Improving the quality of written communication at patient discharge: triangulation of qualitative analyses and intervention co-design.

BACKGROUND: Poor handovers between hospital and primary care threaten safe discharges, with elderly and frail patients most at risk of harm. Using Behavioural Science we explored influences and identified relevant behaviour change techniques (BCTs) to improve written handovers and safety during discharge. METHODS: We conducted two qualitative studies: (1) ethnographic observations (>80 h) collected by five researchers in five purposively sampled clinical areas of a London teaching hospital, investigating routine work and interactions of hospital staff involved in discharges; and (2) 12 semi-structured interviews with hospital staff involved in discharge exploring influences on preparations of written handovers. Written consent was sought from clinical leads for ethnographic observations and from interview participants. Ethnographic fieldnotes and interview transcripts were thematically analysed using inductive and deductive approaches, respectively. Study findings were triangulated to identify key influences, mapped onto the Theoretical Domains Framework (TDF). We identified appropriate BCTs to address observed influences within each TDF domain using the Theory and Techniques Tool. Health-care workers (n=15), patients (n=2) and carers (n=2) selected and designed an intervention to improve written handovers in two workshops. Hospital workshop participants were involved with preparing written discharge handovers. Public participants had either recently been discharged from hospital or cared for someone recently discharged, including patients from groups especially vulnerable during discharge. FINDINGS: Triangulation of study findings generated 11 key influences on preparations of written handovers within five TDF domains: knowledge (eg, lack of awareness of guidelines), skills (staff experience), social or professional role and identity (effective communication), environmental context and resources (working patterns), and social influences (lack of feedback). 14 BCTs were identified to address these influences, including behavioural rehearsal or practice, instruction on how to perform a behaviour, and social support (practical). Workshop participants selected and designed a multifaceted educational intervention to improve written handovers. INTERPRETATION: The quality of handover documentation prepared by hospital staff for primary care teams is affected by influences from multiple domains, requiring a multifaceted approach to improve handovers. Although only based on findings from one hospital, the designed intervention should be tested in clinical settings with key stakeholders, including primary care staff, to evaluate impact on quality of written handovers and patient safety. FUNDING: National Institute for Health and Care Research (NIHR) Imperial Patient Safety Translational Research Centre.

Decoding healthcare teamwork: a typology of hospital teams.

The effectiveness of healthcare depends on successful teamwork. Current understanding of teamwork in healthcare is limited due to the complexity of the context, variety of team structures, and unique demands of healthcare work. This qualitative study aimed to identify different types of healthcare teams based on their structure, membership, and function. The study used an ethnographic approach to observe five teams in an English hospital. Data were analyzed using a combined inductive-deductive approach based on the Temporal Observational Analysis of Teamwork framework. A typology was developed, consisting of five team types: structural, hybrid, satellite, responsive, and coordinating. Teams were challenged to varying degrees with staffing, membership instability, equipment shortages, and other elements of the healthcare environment. Teams varied in their ability to respond to these challenges depending on their characteristics, such as their teamworking style, location, and membership. The typology developed in this study can help healthcare organizations to better understand and design effective teams for different healthcare contexts. It can also guide future research on healthcare teams and provide a framework for comparing teams across settings. To improve teamwork, healthcare organizations should consider the unique needs of different team types and design effective training programs accordingly.

Understanding complex work using an extension of the resilience CARE model: an ethnographic study.

