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Star Wards Impact review 2013

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    A great highlight of my career!

    A menu of good ideas

    A much needed structure and

    focus

    A natural stepping stone

    A new energy

    Above all beneficial

    Affirming

    AmazingAn amazing response

    Animated

    Breath of fresh air

    Bright new idea

    Brilliant

    Brilliantly pragmatic

    Calming influence

    Changing the lives of inpatients

    for the better.

    Completely blown away

    Completely fantasticConfidence is growing

    Creative

    Definitely provides inspiration to

    keep going!

    Do it

    Easy to get going

    Effective

    EnergisedEnjoying

    Everyones read it or doing it

    Excellent anchor

    ExcitingFab

    Fabulous

    Fantastic

    Fun

    Fun to go to work

    Good sound common sense

    Great funHappier clients and staff

    Have a laugh

    Huge fan

    Huge influence

    Improved their skillsInclusive

    Incredibly beneficial and

    worthwhile

    Innovative

    InspirationInspiring and invaluable

    Interesting

    Loved it loved it loved it.

    Magnificent

    Massive inspiration

    Morale

    MotivatingMust have

    Normalises patient life

    Our bible

    Passionate and fired up

    Positive changes

    Powerful impact

    Practical ideasReally beneficial

    Really enjoying it

    Really positive and energising.

    Really positive impact

    Refocus

    Restored hope

    RewardingSense of achievement

    Simple

    So exciting!!!

    So human and humane.

    So inspirationalSomething for everyone

    Spectacular."Speaks" almost personally to

    the staff member

    Springboard

    Stunning

    Talked my language

    Team building

    The best thing i've seen in ages

    Totally excellent

    Totally revolutionised our

    ward

    TransformTriumph

    Useful

    User friendly

    Using initiative

    Very accessible

    Very highly valued

    Very rewarding

    Very satisfyingWonderful

    Wonderful and so accessible

    Worked wonders

    Wow, wow, wow!

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    Contents

    1. Background2. Questions and dilemmas

    3. What does Star Wards currently contribute to inpatient care?

    4. Impact review components

    5. Summary of survey findings

    6. Outputs and key numbers

    7. Survey

    a. What are respondents jobs?

    b. How long have they been involved with Star Wards?

    c. Whats it like trying to implement Star Wards?

    d. What has most helped involvement with Star Wards?e. Biggest barriers to involvement

    f. Whats happening on wards, and how much is due to Star Wards?

    g. Impact of Star Wards

    h. Awareness of Star Wards resources

    i. Talking therapies

    j. What else can we do to help?

    k. Anything else to tell us?

    8. Media, citations etc

    9. Behind the scenes

    a. Funding and supportb. Marions mental illness

    10. Appendix - Tangible results

    1.Background

    We knew from our previous impact review (2009) that Star Wards was definitely having aconsiderable positive impact on mental health wards. It felt crucial to know if this is still the case

    and to understand more about what is proving effective, with whom, why etc as well as the

    obstacles to taking part. Although there are all the usual reasons for assessing our impact

    (accountability etc), by far the most important one is for us to work out what we need to adjust

    given the very different circumstances now compared to when Star Wards began about 7 years ago.

    The situation on wards is both different to 2005 and to 2009. In some ways things are considerably

    betterwards now have a strong expectation and aspiration to have a full programme of

    therapeutic and social activities 7 days a week and that staff should proactively engage with and

    form therapeutic relationships with patients. The progress was very apparent in the 2009 review as

    well as from Buddy and my many visits as well as more formal sources.

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    But then austerity struck and this has had a crushing effect on wards. Probably the most

    problematic development has been the axing of hundreds of inpatient beds over the last few years

    a BBC investigation in October 2013 found more than 1,500 mental health beds have been closed

    since April 2011, representing a reduction of 9%. This results in whats referred to in mental health

    wards as over-occupancy the prison phrase of over-crowding gives a clearer feel. On one of my

    admissions, there were 16 beds on our womens locked ward and 19 patients. Three women slept

    every night on sofas in the lounge, and about five patients were on home leave but without a bed

    to return to if they needed it.

    In addition, wards are having to contend with continuous reorganisations, the threat of job loss and

    indecently tiny budgets leaving almost nothing for staff development and support. The other part

    of the equation is that cuts in community services, employment and benefits are (obviously) having

    an appalling impact on peoples mental health and the deterioration of community support means

    that many people reach crisis, and hospital, before there is effective intervention.

    Two quotes illustrate the pressures wards are under, and the effect that has on being able to takepart in improvement programmes such as Star Wards:

    Probably less of an impact than in years pastwe are mainly focussed on surviving, managing a

    basic service with much reduced bed and staff resourceless opportunity for service

    development.

    Yes, our focus is now squarely on the must-dosbed management, improving physical health,

    improving staff attitudesgetting ready for CQC visits, etc. Inpatient stays are becoming

    briefer

    A final factor which has made our work considerably more challenging is that the Department of

    Healths national structures for inpatient care, and the expert staff who supported these, have allbeen axed. This has huge implications for sector leadership (direction, motivation, information etc)

    and left an intolerable vacuum for inpatient specialists (clinical, academic, voluntary sector) to meet

    and work together. Weve tried to keep at least a semblance of a network together, creating NINE

    (National Inpatient Network Etc) but perhaps the name reveals my lack of enthusiasm for this role

    weve very reluctantly taken on. NINE wasnt included in the survey so Ill quickly mention here that

    although its just about functioned as a stop-gap network, meeting twice a year, it is inescapably

    limp without the national structure of civil servants and the regional network of regional clinical

    reps. It was that regional network that enabled us to get copies of each of our publications onto the

    desk of every ward manager in the country in our first few years.

    2.Questions and dilemmas

    We were pretty sure from what wed seen and heard that the survey would show that Star Wards

    is having less of an impact than a few years ago, despite (we believe) our resources and initiatives

    being of a significantly higher quality than in our earlier years. The prospect of having this

    confirmed was, nevertheless, dispiriting! On the one hand, if we were having insufficient impact,

    it might be best to close or put Star Wards on hold until amore favourable climate re-emerges.

    But conversely, really tough times arent when supportive projects back out. So this led to a series

    of questions:

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    1. How do we know what is good enough? As an outcome of our work? Wards work? Should we

    be looking for x% increase in recorded patient satisfaction? How would we judge to what

    extent, if any, Star Wards positively contributed to this? Is 1 transformed ward enough? 10? 5

    wards improved but still a bit wonky? 50 wards improved but still...?

    2. How do we know whether/what we should be doing differently?

    3. Given the (unusual) constraints organisationally imposed by my mental illness (in particulararound employing more people), to what extent could we do things differently?

    4. How do we find out why wards/trusts arent involved? What else could we do to

    attract/motivate/help the weakest wards?

    Given that the survey findings turned out to be pretty positive, we stopped agonising about these,

    but they remain issues if not active dilemmas for us. However, looking at the tangible results and

    the following quote from the latest (October 2013) editorial in Mental Health Practicereinforces

    our view that Star Wards is still very much needed:

    Acute wards have witnessed huge improvements in the quality of care they provide, thanks to the

    dedication of staff and to innovations, such as the Star Wards programme.

    3.What does Star Wards currently contribute to inpatient care?

    Weve largely avoided getting stuck in a groove of only doing one thingthere was SW1 and 2 but

    3 turned into TalkWell and now the range of things we do is:

    Discover and share good practice(via newsletter, websites, Wardipedia, blogs, twitter and our

    3 publications) Provide practical helpvia newsletter, websites, Wardipedia, blogs, twitter and our 3

    publications

    Massively extend the impact of our resources through an appreciative, collaborative, co-

    production, catalyst, jugaad (frugal innovation) modelwhich motivates wards to share their

    ideas, resources etc with other wards. We produce things that make it easy for

    wards/hospitals/trusts to themselves design training (eg TalkWell training courses and forums!)

