of their care for the 2009 Care Quality Commission survey of mental health inpatients, 73% of patients said it was excellent, very good or good, 12% said it was poor.

We won’t go on and on here about what an incredible achievement it is that the majority of patients have positive experiences of inpatient care, including those who are there very much against their will and perhaps believing they aren’t even ill. (But it is an incredible achievement, along with impressive safety levels and falling suicide rates.) And these are particularly tough times on mental health wards, with service re-organisation, cuts in staffing and resources and patients’ stress levels being greatly exacerbated by the benefits’ cuts programme.

Wardipedia is designed to help! Mental health inpatient staff have generously shared their best practice ideas so that others can adopt and adapt these and have flung in some other information and examples.

“We could do that.” We are regularly told by staff that when they read ways in which other wards are tackling problems or creating new opportunities for patients, this is their response. Wardipedia is a giant exercise in enabling ward staff to feel inspired and informed so that they can do that, or most often, do their own variation of it.

There’s some new stuff, some stuff you’ll already know but may perhaps find presented here in a refreshing way. Vast thanks to all the wards which have generously shared their great examples and ideas, and for letting Buddy and me visit. Wardipedia relies on practitioners’ contributions – the 959 examples are just the start!

We hope you enjoy using (and contributing your own great practice examples to!) Wardipedia. As with all Star Wards’ resources, we’ve collected and created a bunch of ideas, suggestions and possible solutions – but they’re just ideas. Definitely not standards!! They’re examples of what can be done, to use as a springboard for you to bring in your own expertise and for you to adapt to best meet the needs of your patients. Staff often tell us that it’s about doing things differently, not about doing more things. We’ve discovered there’s an Indian concept for this: Jugaad, or frugal innovation.

 

Jugaad – Frugal innovation.

Jugaad is a Hindi word meaning an innovative fix; an improvised solution born from ingenuity and resourcefulness. (Also known as DIY in the US, Gambiarra in Brazil, zizhu chuangxin in China, and Systeme D in France.) Frugal innovation embraces keeping things simple and making sure they’re what people need. For example, after the devastating earthquakes in Gujarat, a village inventor created a fridge made of clay cooled by water – fulfilling the frugal innovation criteria of products and services which are relevant, affordable, accessible.

The BBC’s Peter Day ended a programme on frugal innovation by saying it “turns innovation upside down by focusing on the things outside companies that perhaps people inside big business hardly notice. And then it uses cheap, cheerful and flexible ways to deliver the things that do the job without all the fuss that great big companies often apply to the rolling out of new ideas. Worth a try, this frugality.”

Honey Bee Network is a major hub (OK hive) of frugal innovation: “an organization which collects and disseminates traditional knowledge and helps facilitate and spread grassroots innovation throughout India and elsewhere. It is a crucible of like-minded individuals, innovators, farmers, scholars, academicians, policy makers, entrepreneurs and non-governmental organizations.” It’s also been described as providing “institutional support for scouting, spawning, sustaining and scaling up the grassroots innovations.” That’s pretty much what we aspire to do in Star Wards (with fewer farmers), and Wardipedia is where we’ve put everything we’ve found.

 

 

Structure

The scaffolding for Wardipedia is provided by the seven domains of our IMAGINE acronym, inspired by the superb book If Disney Ran Your Hospital by Fred Lee.

Imagination – what’s it like for the patient?

Mindfulness – chilling out

Activities – social, recreational, physical

Generosity – sharing, kindness, giving  

Involvement – influence, information, independence

Neighbours – friends, family, fellow patients

Empathy – for self and others

 

 

Ways of using Wardipedia

Here’s the thing. Wardipedia is lots of things, particularly suggestions and solutions from ward staff. You can use it in all sorts of ways, including:

  • Practical help for ward staff – its primary purpose:
  • For daily activities, approaches
  • For inspiration and feeling warmly about inpatient care and your role
  • For the “We could do that!” effect
  • A new batch of ‘challenges’ – structure, motivation etc for incremental changes (a follow-up set to Star Wards’ original 75 Ideas)
  • Training:
  • Ward staff and volunteers. It could be used in training sessions, or relevant chunks/chapters given to people. Especially useful for induction.
  • Qualifying and CPD training for nurses, doctors, psychologists, OTs, pharmacists  – clinicians that need to appreciate what’s possible on mental health wards
  • Support staff like security, catering, estates.
  • Campaigning – staff and patients can use the examples and evidence base to influence positive change
  • Service user organisations, especially those working collaboratively with wards
  • Academics, regulators, boards, commissioners, Clinical Commissioning Groups (til they’re replaced in yet another NHS traumatic upheaval)….. to inform expectations/standards – including in trusting staff and patients and arriving collaboratively at standards!
  • Contributing! Becoming part of a gorgeous compendium of great inpatient care, letting others know about the ways in which patients benefit from your care

 

 

Medium print

Sorry to be repetitious but – Wardipedia is full of ideas and suggestions, most of them from ward staff. Like all innovation, most of these are adaptations of others’ adaptations and we’re very grateful for wards generously sharing these with others, who can adapt and share them, for others to adapt and share. The ideas are simply springboards for other wards’ unique interpretation and implementation.

The 77 Ideas in IMAGINE are intended to apply to most wards, although we include extra information about patients with dementia as this seems a particularly challenging environment.

Whether any particular idea, example, approach and so on is appropriate (or strictly contra-indicated!) of course depends on loads of factors, not least:

  • patients’ ages, physical health and acuity of illness
  • patients’ skills, preferences, recovery goals, life aspirations, coping mechanisms (eg using safe products with patients who self-harm), specific risk issues (eg with leaving the ward), specific anxieties, energy levels, group dynamics and a zillion other factors that ward staff expertly and sensitively manage every shift.
  • ward design and purpose
  • staffing levels
  • funds available for resources, especially for activities
  • legal, ethical and other complications

We’re frugal innovators supporting frugal innovators so most of the ideas are low or no cost. The few daftly expensive resources we include are for broad illustrative purposes only and mainly to stimulate frugal adaptations by ever-resourceful ward staff. On the whole they’re small, easy, practical things that wards are or could be doing which make a huge difference to inpatients’ experiences. And we’re slightly obsessed with there being evidence of effectiveness before we recommend the sensible things.

What else? Most of the ideas are ones which ward staff can introduce with ease and without management needing to get involved. A few (eg replacing ward rounds with consultants appointments) are sadly usually outside of wards’ decision-making but ward staff and patients can be highly influential in instigating the changes.

Beyond the practical, we are particularly enthusiastic about practices which chime with Star Wards’ vision of all patients being on wards where:

  • talking therapies play as substantial a role as medication
  • patients are supported in our management of our symptoms and treatment
  • there is a strong culture of patient mutual support
  • patients benefit from a full programme of daily activities
  • patients retain and build on our community ties

and which focus on these aspects of patients’ daily lives in hospital:

  1. Recreation and conversation
  2. Physical health & activity
  3. Visitors
  4. Care planning
  5. Talking therapies
  6. Ward community
  7. Patient responsibility

 

 

 

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