BACKGROUND: Resilient Healthcare research centres on understanding and improving quality and safety in healthcare. The Concepts for Applying Resilience Engineering (CARE) model highlights the relationships between demand, capacity, work-as-done, work-as-imagined, and outcomes, all of which are central aspects of Resilient Healthcare theory. However, detailed descriptions of the nature of misalignments and the mechanisms used to adapt to them are still unknown. OBJECTIVE: The objectives were to identify and classify types of misalignments between demand and capacity and types of adaptations that were made in response to misalignments. METHODS: The study involved 88.5 hours of non-participant ethnographic observations in a large, teaching hospital in central London. The wards included in the study were: two surgical wards, an older adult ward, a critical care unit, and the Acute Assessment Unit (AAU), an extension unit created to expedite patient flow out of the Emergency Department. Data were collected via observations of routine clinical work and ethnographic interviews with healthcare professionals during the observations. Field notes were transcribed and thematically analysed using a combined deductive-inductive approach based on the CARE model. RESULTS: A total of 365 instances of demand-capacity misalignment were identified across the five wards included in the study. Of these, 212 had at least one observed corresponding work adaptation. Misalignments identified include equipment, staffing, process, communication, workflow, and space. Adaptations identified include process, resource redistribution, and extra-role performance. For all misalignment types observed across the five in-patient settings, process adaptations were the most frequently used adaptations. The exception to this was for staffing misalignments, which were most frequently responded to with extra-role performance adaptations. Of the three process adaptations, hospital workers most often adapted by changing how the process was done. CONCLUSIONS: This study contributes a new version of the CARE model that includes types of misalignments and corresponding adaptations, which can be used to better understand work-as-done. This affords insight into the complexity of the system and how it might be improved by reducing misalignments via work system redesign or by enhancing adaptive capacity.

The role of transactive memory systems, psychological safety and interpersonal conflict in hospital team performance.

Safe patient care in hospitals relies on teamwork. Transactive Memory Systems (TMS), are shared cognitive systems that have been linked to team performance in other domains, but have received limited attention in healthcare. This study investigated the role of TMS, psychological safety and interpersonal conflict in predicting team performance in hospital ward teams where team membership is dynamic and often loosely defined. Hospital staff (n = 106) in four wards completed a battery of instruments assessing team performance, TMS, psychological safety and interpersonal conflict. TMS was a weak predictor of team performance, but the relationship was mediated by psychological safety. Overall, team performance was predicted by high psychological safety, low interpersonal conflict and low reliance on team members' knowledge (i.e. TMS credibility). These findings suggest that, in hospital teams, TMS is not a strong predictor of team performance but team culture is critical to ensure the quality and safety of patient care. Practitioner summary: This study investigated the role of Transactive Memory Systems (TMS) and cultural factors in hospital team performance. Team performance was predicted by psychological safety, low interpersonal conflict and low reliance on team members' untested knowledge. This highlights the importance of a supportive and psychologically safe team culture for safe care in hospitals. Abbreviations: TMS: transactive memory systems; HCA: health care assistant.

Reflections, impact and recommendations of a co-produced qualitative study with young people who have experience of mental health difficulties.

BACKGROUND: There is limited evidence of genuine equal partnership where power is shared with young people with mental health difficulties throughout all research stages, particularly in data collection and analysis. OBJECTIVE: To describe how our qualitative study, exploring young peoples' perceptions on the feasibility of using technology to detect mental health deterioration, was co-produced using principles of co-production, whilst reflecting on impact, challenges and recommendations. METHODS: Young people with experience of mental health difficulties were appointed and then worked with researchers throughout all research stages. The study was evaluated against the five principles of co-production. Reflections from researchers and young people were collected throughout. RESULTS: Seven young people formed an initial Young People's Advisory Group (YPAG); three became co-researchers. Reflection was key throughout the process. Sharing power became easier and more evident as trust, confidence and mutual respect grew over time, particularly after a safe space was established. The safe space was crucial for open discussions, and our WhatsApp group enabled continual communication, support and shared decision-making. The resulting co-produced topic guide, coding framework, thematic map, papers and presentations demonstrated significant impact. CONCLUSIONS: To our knowledge, this is the first qualitative mental health study to be co-produced using the principles of co-production. Our rigorous assessment can be utilized as an informative document to help others to produce meaningful co-produced future research. Although co-production takes time, it makes significant impact to the research, researchers and co-researchers. Flexible funding for spontaneous suggestions from co-researchers and more time for interview training is recommended.

MBRRACE in simulation: an evaluation of a multi-disciplinary simulation training for medical emergencies in obstetrics (MEmO).