    Our just ideas ethos not only attracts staff to get involved, but they own what they create,

    making them more committed to it, the adaptations much more suitable for each

    ward/situation etc.

    Advocatefor inpatient care (consultations, collaboration and tussles with other vol orgs,twitter, articles, conferences, NINE)

    Keep the inpatient experts networked(and hopefully help a bit with motivation)

    Improve moraleamong ward staff (appreciative content and tone of our work and

    communications, knowing Star Wards exists and is batting for them even if theyre not taking

    part, visiting wards, Full Monty).

    Reassurepotential inpatients that most wards are safe and therapeutic.

    Establish high quality, usefully imaginative, realistic expectationsof what inpatient care should

    consist of.

    Work collaboratively withthe Care Quality Commission.

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    5.Summary of survey findings

    The wards survey results were interesting and mainly reassuring. They confirmed our concern that

    there has been a drop-off of momentum and scale of participation, but reassured us that the wards

    that are still taking part do value and benefit from this. A few quotes illustrate this:

    I think in [our Trusts wards] Starwards has fallen off the radar and I don't think it feels high on the

    agenda for anyone anymore. I'm not sure what we can do to remedy this and it is a shame.

    It can sometimes be an uphill struggle implementing changes on a psychiatric unit but having the

    star wards has really helped as it gives us something to aim for and also gives the staff and patients

    a good range of ideas for activities and group work.

    When we became involved with Star Wards it was WOW. It still delivers the WOW. The website is

    constantly updated and its great to receive updates and to see what other wards are doing also and

    discuss and share these ideas.

    A full(er) summary of the results is included in section 7 below, but the key findings are:

    Activities

    No impact = 7%

    Big or massive impact = 50%.

    Patient satisfaction

    No impact = 9%Big or massive impact again = 50%.

    Reduced aggression

    No impact = 21%

    Big or massive impact = 19%

    These are mainly similar to last time, but, delightfully, a surge of massive impact from 3% last time

    to 12% this time. (or between quite a big and massive impact = 26% this time, 34% last time. Or

    big or massive = 19% this time and 14% last time.)

    Staff:patient contact increased

    No impact = 14%

    Big or massive impact = 29%

    More time for patient activities

    No impact = 20%

    Big or massive impact = 30%

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    Resources

    o Star Wards website (including downloadable versions of all our resources, blog, Wardi-quote,

    library and benchmarking tools created by our members.)

    o 75 Ideas (including leaflet and wall chart)

    o Star Wards 1

    o Two years of 4 page Star Wards feature, bi-monthly in Mental Health Today

    o Star Wards 2

    o Festival

    o TalkWell

    o Wardipedia

    o Ward Buddywards have downloaded this 3,000 times so far

    o 58 themed newsletters

    About 70 Full Monty awards presented

    Twitterabout 2.500 tweets (some not about Buddy), 626 followers, Klout 48

    We value our work with the Care Quality Commission who are astonishingly receptive to our

    views and the support we provide to wards.

    In development..

    o Brief Encounters(practical resource for general i.e. non-mental health hospitals on

    communicating with mentally ill patients)

    o Ward Stars (validation scheme for healthcare assistants)

    o Resources for patients, staff and relatives of inpatients on young peoples wards and for

    learning disabled inpatients, staff and relatives

    o Removing obstacles (largely awareness) to having pets on wards

    o Networkingfaith communities, time credits, senior figures in the sector etc.

    Website stats

    Analysis of website usage is surprisingly fun and detailed with Google analytics, and we do drill

    down regularly to see how many people are visiting which pages, for how long,

    Below are the average monthly visits and pageviews for the last year. (These figures take out visits

    of less than 3 minutes as its likely these werent of much help or, for the under 10 seconds,

    probably a typo caused by a film being named after our project.)

    Star Wards

    Visits 335 Pageviews 2,785

    Wardipedia

    Visits 415 Pageviews 2,375

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    7. Support from Trust / hospital management

    8. Seeing the impact Star Wards has had on other wards

    9. Setting aside dedicated time

    10. Keeping it on the ward meeting agenda

    11. Getting the Full Monty award is an incentive

    12. Attending a regular Star Wards forum13. Having a dedicated Star Wards budget

    14. Having a Star Wards lead in the hospital / unit

    15. Other

    This is deeply heartening!! Til now, creating resources has been by far the biggest input (and

    output!), its no surprise that keen staff members are crucial, and its great that patient input is

    recognised as being essential. Similarly, its lovely that people are motivated by seeing the positive

    impact of taking part. I am surprised that having a Star Wards lead isnt nearer the top of the list,

    but given that many wards dont/cant arrange this, its good that this isnt necessarily a major

    obstacle.

    Comments included:

    Having the star wards wardipedia and talkwell are great for myself and my fellow activity co

    ordinator colleague to refer to so that we can improve things on the unit and come up with different

    ideas to keep our patients motivated to join in with groups and activities each day.

    It would be great if maybe you send us a DVD or some kind of an educational info to promote the

    idea of Star Wards. Even better come Down Under!

    We have a star wards board on the ward and we also have a standing item on the community

    meeting agenda.

    Having Marion and Buddy talking about star wards to our pts was great.

    Unfortunatley my impression is that Star Wards has gone on the back burner a bit.

    other things seem to have become more important and these tend to be the must dos like our

    service reconfigaration, CQuins and CQC targets.

    This has motivated the staff and given them more confidence in taking the residents out and

    enjoying spending time away from the unit

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    e. Biggest barriers to involvement

    No surprises, really. One comment was particularly interesting as it illustrates the pressures wards

    are under and the dedication of staff:

    Our main barrier in involvement with star wards is finding time in our busy days to go through the

    latest talk well and wardipedia updates as we work on a really busy unit with lots of different groups

    and activities going on and rarely find time to sit down at a computer to log on to star wards, which

    is why I find it easier to log on at home and forward any new ideas to my work computer ready to

    print off and go through at our ward community meetings.

    f. Whats happening on wards, and how much is due to Star Wards?

    0.0%

    10.0%

    20.0%

    30.0%

    40.0%

    50.0%

    60.0%70.0%

    Lac

    ko

    f

    staff

    interest

    Lac

    ko

    f

    m

    anageme

    ntsupport

    Time

    pressures

    No

    tsure

    where

    to

    start

    Little

    orno

    money

    identified

    Other

    priori

    ties

    Other

    reasons

    What are the biggest barriers to your involvement with StarWards? Please tick all that apply

    0

    10

    20

    30

    40

    50

    60

    Ward

    Contact

    Library/

    Art

    Garden

    ing

    Mus

    ic

    Computers

    Physical

    Games(eg

    Talking

    Volunteer

    Accessto

    Accessto

    Sanc

    tuary

    ,

    Familyand

    Accessto

    Peer

    Systematic

    Systematic

    Other

    What s happening on your ward(s)?

    Happening

    HappeningbecauseofStarWards

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    Its hard to knowhow to evaluate this. It would be easy to feel disheartened, but:

    1. Its complicated to ascertain what might or might not be because of Star Wards. The first

    comment given was: We do have lots of excellent initiatives and its difficult to say if some

    were in place before which is true of some but certainly starwards has helped with the process

    undoubtedly.

