Evaluating the huddle as a method of improving staff communication and process efficiency on a psychiatric inpatient ward

Background/Aims Variation in healthcare processes is widespread in mental health care and can lead to inefficient processes and unnecessarily long inpatient stays. This study aimed to identify sources of variation and implement a huddle intervention to increase system efficiency on a psychiatric inpatient ward in London. Methods Using a Lean Six Sigma approach, areas for improvement on the authors' ward and processes working well on other wards were identified through process mapping and stakeholder interviews. The huddle intervention was implemented, then evaluated and improved through four Plan Do Study Act cycles based on feedback from staff and green-to-red methodology. Results Inconsistencies in multidisciplinary team communication was identified as the most prominent area of concern and inefficiency. The huddles were found to improve staff communication and increase ward activity. Concerns regarding the huddles' duration and focus on tasks were identified and addressed. Conclusions Huddles are a useful means of improving staff communication and increasing ward efficiency without taking up a significant amount of clinicians' time to care for patients. This could increase ward efficiency and reduce lengths of stay, although further research is required to establish this.

Interaction on Ward 8: Physical Settings and Behavioral Change

A process of participatory design–in which users of the ward environment, staff and patients, influenced the outcome–was initiated on Ward 8 at Cleveland State Hospital, an old Kirkbride-modeled mental hospital where several experimental ward environments were created by ARC (Architecture-Research-Construction), an interdisciplinary team of designers and social scientists who researched, designed, built, evaluated and documented the new ward settings. At the end of that process, interaction–one observable category of ward activity–was more than doubled among a group of 22 long-institutionalized patients over a 16-month period, as observed and measured by “behavioral mapping,” a technique for studying influences of immediate environments on the behavior of groups.

Pain Sensitivity, Age and Activity Level in Chronic Schizophrenics and in Normals

Merskey, Gillis, and Marszalek (1962) reported that in chronic schizophrenic patients reaction to pain was greatest in those patients showing either over-activity or under-activity as measured by a ward activity rating scale. They also reported a significant difference between certain age groups, the oldest and youngest age groups showing the greatest reaction to pain. The authors attributed the difference between age groups to the effects of tranquillizing drugs, since there existed a high correlation between age groups and their dosage of such drugs. It was concluded that ward behaviour in schizophrenics is a poor indicator of their sensitivity to stimulation.