The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions, known as 'indirect deaths'. The MBRRACE report identified serious gaps in clinicians' human factors skills, including communication, leadership and teamwork, which contributed to maternal death. In response, we developed the first multi-disciplinary simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Employing a mixed methods design, this study evaluated the educational impact of this training programme on the healthcare staff (n = 140), including the medical doctors (n = 91) and the midwives (n = 49). The training improved participants' clinical management of medical deterioration in pregnancy (p=.003) alongside improving their human factors skills (p=.004). Furthermore, participants reported the translation of these skills to their routine clinical practice. This flexible training is responsive to the changing national needs and contextualises the MBRRACE findings for healthcare staff. It is a promising avenue for reducing the rates of in-direct death in pregnancy. Impact statement What is already known on this subject? The majority of maternal deaths in the UK are due to pre-existing or new-onset medical conditions. The management of medical conditions in pregnancy relies on a multi-professional approach. However, serious gaps in clinicians' human factors skills, highlighted by the MBRRACE report, may contribute to maternal death. What do the results of this study add? This study evaluated the first multi-disciplinary, simulation-based training programme designed to address Medical Emergencies in Obstetrics (MEmO). Training significantly improved participants' management of medical deterioration in pregnancy and human factors skills, particularly in the areas of leadership, communication and teamwork. Moreover, the participants learning translated into their clinical practice. What are the implications of these findings for clinical practice and/or further research? The delivery of multi-disciplinary team training for all healthcare staff involved in the complex management of medical conditions in pregnancy can help develop a greater understanding of others' professional roles, and demonstrate the importance of interprofessional teamwork. Furthermore, it provides the space to reflect on team working approaches, including the leadership and professional autonomy, and their potential impact on patient care. Future research should evaluate the impact of this training on the objective outcome measures of medical emergencies in pregnancy.

Predictors of effective de-escalation in acute inpatient psychiatric settings.

AIMS AND OBJECTIVES: To explore the factors that influence the use of de-escalation and its success in halting conflict in acute psychiatric inpatient setting. BACKGROUND: De-escalation is the use of verbal and nonverbal communication to reduce or eliminate aggression and violence during the escalation phase of a patient's behaviour. Although de-escalation is a first-line intervention in aggression management in acute psychiatric settings, little is known about the use or effectiveness of this technique. DESIGN: A retrospective case note analysis. METHODS: For each patient (n = 522), their involvement in conflict (e.g. aggression) or containment (e.g. coerced medication) during the first two weeks of their admission was recorded. The frequency and order of the conflict and containment events were identified during each shift. The sequences of events occurring in shifts involving de-escalation were analysed. Sequences where de-escalation ended the pattern of conflict or containment were categorised as 'successful', and all others were categorised as 'unsuccessful'. RESULTS: Over half of patients (53%) experienced de-escalation during the first two weeks of admission, with the majority of these (37%) experiencing multiple episodes. De-escalation was successful in approximately 60% of cases. Successful de-escalations were preceded by fewer, and less aggressive, conflict events, compared with unsuccessful de-escalations, which were most frequently followed by administration of pro re nata medication. Patients with a history of violence were more likely to experience de-escalation, and it was more likely to be unsuccessful. CONCLUSIONS: De-escalation is frequently effective in halting a sequence of conflict in acute inpatient settings, but patients with a history of violence may be specifically challenging. RELEVANCE TO CLINICAL PRACTICE: These findings provide support for de-escalation in practice but suggest that nurses may lack confidence in using the technique when the risk of violence is greater. Providing evidence-based staff training may improve staff confidence in the use of this potentially powerful technique.

Nonverbal behavior during face-to-face social interaction in schizophrenia: a review.

Patients with a diagnosis of schizophrenia display social cognitive deficits. However, little is known about patients' nonverbal communication during their social encounters with others. This review identified 17 studies investigating nonverbal communication in patients' unscripted face-to-face interactions, addressing a) nonverbal differences between patients and others, b) nonverbal behavior of the patients' partners, c) the association between nonverbal behavior and symptoms, and d) the association between nonverbal behavior and social outcomes. Patients displayed fewer nonverbal behaviors inviting interaction, with negative symptoms exacerbating this pattern. Positive symptoms were associated with heightened nonverbal behavior. Patients' partners changed their own nonverbal behavior in response to the patient. Reduced prosocial behaviors, inviting interaction, were associated with poorer social outcomes. The evidence suggests that patients' nonverbal behavior, during face-to-face interaction, is influenced by patients symptoms and impacts the success of their social interactions.

Quirky conversations: how people with a diagnosis of schizophrenia do dialogue differently.