    For some issues, very close to our hearts, were having a good impact eg contact with animals

    (50% attributed to Star Wards), volunteer input (35%), peer support (50%), sanctuaries/chillout

    rooms (32%)

    2. Over time weve had an impact on hundreds of wardsso the cumulative effect of the things

    that are due to Star Wards is probably decent

    3. These answers need to be seen in the overall context of what we know about our impact the

    tangible results illustrate this vividly. (Appendix 1).

    In terms of the specifics of what issues Star Wards seems to have most impact:

    Happening

    HappeningbecauseofStarWards

    Wardcommunitymeetings 46 4

    Contactwithanimals 21 10

    Library/booksandmagazines 43 11

    Art 48 3

    Gardening 45 7

    Music 45 6

    Computersandinternet 27 6

    Physicalactivities/exercise 49 8Games(egboardgames) 48 7

    Talkingtherapies 39 2

    Volunteerinput 37 13

    Accesstobenefitsandfinancialadvice 39 3

    Accesstorecoveryplansorworkbooks 36 7

    Sanctuary,chilloutorrelaxationroom(orsimilar) 25 8

    Familyandfriendsinvolvedandnurtured 35 7

    Accesstovisitingroom 32 4

    Peersupport(egBuddysystem,peersupportworkers) 20 10

    Systematiccollectingoffeedbackfrompatients,friendsandfamily 39 8Systematicinvolvementofpatientsinhowwards/hospital/trustisrun. 30 6

    Other 5 0

    It was fabulous to see the following comment, as it illustrates something close to our hearts one

    of the most beneficial aspects of Star Wards is that it enables staff to take stock, to reflect on the

    (huge!) value of their work and commitment and to get a boost in pride and motivation:

    Writing it out now I realize that we are doing pretty well! Go us.

    Some other comments:

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    Patient satisfaction

    No impact = 9%

    Between some and massive difference = 77%

    Between quite a big and massive impact = 56%

    Big or massive impact again = 49%. Again lets say 50%.

    Reduced aggression

    No impact = 21% - a bit down from 15% last time

    Between some and massive difference = 60%

    Between quite a big and massive impact = 26%

    Big or massive impact = 19%

    These are mainly similar to the 2009 survey, but, delightfully, a surge of massive impact from 3%

    last time to 12% this time. (or between quite a big and massive impact = 26% this time, 34% last

    time. Or big or massive = 19% this time and 14% last time.)

    Staff:patient contact increasedNo impact = 14%

    Between some and massive difference = 81%

    Between quite a big and massive impact = 55%

    Big or massive impact = 29%

    More time for patient activities

    No impact = 20%

    Between some and massive difference = 68%

    Between quite a big and massive impact = 50%

    Big or massive impact = 30%

    Improved team working

    No impact = 14%

    Between some and massive difference = 71%

    Between quite a big and massive impact = 43%

    Big or massive impact = 26%

    Improved physical environment

    No impact = 15%

    Between some and massive difference = 71%Between quite a big and massive impact = 54%

    Big or massive impact = 39%

    We can also compare these to the same questions asked in the 2009 survey:

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    Table 1: Impact of Star Wards-related activities (percentages) (n=188)

    No,not

    reallyA little

    bit

    Quite a

    lot

    A big

    difference

    Amassivedifference

    Don't

    knowImproved wardatmos here 5.9 20.7 38.3 20.2 6.4 8.5

    Increased activities onward

    Increased patientsatisfaction 5.9 23.4 34 23.4 2.7 10.6

    Increased availability oftalkin thera ies 31.4 28.2 15.4 9.6 3.2 12.2

    Reduced aggression onward

    Increased length ofatient sta s on ward

    Reduced the number ofatients oin missin 46.8 10.1 6.4 1.6 0 35.1

    Increased amount of staff-atient contact time

    Freed up time for patient-related activities 13.3 35.6 25 9.6 5.9 10.6

    Reduced staff sicknessrates 47.3 13.3 2.7 2.1 0 34.6

    Improved team workingon the ward 13.8 31.4 27.7 11.7 3.2 12.2

    Improved physicalenvironment of the ward

    h. Awareness of Star Wards resources

    A)Areyouawareof

    B)Haveyouseen

    C)Haveyouused

    D)Haveyouadapted

    E)Notaware

    StarWards1 14 8 14 9 7

    StarWards2 14 9 15 9 7

    TalkWell

    15 6 15 3 13

    Wardipedia 14 9 11 4 15

    Starwards'website 16 3 20 4 9

    WardBuddy 11 6 25 2 9

    Newsletters

    18 12 7 2 11

    StarWardsorWardipediaTweets 16 13 14 2 9

    Marion,Buddy,Nicvisiting 13 4 6 1 24

    FullMontyaward 8 4 10 5 23

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    So, quite a bit of scope here for increasing awareness! Less clear how to do this without

    bombarding wards, although posters would be great. A strange and possibly incorrect (or at least

    unrepresentative) finding is that Ward Buddy is already being used much more than Wardipedia.

    Anecdotal feedback suggests the exact opposite.

    i. Talking therapies

    We included this not because we are under any illusion that we could possibly be making an

    impact, but precisely because this is a long, slow haul and we need to maintain profile and pressure

    on the issue. We also thought it might be interesting for the British Psychological Society etc to

    have this info, however unrigorous it is.

    Numbers PercentageCognitiveBehaviouralTherapy 35 41Arttherapy 28 33

    Psycho-SocialInterventions 25 29

    SolutionFocusedTherapy 22 26

    Musictherapy 16 19

    DialecticalBehaviouralTherapy 15 18

    Other 10 12

    Dramatherapy 8 9

    MentalisationBasedTreatment 5 6

    j. What else can we do to help?

    Most of the comments were along the lines of Keep on doing what you are doing!!

    Suggestions included having a national conference, cloning Buddy and me so were on every ward

    and visiting Australia!

    k. Anything else to tell us?

    Comments were mainly thanking us.

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    The number of recorded incidents fell from an average of 30 per month during the first three

    months of the first year to an average of 13 per month during the last three months. And the

    average length of stay declined from 25.5 days to 20.3 days. Other remarkable service

    improvements included:

    service users reported being:

    offered more information when they arrived on the wards

    more involved in decisions about their treatments

    more occupied in useful and relevant activities

    respected more

    more satisfied with the care they received.

    new group activities were developed in consultation with service users eg carer support, health

    and wellbeing, and hearing voices, and a comprehensive programme of group activities now

    takes place on each ward.

    the development of a ward library, a gardening group and a ward-based internet caf, and the

    running of regular movie nights.

    9.Behind the scenes

    a. Funding and support

    We are very very fortunate to have a group of funders who are wonderfully flexible, interested and

    supportive. This enables us, firstly, to devote almost all our time to improving patients experiences

    rather than being drowned in fundraising activity. Our independence (from the Department of

    Health, any one hospital or Trust or profession and from regulators) also means we are trusted bystaff, patients, commissioners and regulators, and we can be very informal (i.e. friendly and

    human!), quirky and free-thinking.

    About 90% of our income comes from charitable foundations, who themselves cherish their

    independence and the ensuing freedom to innovate, take risks, occasionally fail, and to back

    effective but controversial projects. We are deeply grateful to be currently funded by:

    Esme Fairbairn Foundation

    John Ellerman Foundation

    LankellyChase Foundation

    Stone Family Foundation

    A big thanks also to our previous funders: Allen Lane Foundation (who heroically took the plunge as

    our first funder), Comic Relief, Javon Foundation, London Development Centre and to the

    Department of Health for s64 funding and support from the, greatly missed, NIMHE/CSIP.

