By Dr Seth A. Mensah, MB ChB MSc DPM MRCPsych, neuropsychiatrist with consultant responsibility for the Welsh Neuropsychiatry Service.
People who are supported by the Welsh Neuropsychiatry Service represent the most complex in behavioural, emotional and psychiatric need. As a specialist team of neuropsychiatrists, psychologists, nurses, therapists and support workers, our vision and aim are to work collaboratively with others so people, and those who are important to them, adjust and live well with brain injury. We aim to optimise recovery within a person-centred and inter-disciplinary approach.
With the service experiencing an increasing demand for a specialist multidisciplinary model for neuropsychiatric rehabilitation, due to advances in emergency medical care, the introduction of the Welsh major trauma centre and network, and a focus on delivering care closer to home, we knew we needed to take a whole system approach to service development.
We recognised the service needed more staff to align closer towards British Society of Rehabilitation Medicine (BSRM) recommended standards, to enable full delivery of comprehensive and appropriate clinical therapeutic interventions. We also recognised there was inequity of service provision within Wales, with patients in north Wales often travelling to England for many neuropsychiatry services, due to the physical location.
We wanted to use resources differently and effectively to achieve equitable outcomes across Wales and improved experiences for patients and their support network. To develop our thinking, we wanted to speak to our stakeholders. We felt we knew who they were – our patients, families, carers, health boards, teams within boards, the third sector and others – but we didn’t know the best way to gather their opinions.
Going through the Lab process
Q Lab Cymru, a partnership between Improvement Cymru and Q, with funding from the Health Foundation, worked with us to develop and facilitate stakeholder workshops. Through their expertise in design thinking and their creative, collaborative approach to promoting change, the Q Lab Cymru team enabled us to find a space to link with others and share ideas, problems and potential solutions. We felt fully supported throughout the design process. As a team, we took an active role in the workshop design and within the workshops themselves. We were able to listen to lots of different people’s opinions, such as current and former service users, and even those trying and being unable to access the service. Being part of the workshops meant we heard what people wanted, not what we thought they wanted.
We didn’t know what a liaison model would look like, but the Q Lab Cymru team reassured us that we weren’t going to have all the answers at the end of the workshops. They were an opportunity for us to have more in-depth discussions with the people that mattered.
What was impactful?
Patient stories were integral to the workshop design and had a huge impact on everyone who attended. The workshop discussions helped us to reappraise our current service model and processes, opening our eyes to the challenges people have, for example, in accessing our service. The Q Lab Cymru team suggested that we set out our commitment to changing practice in a You Said, We Will document. This is testament to the process of reflective and collaborative learning that they enabled.
We thought the workshops would answer a factual question of what a liaison model would look like, but instead they completely changed our thinking. The discussions arising from the workshops made us realise that our original plan for a discrete liaison service was not what people wanted. People didn’t want one service from Cardiff trying to solve problems across Wales. They wanted a liaison model approach, with teams in north and south Wales, building a neuropsychiatry network and community of expert practice across the country.
What does this mean for the future?
We are using the outcomes from the workshops, patient stories, and the You Said, We Will document to influence the business case we are developing, working with Welsh Health Specialist Service Commissioners (WHSSC). By working together in a different way, we aim to provide equitable outcomes for people living with brain injury irrespective of where they live.
The design thinking approach, together with the rich data captured via the workshops has given us new ideas to re-model current processes and look at how we capture information to truly coproduce our service developments. The process has also presented us with a structure to take real action in developing a community of practice for neuropsychiatry and in designing the finer detail of the neuropsychiatry liaison model for Wales.
The clinical territory of neuropsychiatry is broad and straddles the lifespan. Specialist neuropsychiatric rehabilitation for people with acquired brain injury is a small part of the neuropsychiatry field. We understand that challenges remain in delivering a complete neuropsychiatry service across Wales and that there are gaps in broader neuropsychiatry service provision. However, by discussing this within a community of practice we have identified a shared interest in ensuring our patients don’t fall through those gaps.
We are grateful for the generous support of the Q Lab Cymru team in sharing their expertise to help us investigate and seek solutions in delivering against what is a complex service development. We now feel better equipped as a team to continue the service improvement journey. If you are interested in finding out more about Q Lab Cymru, then please contact the Q Lab Cymru team directly.