People with a diagnosis of schizophrenia (PSz) have difficulty engaging in social interaction, but little research has focused on dialogues involving PSz interacting with partners who are unaware of their diagnosis. Using quantitative and qualitative methods on a unique corpus of triadic dialogues of PSz first social encounters, we show that turn-taking is disrupted in dialogues involving a PSz. Specifically, there are on average longer gaps between turns in groups which contain a PSz compared to those which do not, particularly when the speaker switch occurs from one control (C) participant to the other. Furthermore, the expected link between gesture and repair is not present in dialogues with a PSz, particularly for C participants interacting with a PSz. As well as offering some insights into how the presence of a PSz affects an interaction, our results also demonstrate the flexibility of our mechanisms for interaction. This article is part of a discussion meeting issue 'Face2face: advancing the science of social interaction'.

A Systematic Review of Training Interventions for Emergency Department Providers and Psychosocial Interventions delivered by Emergency Department Providers for Patients who self-harm.

OBJECTIVES: People who self-harm frequently present to the emergency department (ED) and are treated by generalist healthcare staff with no specialist mental health training. We systematically reviewed (i) training interventions for generalist ED providers and (ii) psychosocial interventions delivered predominantly by generalist ED providers for people who self-harm. METHOD: Five databases were searched for studies reporting on training interventions for generalist ED staff (at least 50% of the sample needed to be generalist ED staff) or psychosocial interventions for people who self-harm delivered predominantly by generalist ED staff. No limitations were placed regarding study design/country. Narrative synthesis was conducted. RESULTS: Fifteen studies from high-income countries were included. Nine studies of moderate methodological quality evaluated training for generalist ED providers (n = 1587). Six studies of good methodological quality evaluated psychosocial interventions for adults who self-harm (n = 3133). Only one randomized controlled trial was identified. Training was linked with pre-post improvements in staff knowledge, and less consistently with improvement in skills, attitudes, and confidence. Evidence on patient outcomes was lacking. Patient-level interventions involving common suicide prevention strategies-safety planning and follow-up contact-were consistently linked to pre-post reductions in suicide attempts. Effects on treatment engagement and psychiatric admissions were unclear. CONCLUSIONS: There is a clear need for further RCTs to improve the evidence base for ED generalist providers managing patients with self-harm. Evidence supports potential benefits of training for improving staff knowledge, attitudes, and skills, and of safety planning and follow-up contact for reducing repeat suicide attempts. HIGHLIGHTSMore RCTs are needed to improve the evidence base for ED providers managing self-harmSafety planning and follow up contacts are linked to reductions in repeat suicide attemptsFuture research should investigate the impact of staff training on patient outcomes.

People with arthritis-disability and provider experiences with chronic opioid therapy: A qualitative inquiry.

BACKGROUND: Growing concerns about opioid overprescribing, opioid use disorder (OUD), and overdose led to opioid misuse prevention practices that may impact the lives of people with disability (PWD) and chronic pain. OBJECTIVE: To investigate the experiences of providers and people with arthritis related disability with opioid prescribing and monitoring following release of the Centers for Disease Control and Prevention Guideline for prescribing opioids for chronic pain. METHODS: We conducted semi-structured interviews with 24 specialists and primary care providers and 24PWD. Providers were required to prescribe opioids to people with arthritis-disability. PWD were required to have arthritis-disability causing chronic pain and to be on chronic opioid therapy (COT) or have been treated for OUD. We used a deductive and inductive analytic approach to develop themes. RESULTS: Providers recommended COT when other pain treatment options were exhausted or unaffordable. PWD reported their provider recently reduced their opioid treatment intensity and frequent visits were required. PWD didn't remember or recalled hearing limited information about opioid risks and benefits. Some PWD were unsure if the benefits of opioids outweighed the risks. Few providers identified chronic pain care considerations specific to PWD. CONCLUSIONS: Our findings facilitate a better understanding of the challenges faced by PWD living with chronic pain and their providers related to COT. The findings show the need for better informing PWD about the risks and benefits of opioids prior to initiating treatment, training on person-centered care tailored to PWD's unique needs and improved coverage of nonopioid treatments for chronic pain.