    Its impossible to overstate the benefits that this flexibility provides. While we have a long list of

    projects wed like to do, our plans invariably change because wards come up with great new ideas

    or because one project sparks a connected one. For example, we wanted to create a version of

    Wardipedia (the best practice online compendium) for patients. This then morphed into a recovery

    companion, Ward Buddy. A ward for young people in Kent then contacted us to see if they could

    help us create a version for young inpatients, which were now doing. And working closely with a

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    young peoples ward (and the recent experience of a friend of mines 15 year old in hospital) made

    us realise the poverty of information and resources for young inpatients, their families and ward

    staff. We are exploring the possibility of a partnership with the highly specialist child mental health

    centre, the Anna Freud Centre.

    Most of these were not featured in our grant applications! But they are each, as far as we can tell,

    the most helpful thing we can do to improve inpatient experiences. Id like to report here that I am

    meticulous about consulting with (or at least informing!) our funders about the changes in plan. But

    Im not good about this and funders continue to be totally understanding and trusting.

    Some may wonder why we rely largely (90%) on grants from charitable foundations. In addition to

    the positive factors above (of independence and flexibility), the sad reality is that Im pathologically

    incapable of selling anything, so that rules out a social business model; we dont want to take

    money from pharmaceutical companies; and our sortie into mild commercialism, charging private

    wards 500 a year membership has brought in greatly needed income, currently about 9k a year,

    but only a small and sharply reducing number of private wards subscribed. (Everything is freeonline! The one real bonus of paid membership is that private wards can then take part in The Full

    Monty.) However, the one group of private hospitals which have continued to pay subscriptions is

    the Cambian Group. We are very appreciative of their support and energetic enthusiasm for Star

    Wards and even more so of the awesome services they provide.

    Our relationship with funders mirrors ours with wards and great managers with their teams and

    staff with patients. Its all about trusting, supporting and equipping people. Foundations give us all

    the leeway we need to be responsive to wards and provide us not just with funds to run the

    organisation, but also additional practical help and strong encouragement. Star Wards is based on

    appreciation for and trust in ward staff, so our role is to help with supporting and equipping them,in as flexible and responsive way we can. We are evangelical (and strongly influenced by the

    leadership guru Henry Stewart) about the need for managers to be trusting and supportive of their

    staff. (This was very much the year of the Francis Report, and weve made brief contributions to the

    debate.) Well-supported staff who have a strong sense of being valued and highly capable are then

    in a position to be a validating and trusted support to patients. A sort of serial sowing and reaping

    of trust, empathy and practical help from funders through to patients.

    We wrote to our funders asking for their views on our impact, as it is obviously essential that we

    know to what extent we are meeting their expectations. We had one reply and are very grateful to

    Eibhlin Ni Ogain from the amazing New Philanthropy Capital for her responses:

    1. What were your expectations from your grant to Star Wards?

    We hoped the grant to Star Wards would support the core work of the charity and contribute to the

    stability of Star Wards projects. This is why the grant is core and unrestricted funding to be spent as

    Star Wards sees fit.

    2. What was the most you were hoping for and what was the least?

    The most we were hoping for was that Star Wards continued the fantastic work it is doing for wardsand complete the projects it wanted to, e.g. Ward Buddy and Wardipedia. The most we were

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    b. Nic

    Gush alert! Its very hard not to get all gushy about Nic Higham who joined Star Wards last year.

    Hes a vastly skilled clinician (still working a day a week as a healthcare assistant on mental health

    wards), talented writer, creative thinker, Star Wards devotee, super-flexible colleague and, above

    all, utterly committed to truly therapeutic experiences for patients.

    Before meeting Nic, colleagues had responded very badly (and traumatically for me) to my illness

    and the self-destructive behaviour it provokes in me. The trustees and I were at the far reaches of

    caution about employing someone to share the work, but Nic was so impressive and so sussed

    about the realities of living with a severe mental illness that we took the risk. His expertise,

    imagination, patience and professionalism have transformed the amount and quality of what weve

    been able to produce for wards. Notably this includes his building our service user teamthe SU

    Crew. Paradoxically, and very unfortunately, I havent beenable to work effectively with service

    users. But Nic excels at the thoughtful, creative approach that enables us to neither under-estimate

    peoples resilience nor over-burden them with inappropriate volume or deadlines.

    c. SU Crew

    We are very lucky to now have the input of a group of highly skilled service user associates,

    contributing to our resources with ideas, practical examples of great practice, and other input. Matt

    Moore is a highly regarded professional illustrator and animator and created wonderful pictures for

    Ward Buddy and is working on illustrations for Ward Stars.

    d. Buddy!

    Buddy is rarely behind the scenesIndeed, it is her presence on wards that is so cherished by

    patients. (Im only vicariously popular. Even having done a stand-up comedy course.) Before Buddy

    was my support dog, I found it very difficult and possibly inappropriate to chat to patients during

    my relatively flying visits to wards. But Buddy is the ultimate ice-breaker, with patients of all ages,

    in all kinds of emotional turbulence and distress. This is how Buddy is when meeting new people:

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    Patients know that Buddy isnt judging (or assessing or observing or worrying about) them, she

    brings happy memories of patients own pets and responds ecstatically to being stroked and made

    a fuss of. Very occasionally I get given chocs or flowers, but invariably theres a goody bag for

    Buddy!

    Buddys good-natured friendliness resulted in an extraordinary accolade. Thanks to our trustee,

    Geoff Brennan, a room at the Maudsleys gorgeous new learning centre, Ortus, has been named

    after Buddy. Here are the three of us at Ortus. (Geoff modelling what great ambassadors our

    trustees are for Star Wards.)

    e. My mental illness

    Ive tried finishing the review without including my illness, but this would leave a rounded

    consideration of our work glaringly incomplete. Im coming up to the decade anniversary of my

    illness (Borderline Personality Disorder) erupting, and although it wreaks much less havoc with my

    life now, it still greatly impairs my ability to function. Returning to the trust, equip and supporttheme, the trustees unswerving understanding and support have made it possible for me to

    manage my illness and run Star Wards. In particular, our chair, Ian Hulatt, is beyond saintly in his

    willingness to have identical conversations, weekly, about how many hours Im able to work vs

    what my work produces.

    One of the primary reasons that Ive been able to continue working through a very problematic and

    high risk illness has been the exceptional support Ive had from the NHS. My psychiatrist/therapist

    has maintained his trust that Im doing all I can to recover and that this will eventually happen. Ive

    had specialist weekly therapy on the NHS for seven years, but in our ninth year Ive initiated longer

    gaps and now have monthly sessions. In addition to this, for several (very rocky!) years I had an outof hours crisis therapist, paid for from a phenomenally thoughtful and generous additional grant

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    from Esme Fairbairn. Its perhaps worth pausing here. One of our funders, rather than feeling I

    was too high risk to fund, in addition to a generous grant to the project, also offered us an

    additional grant (of 20,000) to use if necessary to support my mental health. Extraordinary and

    deeply appreciated.

    10. Conclusion

    In our first publication, Star Wards, I wrote Were not seriously suggesting that any ward adopts all

    75 ideas. (Although that would be good.) We were astonished and thrilled when almost instantly

    a hospital (Highgate Mental Health Centre) designed a template for benchmarking against all 75

    ideas. And then wards got in touch to let us know that theyd managed to get all (relevant) ideas

    implementedmany of these theyd already had in place but the structure had helped them to

    introduce many more improvements which benefit patients. The 75 ideas remain the backbone of

    wards involvement with us, but we have since developed all sorts of resources and initiatives whichboth complement and diversify from these. For us, Wardipedia is our ultimate resourcea

    comprehensive compendium of great practice.

    This review has confirmed that we are still certainly having an impact, but less than in our earlier

    years both in terms of numbers of wards using our approach and resources and also in the extent of

    wards focus on Star Wards. The report covers how weve wrestled with this to work out what is the

    most helpful way we can support wards at a time when they are so overwhelmed. We concluded

    that:

    1. We should continue! Id previously set up a short-term campaign to reduce the numbers of non-violent offenders sent to prison which I then closed, as planned, after four years. So, rather

    unusually, I dont have a problem with ending initiatives which have done as much as they can.

    One of the most persuasive arguments for keeping going was in a response from one of our

    trustees who is a senior manager in a mental health trust. He wrote: Star Wards has achieved so

    much in a relatively short time, some initiatives have come and gone never to be seen again and

    Star wards is still there and strong as a product and meaningful initiative.

    2. The recession wont last forever and when things pick up, its important that were still around to

    support wards. It seems that the (many) wards and trusts currently no longer involved are

    overwhelmed with the pressures of surviving and unable to focus on improvements. It doesnt

    seem to be because they didnt find StarWards helpful (on the contrary) and this would strongly

    suggest they are likely to re-engage in due course when there is a reduction of daily pressures.

    3. Wards that do use our resources unequivocally benefit from this. Were a tiny, lean (and keen!)

    organisation and thanks to our incredibly generous, committed funders we can be optimistic

    that we can continue to be of practical help to wards. We are able to be very flexible (again

    thanks to our funders) and respond not only to suggestions from wards (eg for a version of Ward

    Buddy for young peoples wards) but also to step back, review whats happening and change

    course considerably to be able to continue to be relevant to wards even in these highly

    demanding times.

    4. Our approach, resources and initiatives are mainly time-neutral so could be in use in 20 or 50

    yearstime. In other words, even with a decline in impact at the moment, we can be fairly

    confident that the work we continue to produce will have a long-term effect.

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    Continuing with the theme of sustainability, this is probably best illustrated with quotes from wards,

    showing different aspects of ongoing impact:

    Although our specific 'star wards' group has fallen apart (we tried to meet regularly and

    implement ideas from star wards but other commitments slowly took over), we have still

    managed to use heaps of ideas, continue to consult and be inspired by the resources.

    Perhaps we are not officially involved... but we use the resources.

    Over the last two years since gaining the Full Monty Award we have strived to keep these ideals

    as part of the unit. We also display these ideals and our award on the unit and use these as a

    reference for internal audits and patient surveys.

    Star Wards impact remains much the same. Wardipedia is really useful and we are hoping to

    implement Ward Buddy on the unit soon.

    The impact still continues as it has from the start but also has improved with new ideas and

    activitys that has been going on Eg: New equipment for our Gym, More inhouse and outhouse

    activitys etc.

    The impact has not changed over the last two years. As a lead reviewer for the AIMS project with

    the Royal College of PsychiatristsI actively encourage other wards to use Star Wards

    particularly selling it to nursing assistants.

    The Philip Kemp research mentioned in Section 8 had this to say about our sustainability:

    Structures and processes have been embedded in NELFT practice and will be extended to all

    inpatient facilities in the trust. Responsibility for the project practices has been transferred from the

    Star Wards and Productive Ward leads to modern matrons, and its outcomes have been

    incorporated into the trusts performance framework. In other words, the developments have

    become business as usual.

    So having decided that its important to keep providing support to the wards, weve carefully

    considered what we need to do differently to take account of these particularly fraught times. It

    feels like (most) wards are at saturation point with generic practical resources (i.e. applying to all

    wards) like TalkWell and Wardipedia. Were developing the following changes in direction:

    1. Structures that help staff reflect on and provide examples of the incredible work they do.

    Ward Stars is a validation scheme for healthcare assistants who currently receive almost no

    training despite the huge complexities and responsibilities of their role. Ward Stars has a

    relatively simple structure for HCAs to notice and feel appreciated for all the professional

    skills and personal qualities they bring to their role. It has been endorsed by the Royal

    College of Nursing who are keen to help us promote the initiative. And in a stroke of great

    timing luck, the recently published Cavendish Review (into training and support for HCAs in

    health and social care) is a wonderfully appreciative account of HCAs work and dedication

    and is recommending a Certificate of Fundamental Care. We believe that Ward Stars fits inperfectly with the contents, spirit and recommendations of the Cavendish review.

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    2. Developing resources for specialist wards and/or patients on mainstream wards who have

    very distinctive additional needs. Were working with partner organisations to develop

    resources for young peoples wards and for inpatients who have a learning disability.

    3. Rather than relying on ward and other hospital staff to create all the positive experiences

    for patients, weve started networking with other agencies who could potentially involve

    local people in satisfying, therapeutic and social opportunities. Weve begun working with

    Faith Action, a voluntary organisation for faith communities wanting to support local

    involvement with health services and service users. (On my first admission, there were no

    activities at allapart from once a week when members of a local church heroically came in

    for a singing and chatting session.) Weve also begun discussing with the charity Spice time

    credits people are rewarded for their contributions in credits which can be spent either

    within the group or in local places like cinemas, gyms etc.

    4. Tackling mad rules. The worst is the rule that pets arent allowed on wards contrary to

    popular belief, there are no legal restrictions and there is a large evidence base for the

    benefits of pets for people with mental illness and in hospital. Buddy was able to persuade

    Rethink to choose pets on wards as one of their main initiatives following on from theSchizophrenia Commission, which itself strongly recommended wards having pets.

    5. Getting a bit more political! Til now, weve largely left the campaigning (eg about levels of

    funding for wards) to our colleagues in the mental health voluntary sector. Now feels the

    time to join in and we have meetings planned with senior figures in the mental health

    sector.

    6. Focusing on leadership. This feels timely, given all the interest in leadership following the

    Mid-Staffs disaster and the ensuing Francis Report, and our very fortunate relationship with

    Henry Stewart and Happy.

    We are continuing our core activitieswebsites, visits, Full Monty, newsletter, Twitter etc. Werenot sure what to do about the interim network we set up for inpatient experts (NINE)the

    meetings dont feel like the best way to meet the networking need and it might be that a social

    media forum, such as Yammer, works better.

    Finally, we remain confident about our working model, which fits many of the criteria for jugaad(a

    Hindi term for frugal innovationa creative or innovative idea providing a quick, alternative way

    of solving or fixing a problem) and all of the factors listedin the following piece.

    An extract from Find the 15-Minute Competitive Advantage

    by Rosabeth Moss Kanter, Harvard Business Review, Nov 2009http://blogs.hbr.org/2009/11/find-the-15minute-competitive/

    .. Call this the 15 minute competitive advantage: changing in short fast bursts rather than

    waiting for the breakthrough that transforms everything. If every proverbial 15 minutes, you learn

    something and incorporate it into the next speedy step, youll continue to be ahead. And a few time

    periods later, transformation will be underway

    Here are some characteristics of innovations most likely to succeed at gaining support:

    http://blogs.hbr.org/2009/11/find-the-15minute-competitive/http://blogs.hbr.org/2009/11/find-the-15minute-competitive/http://blogs.hbr.org/2009/11/find-the-15minute-competitive/
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    Trial-able: The idea or product can be demonstrated on a pilot basis. Customers can see it in action

    first and incorporate it on a small scale before committing to replace everything.

    Divisible: It can be adopted in segments or phases. Users can ease into it, a step at a time. They can

    even use it in parallel with current solutions.