Capturing challenges and trade-offs in healthcare work using the pressures diagram: An ethnographic study.

Healthcare workers must balance competing priorities to deliver high-quality patient care. Rasmussen's Dynamic Safety Model proposed three factors that organisations must balance to maintain acceptable performance, but there has been little empirical exploration of these ideas, and little is known about the risk trade-offs workers make in practice. The aim of this study was to investigate the different pressures that healthcare workers experience, what risk trade-off decisions they make in response to pressures, and to analyse the implications for quality and safety. The study involved 88.5 h of ethnographic observations at a large, teaching hospital in central London. The analysis revealed five distinct categories of hospital pressures faced by healthcare workers: efficiency, organisational, workload, personal, and quality and safety pressures. Workers most often traded-off workload, personal, and quality and safety pressures to accommodate system-level priorities. The Pressures Diagram was developed to visualise risk trade-offs and prioritising decisions and to facilitate communication about these aspects of healthcare work.

Understanding adaptive teamwork in health care: Progress and future directions.

Health care teamwork is a vital part of clinical work and patient care but is poorly understood. Despite poor teamwork being cited as a major contributory factor to adverse events, we lack vital knowledge about how teamwork can be improved. Teams in health care are diverse in structure and purpose, and most patient care depends on the ability of different professionals to coordinate their actions. Research in this area has narrowly defined health care teams, focused mainly on a small range of settings and activities and addressed a limited range of research questions. We argue that a new approach to teamwork research is needed and make three recommendations. First, the temporal and dynamic features of teamwork should be studied to understand how teamwork unfolds sequentially. Second, contextual influences should be integrated into study designs, including the organization of work, tasks, patients, organisational structures, and health care system factors. Finally, exploratory, rather than confirmatory, research designs are needed to analyse the complex patterns of social interaction inherent in health care work, to build our theoretical understanding of health care teams and their work, and ultimately to develop effective interventions to support better teamwork for the benefit of patients.

Bridging Knowledge Systems: A Community-Participatory Approach to EcoHealth.

Earth's life-supporting ecosystems are integral to human and planetary health. Ecosystem services connect ecosystem functions to human wellbeing. The complex, multifaceted socio-ecological challenges of ecosystem decline necessitate a transdisciplinary approach, including the active and meaningful engagement and participation of local communities. Communities uniquely possess expert local knowledge, which, when integrated into policy development and community planning, has the potential to enhance and sustain ecosystem benefits for health and wellbeing. Community-informed mapping tools provide an opportunity for integrating science, policy, and public participation in data collection. However, there is a dearth of community-informed mapping tools demonstrating the interconnection of the ecological and social determinants of health at a place-based level. This paper presents a study that employs a community-based participatory research approach to mapping local knowledge systems on EcoHealth. The study seeks to develop a community mapping tool for shared dialogue and decision-making on EcoHealth between local communities and policymakers. The participatory research methods used to explore community awareness and knowledge regarding ecosystem services, health, and sustainability in the local area are described. The process of co-producing a Community EcoHealth Toolkit, based on the integration of different knowledge systems into local policy and planning, is discussed.

Interprofessional teamwork for managing medical deterioration in pregnancy: what contributes to good clinical performance in simulated practice?

OBJECTIVES: To identify the patterns of teamwork displayed by interprofessional teams during simulated management of medical deterioration in pregnancy and examine whether and how they are related to clinical performance in simulated practice. DESIGN: Exploratory observational cohort study. SETTING: Interprofessional clinical simulation training with scenarios involving the management of medical deterioration in pregnant women. PARTICIPANTS: Seventeen simulated scenarios involving 62 qualified healthcare staff working within the National Health Service attending clinical simulation training (midwives (n=18), obstetricians (n=24) and medical physicians (n=20)). MAIN OUTCOME MEASURES: Teamwork behaviours over time, obtained through detailed observational analysis of recorded scenarios, using the Temporal Observational Analysis of Teamwork (TOAsT) framework. Clinician rated measures of simulated clinical performance. RESULTS: Scenarios with better simulated clinical performance were characterised by shared leadership between obstetricians and midwives at the start of the scenario, with obstetricians delegating less and midwives disseminating rationale, while both engaged in more information gathering behaviour. Towards the end of the scenario, better simulated clinical performance was associated with dissemination of rationale to the team. More delegation at the start of a scenario was associated with less spontaneous sharing of information and rationale later in the scenario. Teams that shared their thinking at the start of a scenario continued to do so over time. CONCLUSIONS: Teamwork during the opening moments of a clinical situation is critical for simulated clinical performance in the interprofessional management of medical deterioration in pregnancy. Shared leadership and the early development of the shared mental model are associated with better outcomes.