    Reversible: If it doesnt work, its possible to return to pre-innovation status. Eventually you want

    life to be unimaginable without it, but at least in theory, its possible to go back to zero.

    Tangible: It offers concrete results that can be seen to make a difference in something that users

    need and value.

    Fits prior investments: The idea builds on sunk costs or actions already taken, so it looks like not

    much change is involved.

    Familiar: It feels like things that people already understand, so it is not jarring to use. It is consistent

    with other experiences, especially successful ones.

    Congruent with future direction: It is in line with where things are heading anyway. It doesnt

    require people to rethink their priorities or pathways, even though of course it changes things.

    Positive publicity value: It will make everyone look good.

    These principles leave plenty of room to promote revolutionary ideas under cover of evolutionary

    change. But to find and grow a market for anything whether green products or new health

    delivery plans means staying close to what users can adopt easily and then leading them to the

    next iteration.

    Innovators who take risks must reduce the risk for others. Think long-term trends but short-term

    steps 15 minutes at a time.

    Marion Janner

    October 2013

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    Appendix - Tangible results of Star Wards

    The following are developments which wards have specifically said were due to their involvement with Star

    Wards. They are taken from emails, Full Monty reports, surveys and other feedback, from the time Star

    Wards was set up2007. Although its a wonderfully heartening catalogue of ward improvements, we know

    that there has been considerable attrition and some of these achievements will now have withered or

    ceased. But we hope that wards which have experienced the benefits of taking part in Star Wards will, when

    circumstances are more favourable, resume their involvement. And our final section of quotes

    (Sustainability) also gives us hope.

    Contents

    1. Philip Kemp research

    2. Staff satisfaction

    3. Patient satisfaction, involvement and autonomy

    4. Leadershipby managers, ward staff and patients

    5. Improved staffing and resources

    6. Patient activities

    7. Supporting recovery

    8. Better relationships

    9. Improving the ward environment10. Involving family, friends and carers

    11. Contact with animals

    12. Staff training

    13. Star Wards as inspiration etc

    14. Star Wards as a structure, and structuring Star Wards activity

    15. Sustainabilityin UK and overseas

    1. Philip Kemp research

    Very significantly for us, there was an article by Philip Kemp and colleagues at South Bank

    University worked with North East London Foundation Trust to evaluate the impact of introducing

    both Productive Ward and Star Wards. Their articleHow to turn innovations into everyday

    practicewas published in the October 2011 edition of Mental Health Practiceand outlines some

    incredible achievements by NELFT eg:

    The number of recorded incidents fell from an average of 30 per month during the first three

    months of the first year to an average of 13 per month during the last three months. And the

    http://www.deepdyve.com/lp/royal-college-of-nursing-rcn/how-to-turn-innovations-into-everyday-practice-Ize0ziyyQXhttp://www.deepdyve.com/lp/royal-college-of-nursing-rcn/how-to-turn-innovations-into-everyday-practice-Ize0ziyyQXhttp://www.deepdyve.com/lp/royal-college-of-nursing-rcn/how-to-turn-innovations-into-everyday-practice-Ize0ziyyQXhttp://www.deepdyve.com/lp/royal-college-of-nursing-rcn/how-to-turn-innovations-into-everyday-practice-Ize0ziyyQXhttp://www.deepdyve.com/lp/royal-college-of-nursing-rcn/how-to-turn-innovations-into-everyday-practice-Ize0ziyyQXhttp://www.deepdyve.com/lp/royal-college-of-nursing-rcn/how-to-turn-innovations-into-everyday-practice-Ize0ziyyQX
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    We have only just started this process and there isn't much to go on to help with a day hospital or

    memory clinic so we are making up the rules as we go. However my team are so motivated that it is at

    the moment a really enjoyable experience and its great watching them come up with new ideas and

    following them through to fruition. Our clients will really benefit.

    Star Wards allows us to be creative and use immagination. Its a great source of inspiration for all staff.

    More activities for our patients; it also gives staff a bit more structure to do activities with patients as our

    activities are protected engagement time; all staff know about this and facilitate this to happen. It has

    also meant that staff have become more creative in thinking about the variety of activities and events

    they can organise to make the stay of patients on our ward more comfortable. It has given staff more

    confidence.

    Just again to let you know how much of a huge impact the star wards has had here and how i

    myself have enjoyed the whole process.

    Better staff dynamics. A happier more optimistic environment for all.

    More activities for our patients; it also gives staff a bit more structure to do activities with patients as our

    activities are protected engagement time; staff have become more creative in thinking about the variety

    of activities and events they can organise to make the stay of patients on our ward more comfortable. It

    has given staff more confidence.

    Some have said that there is a real buzz about the place.

    Seeing how units all over the country with diverse environments adapt to Star Wards to improve

    patient care.

    Staff have also benefited from the activities programme. They have improved their skills and their

    confidence is growing in the running of most activities. They also have a sense of achievement, their

    relationships with patients have improved and they feel they are aiding patients recovery.

    It cheers me up to know that there is good practice going on. I've never actually taken on an idea though -

    the best ones come from within.

    Some staff feeling that they are doing the job that they trained to do.

    Really enjoyed using the online resources to implement ward activity where I work.

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    3. Patient satisfaction, involvement and autonomy

    Patients feel more empowered, this creates more motivation, improved relationships between staff and

    patients, staff and staff, less division, more optimistic attitude, improved mental health for patients and

    some discharges which I believe have happened sooner.

    It is helping the patients to socialise and it is great fun. For example we now have karaoke on the ward

    which is headed up by a patient. We even have patients from other wards who come and join us for this.

    We are all really enjoying it.

    Giving the service users the opportunity to participate in the star wards process encouraged and

    facilitated a sense of involvement, belonging and responsibility for service users. It was an opportunity

    for them to feel that their opinions are valued.

    We had our first meeting today with 4 patients, and practically before we started had loads of great ideas

    and comments flowing. It was fantastic to see it take off so naturally and easily and we have 4 actions to

    work on, all do-able by next week! We will have a weekly meeting, as part of our group programme.

    Relatives have commented on more activities. The last Mental Health Act commissioners visit

    commented on calm ward environment.

    Increasing patient inclusion in care planning is definitely an area we have worked hard to achieve over

    the last year.

    As a unit, we use Star Wards to ensure that patients are involved in several aspects of their care. They

    have input into different activities, the unit environment (e.g. artwork) Star Wards helps patients to feel

    welcomed and at home on the unit.

    Star Wards encourages patients to become involved in several aspects of their care. It enables staff to see

    things from their point of view in order to meet their needs holistically

    Star Wards has had a great impact here in giving us more of an understanding on what our clients

    like/enjoy and also getting them involved and getting to understand there needs

    Its a good way in finding out our clients needs and a chance to get everyone involved in making their stay

    here a more relaxed feeling rather than a hospital setting.

    [Improvements have included:]

    o More person centred

    o Greater attendance (which indicates ? more interesting / appealing / enjoyable?)

    o Patients have a reason to get up on a morning

    o Patients are socialising more with others and developing supportive relationshipso Greater links with community services and agencies who can continue to support upon discharge

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    o Greater stimulation / distraction

    o All new patients provided with distress tolerance activities (e.g. word searches, colouring sheets,

    crosswords, self-soothe items).

    A system for patient feedback - Points of You

    Daily community meetings and a personal patient profile with copies of care plans and a diary for

    appointments etc, along with ward information, advocacy information and other information

    Patients producing writing, drawings and photos about social and therapeutic experiences on ward, and

    displaying these.

    Wish List so patients can influence how OT budget is spent.

    Buddy system

    Community meetings at start and end of dayhas ended tension about financial incentives programme.

    Introducing therapeutic earnings.

    The daily community meetings and the use of the recreational budget to allow us to have DVD nights and

    have takeaways and have had positive feedback from the service users of how this has made a more

    integrated feeling between the staff and service users.

    Carrying on with the idea of communication, we have put up new notice boards on each unit. These

    incorporate the clients profiles and various client information. The clients decided that for their profiles

    they wanted short and concise points alongside their photograph so that any new staff could identify

    them quickly. The profiles are written in the clients own words and contain information about likes and

    dislikes as well as triggers and effective de-escalation techniques.

    The clients get a sense of pride of having their photograph displayed and comfort in knowing staff will

    understand them better thanks to the work they have done. The notice board is maintained by a differentclient on each unit and they take care in ensuring that weekly activities, staff members on shift and

    upcoming events are displayed.

    Greater service user feedback (e.g. from activity planning meetings) which feeds into developments and

    makes it more service user led

    One of the ideas is day begins with ward community group. This was happening only on one ward. We

    introduced the idea over the other two units. It was difficult to get consistency at first but now the clients

    remind staff if the Nurse forgets to hold the meeting! Our clients decided they would only like a morning

    diary meeting and not an evening, so we went with this. The clients have fed back that they feel calmer

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    and more relaxed about the day ahead as by 9.30am each day they know what is happening during their

    day.

    Another recommendation was related to ward meetings daily. This has been happening for a

    couple of years too and is terrific. It typically is one of the most attended groups and hasprovided a much needed feedback forum and an opportunity for clients and staff to get together

    and talk about how things are going on the unit.

    Daily ward community group

    Implementing the Star Wards process has ensured that as a team on [the ward] we have reviewed how

    we involve patients on the ward and how they contribute to planning their care. It has demonstrated

    that they continue to be at the centre of the ward and has encouraged them to take more responsibility

    for making decisions on the ward. For examplewe introduced a Wish List so that service users have a

    say in how the OT budget is spent. Another example would be the Buddy system, allowing currentservice users to guide new service users through the initial stages of their admission, offering support,

    advice and useful information.

    We introduced a Wish List so that service users have a say in how the OT budget is spent. The Buddy

    System provides the opportunity for new service users to learn about the ward and to feel welcomed on

    the ward by current service users. The move to a new ward can be daunting and anxiety provoking.

    Discussion about wrong payment and incentive levels during community meeting has stopped as patient

    are able to address this issues daily during start the day and end the day session. They feel that the team

    have true reflection of their engagement in treatment program.

    Tomorrow we are starting daily community meetings and a personal patient profile with copies of care

    plans and a diary for appointments etc, along with ward information, advocacy information and other

    information.

    We now have daily reviews of patient care by the Multi Disciplinary Team, firmly embedded as a given,

    from the Star Ward idea instead of our previous weekly review, which initially was met with some

    resistance from different members of the team (mostly medical) but this has now been embraced by all.

    4. Leadershipby managers, ward staff and patients

    Since the inception of the Star Ward initiative I have become more creative and innovative in the way I

    execute my role as a SHCA than before. I have made enormous contribution towards the achievement of

    most of the 75 Star Ward ideas.

    Clients running special interest sessions eg drama groups and productions.

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    Another example would be the Buddy system, allowing current service users to guide new service users

    through the initial stages of their admission, offering support, advice and useful information.

    Clients running special interest groups. For example, we had a client who was very interested in birds. We

    spend two weeks making bird cakes during a gardening project group, drawing and spotting birds during

    a nature session and creating bird colleges during an art workshop. This climaxed with the arrival of

    Falconry UK. They attended [our hospital] for an hour and gave the most interesting talk about Falconry.

    Having the star wards wardipedia and talkwell are great for myself and my fellow activity co ordinator

    colleague to refer to so that we can improve things on the unit and come up with different ideas to keep

    our patients motivated to join in with groups and activities each day. Leadership is vital.

    The best aspect of completing the project has been patients exploring ways of improving their immediate

    environment, whilst creatively incorporating their skills and engaging in activities that they find

    meaningful. Some patients have really embraced the ethos of the project, and have been activelyinvolved in taking responsibility for their own care and generating ideas on how to improve their stay

    within this setting.

    Hopefully the new ideas have provided more opportunities for service users to access a wider range of

    resources (such as the ward library and ward internet access). This process has demonstrated that

    service users continue to be at the centre of the ward and has provided them with the opportunity to

    take more responsibility with regards to accessing the resources and making decisions on the ward. For

    example, the daily Planning and Debrief Meetings are chaired by a named service user who is paid for the

    role. Another example is that the wards recreation budget is spent according to the requests of the

    service users.

    With so many pressures now faced, at times we needed to work hard to keep it on the agenda and not

    loose sight of the positive things that could be gained from Star Wards. What pleased me most was how

    the team really thought about it, involved the service users, and were often willing to go the extra mile to

    help service users, for example one staff member changed his shift to take a service user to see a

    comedian at a theatre, even though it mean not getting home until midnight. Other staff will often come

    in early or stay late to go out with service users, to ensure that they are able to have as positive

    experience as possible whilst they are staying here.

    I believe one of the best ideas we have implemented is that clients run special interest groups. For

    example, we had a client who was very interested in birds. We spend two weeks making bird cakes during

    a gardening project group, drawing and spotting birds during a nature session and creating bird colleges

    during an art workshop. This climaxed with the arrival of Falconry UK. They attended [our hospital] for an

    hour and gave the most interesting talk about Falconry. The clients (and staff!) were able to hold a variety

    of birds and it proved the talking point in Walk and Talk for weeks! This idea really made us appreciate

    how important it is for clients to take the lead in sessions and feel empowered by their unique interests

    and skills.

    The most rewarding and fun idea we have fully embedded into the Activity Timetable is that clients run

    special interest sessions. One of the clients is keen on drama and hence we now have weekly dramasessions. The sessions tend to be made up of playing games and writing our own scripts! Since the

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    summer, we have put on two very successful productions. One was called Twistedthis was a twist on

    Snow White where Snow White was evil and killed her Step Mother with the help of an imaginative evil

    dwarf! Our second play was called Spellbound (a comedy this time!) which centred on a good witchs

    love potion that goes wrong. Everyone who came to watch the production was astounded by the way

    that the clients performed. One client who takes several moments to answer a question was able to

    remember all his lines and talk with ease, whilst another client who does not interact very much withothers did a sterling job of performing in front of a crowd. Hardly anyone could believe how the clients

    had led the sessions which led up to the production: script writing, directing, and learning of lines, team

    building and prop making. It was a team effort and the results were spectacular.

    Support from management has also been necessary and greatly appreciated, without this, time would not

    be dedicated to the projects and it would not be seen as a priority. Thankfully our management has

    appreciated the impact of Star Wards and encouraged us all of the way

    One thing that has been introduced by 3 of the healthcare assistants has helped to raise awareness of

    some aspects. They have implemented a regular session where patients can write a diary, draw picturesor display photographs about their social and therapeutic experiences on the ward. This will include

    community trips and sessions organised on and off the ward. These are displayed in the main corridor of

    the ward and will always be a work in progress, older items being removed as new ones are added. The

    patients appreciate being able to see their work on display and it is a reminder of some of the good times

    they have had on the ward. A recent seaside trip and summer garden party are new additions. Patients

    have really enjoyed writing about their trips and displaying their artwork in the corridor. They are very

    proud of the work they do and really appreciate having it on display. It is becoming a focal point of

    discussion for visitors to the ward and is helpful for newcomers to see the range of activities that they

    may become involved in. The patients are now also coming up with new ideas for additional artwork that

    they would like to have a go at and where they would like it to be displayed to brighten up the ward. It is

    nice to have such a positive response to this.