Threats to safe transitions from hospital to home: a consensus study in North West London primary care.

BACKGROUND: Transitions between healthcare settings are vulnerable points for patients. AIM: To identify key threats to safe patient transitions from hospital to primary care settings. DESIGN AND SETTING: Three-round web-based Delphi consensus process among clinical and non-clinical staff from 39 primary care practices in North West London, England. METHOD: Round 1 was a free-text idea-generating round. Rounds 2 and 3 were consensus-obtaining rating rounds. Practices were encouraged to complete the questionnaires at team meetings. Aggregate ratings of perceived level of importance for each threat were calculated (1-3: 'not important', 4-6: 'somewhat important', 7-9: 'very important'). Percentage of votes cast for each patient or medication group were recorded; consensus was defined as ≥75%. RESULTS: A total of 39 practices completed round 1, 36/39 (92%) completed round 2, and 30/36 (83%) completed round 3. Round 1 identified nine threats encompassing problems involving communication, service organisation, medication provision, and patients who were most at risk. 'Poor quality of handover instructions from secondary to primary care teams' achieved the highest rating (mean rating at round 3 = 8.43) and a 100% consensus that it was a 'very important' threat. Older individuals (97%) and patients with complex medical problems taking >5 medications (80%) were voted the most vulnerable. Anticoagulants (77%) were considered to pose the greatest risk to patients. CONCLUSION: This study identified specific threats to safe patient transitions from hospital to primary care, providing policymakers and healthcare providers with targets for quality improvement strategies. Further work would need to identify factors underpinning these threats so that interventions can be tailored to the relevant behavioural and environmental contexts in which these threats arise.

An evidence based framework for the Temporal Observational Analysis of Teamwork in healthcare settings.

OBJECTIVE: Effective teamwork is critical to patient safety across multiple healthcare settings. However, current observational tools assessing teamwork performance tend to be developed for specific settings or tasks and do not capture temporal features of interaction. This study aimed to develop a valid and reliable observational teamwork behaviour framework, which is based on healthcare practice, applicable across a variety of healthcare contexts and can be used to capture temporal team dynamics. METHODS: Team interactions were audio-visually recorded during routine simulation training at two large clinical education centres specialising in physical and mental healthcare. The framework was based on theoretical models of teamwork and was developed in three steps: 1-micro analysis of verbal and nonverbal behaviour during recorded scenarios (n = 20); 2-iterative test and refine cycles; 3-final behavioural framework applied to a cohort of acute emergency scenarios (n = 9) by two raters to assess inter-rater agreement. RESULTS: The framework contains twenty-three specific verbal and nonverbal behaviours that can be identified during observations. Behaviours are grouped conceptually based on their function resulting in thirteen behavioural functions, which cluster into five overarching teamwork domains. Inter-rater agreement was excellent (Cohen's Kappa = .84, SE = 0.03). CONCLUSION: We present a valid and reliable behavioural framework, grounded in teamwork theory and empirical observations of clinical team behaviour. This framework enables analysis of the nuances and temporal features of clinical practice in depth and across a wide range of clinical contexts and settings. Use of this framework will advance our understanding of teamworking in healthcare.

The physical and mental health of acute psychiatric ward staff, and its relationship to experience of physical violence.

To evaluate and describe the physical and mental health of staff on acute psychiatric wards and examine whether violence exposure is linked with health status. We undertook a cross-sectional survey with 564 nursing staff and healthcare assistants from 31 psychiatric wards in nine NHS Trusts using the SF-36, a reliable and valid measure of health status and compared summary scores with national normative data. Additional violence exposure data were collated simultaneously and also compared with health status. The physical health of staff was worse, and their mental health was better than the general population. Physical health data were skewed and showed a small number of staff in relatively poor health while the majority were above average. Better physical health was associated with less time in the current post, a higher pay grade, and less exposure to mild physical violence in the past year. Better mental health was associated with being older and from an ethnic minority background. Violence exposure influenced physical health but not mental health when possible confounders were considered. Mental health was strongly influenced by ethnicity, and further research might highlight the impact on own-group ethnic density on the quality of care. The impact of staff whom are physically unwell or impaired in the workplace needs to be considered as the quality of care may be compromised despite this being an example of inclusiveness, equal opportunities employment, and positive staff motivation.

Beyond the clinical team: evaluating the human factors-oriented training of non-clinical professionals working in healthcare contexts.

BACKGROUND: As clinical simulation has evolved, it is increasingly used to educate staff who work in healthcare contexts (e.g. hospital administrators) or frequently encounter clinical populations as part of their work (e.g. police officers) but are not healthcare professionals. This is in recognition of the important role such individuals play in the patients' experience of healthcare, frequently being a patients' first point of contact with health services. The aim of the training is to improve the ability of the team to communicate and co-ordinate their actions, but there is no validated instrument to evaluate the human factors learning of non-clinical staff. Our aim was to develop, pilot and evaluate an adapted version of the Human Factors Skills for Healthcare Instrument, for non-clinical professionals. METHOD: The 18-item instrument was developed reflecting the human factors skills of situation awareness, decision making, communication, teamwork, leadership, care and compassion and stress and fatigue management. The instrument was piloted pre- and post-training with non-healthcare professionals (n = 188) attending mental health simulation training within an 11-month period (June 2017-April 2018). Trainees were hospital/primary care administrators (n = 53, 28%), police officers (n = 112, 59%), probation officers (n = 13, 7%) and social workers (n = 10, 5%). Most participants were female (n = 110, 59%) and from White ethnic backgrounds (n = 144, 77%). RESULTS: Six items were removed, five were not sufficiently sensitive to change (d < .3) and one showed poor reliability. The remaining 12 items revealed a Cronbach's alpha of .93. An exploratory factor analysis revealed a one-factor solution, which explained 58.3% of the variance. The final 12-item instrument was sensitive to change post-training (p < .0001) with large effect sizes (d > .7). Cluster analysis revealed that participants with lower pre-training scores showed the greatest improvement. DISCUSSION: The Human Factors Skills for Healthcare Instrument-Auxiliary version (HuFSHI-A) provides a reliable and valid instrument for the evaluation of human factors skills learning following training of non-clinical populations working in healthcare contexts. Although this instrument has been developed and evaluated with training courses specifically focusing on mental health topics, HuFSHI-A is applicable for any training where teamwork and co-ordination between clinical and non-clinical professionals is considered.

Young adults' perceptions of using wearables, social media and other technologies to detect worsening mental health: A qualitative study.

BACKGROUND: Technological interventions may help support and improve mental health. However young peoples' perspectives on using different technologies to detect deteriorating mental health in those already diagnosed with a mental health condition is lacking. The study aim was to explore the perspectives of young patients on the feasibility and acceptability of using wearables, social media and technologies to detect mental health deterioration. METHODS: The study was co-produced with young adults with past mental health difficulties. Semi-structured interviews were conducted with young adults with a severe mental health condition in a private room at a community mental health site. Data was triangulated by comparing codes and ideas across the two co-researchers and two researchers over two virtual meetings. Themes were finalised and presented in a thematic map. RESULTS: Sixteen participants were interviewed (81% female). There were four main themes: dealing with mental health symptoms, signs of mental health deterioration, technology concerns and technological applications to identify worsening mental health. Wearables and mobile apps were considered acceptable and feasible to detect mental health deterioration in real-time if they could measure changes in sleep patterns, mood or activity levels as signs of deterioration. Getting help earlier was deemed essential particularly in reference to dissatisfaction with the current non-technological mental health services. However, patients identified issues to consider before implementation including practicality, safeguarding and patient preference. CONCLUSION: Wearables and mobile apps could be viable technological options to help detect deterioration in young people in order to intervene early and avoid delay in accessing mental health services. However, immediate action following detection is required for the patient to trust and use the intervention.