    We are very lucky that our organisation is a great supporter of Marion and all things Starwards etc

    The ward administrator has helped to set up many of the new activities on the ward, and organise the

    weekly schedule. She says, This scheme is particularly great for patients who are unable to leave the

    ward. It keeps the patients busy, rather than them sitting watching television all day. Patients are

    constantly coming up to me asking me what activities are planned for the day.

    Service user chairs daily planning and debrief meetingsa paid role.

    Within the low secure service, one fantastic idea that came out of the Star Wards Patient Focus Group

    was patient-led skills sessions. It was discussed that many of our patients have exceptional talents and

    skills that others were interested in learning. We are now in the process of setting up this initiative and

    have patients who are willing to teach origami, sugar craft, baking, cooking, art, music and basic

    computer skills. We envisage that this project will have a positive long term impact on patients self-

    concept by improving self-esteem, confidence and providing patients the opportunity of giving

    something of themselves in a safe environment.

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    Patients were enthusiastic about creating patient-led skills sessions where they could share their interests

    and skills with others. This initiative idea that is being developed and we have a number of patients who

    would like to facilitate sessions on origami, cooking, sugar craft, art, music and basic computer skills.

    By encouraging some of our most distressed and troubled patients to take the lead and ownership of new

    initiatives, we have seen a decrease in risk behaviours and a greater sense of community on what is a

    challenging environment to live in!

    Our patients have been able to bring new ideas such as the new service user forum where service users

    discuss their problems with managers and service advocates.

    We have been implementing & benchmarking our achievements with regard to your brilliant initiative

    known as star wards for over 6 months now & the impact it has had on our unit is amazing. We are

    fortunate enough to have a patients council which is run weekly by ex service users enabling us to easily

    implement Star Wards suggestions. We also have a carers council who meet monthly & help us bench

    mark where we are at & lead where we are headed.

    5. Improved staffing and resources

    Development of Groups/Activities Nurse role (me!).

    Particularly I would say the presence of an activity coordinator and having a weekly activity programme

    have changed patient experiences for the better. It makes life on the ward less tiresome and more

    dynamic, providing patients with an actual therapeutic environment, social interaction, learning of new

    skills and having fun! Also, the presence of an OT has helped to facilitate more home visits and leave

    plans, and ensure activity programme is going ahead, and is interesting and relevant for the patient

    group.

    Others suggested that the main impact was providing a toolor new focus for the ward staff and for a

    few wards it included the development of new staff posts such as activity co-ordinators or the

    employment of occupational therapists.

    Appointed a staff member to work 10-6 3 days a week for Star Wards activities

    . *we appointed a+ permanent activities coordinator.

    Position of Activities Co-ordinator on the ward.

    Activities Co-ordinator.

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    Something I believe which has come as a great achievement as a result of the ideals has been the cross

    team involvement in activities with patients. An example of this can be seen in the activities that were

    initiated, developed and run by the domestic team and Head of Hotel Services. A member of the

    domestic team worked alongside the Occupational Therapist to develop a household skill focused group,

    which enabled the Occupational Therapist to assess individuals abilities as well as provide patients with

    professional advice from the domestic staff.

    In addition to this the Head of Hotel Service along with one of the Therapy Coordinators developed a

    group called Master Chef. The focus of this group was to be fully led by the Head of Hotel Services,

    providing sessions on topics that would teach skills specific to cooking beyond that of everyday cooking.

    Another cross team involvement has been the dedication of interest from one of the support workers for

    his DJing. This Support Worker has on several occasions hosted the music for some of our parties and

    celebrations. As well as playing the music he has also encouraged patients who have expressed an

    interest in DJing and provided them with 1:1 tuition during events.

    Non-medical staff much more involved in ward life.

    Our non-medical staffs have defiantly become planted in our daily activities with the clients. They are

    always invited to events and parties that we hold in the therapy centre. They often pop in when an

    activity is taking place or on the units just to join in and have fun! There is much more of a sense of

    togetherness now than there was 18 months ago. For example, we are holding a Christmas Carol Service

    later this month and lots of our team cannot wait to attend and join in (and eat the mince pies!). One

    staff member has even donated a Christmas tree for the therapy centre ready for the event. I believe the

    change in our practice has bought everyone together and boosted staff morale. The clients really

    appreciate the support from everyone who works alongside them and it is clear to see how much of a

    confidence boost they get from everyone wanting to support them in their recovery.

    The major change has been how support workers and all staff across site have interacted in a more

    positive and creative way. For example, we put on regular drama productions and staff from

    housekeeping, admin and managers attended. I feel that there is a flare of creativity running through [our

    hospital] thanks to Star Wards.

    Getting more staff involved and on board with the ideas eg. Holding community/carer groups and using

    bank staff to run activities. The process feels like a team effort.

    Increase in outside agencies involvement in group work.

    More volunteers on the ward.

    Far and away the greatest impact has been the recommendation of having up to 4 hours of peer

    volunteer time per day. This one recommendation has been transformative. Whereas previously we had

    about 4 hours per week we now have 30 hours per week of peer support (no longer volunteers, we havea paid peer support worker positions) in addition to which we have another 6 hours per week of peer

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    volunteers helping with activities. It is a rare week that goes by when some client does not say something

    about how helpful it has been to talk with one of our PSW's. Their presence on the unit also goes a long

    way towards reducing stigma as they are firmly entrenched in the 'staff' role thereby blurring the

    distinction between staff and clients.

    As a newly established service, the low secure wards found that by working through the Star Wards

    criteria, we were able to identify much needed resources and have resulted in the establishment of a

    library and increased leisure equipment, including a pool table, swingball set and Wii Fit Board. It is

    important to mention that these requests were supported strongly by our line manager [Head of

    Therapies] who was both enthused and excited by the work we were doing and the Star Wards Initiative

    in general. We also developed a Patient Information Pack which contains information that patients within

    the focus group thought it would be useful for newly admitted patients to receive. This pack will remain

    with the patients and there are also sections where patients can store care plans, recovery plans and

    other documentation that they receive whilst in hospital.

    Star Wards was discussed in our community meeting. Volunteers were asked to meet up with the

    Assistant Psychologist to discuss the items we did not have in place (i.e. not having magazines/games in

    the Visitors Room). The group met up at the end of February and came up with a number of ideas about

    how to improve the Visitors Room including putting games in the room, putting their art work on the

    walls, putting up to date magazines in the room etc. They also suggested that it would be useful to

    provide all new admissions with distress tolerance activities (e.g. word searches, colouring sheets,

    crosswords, self-soothe items). We agreed to have a cupboard moved into the Visitors Room which

    patients could fill with games and jigsaws. The cupboard was moved into the Visitors Room. More

    recently magazines have been added to the Visitors Room.

    Daily community meetings and the use of the recreational budget to allow us to have DVD nights andhave takeaways

    During discussions we looked at the equipment that was available on the ward for people to engage in

    self directed activity. One of the areas lacking was music, an area which lots of people identified that

    they were interested in. We already had music to listen to and an old keyboard that was well used but

    lots of people played or wanted to learn to play the guitar. In

    partnership with the hospital league of friends we purchased an electric guitar, which sits in the general

    dining room/activity area and is used frequently. Its not uncommon to be working with patients in a

    group to a musical accompaniment.

    Ward library

    Internet access

    A wide and varied selection of games and books on the ward at all times.

    A library of books, CDs and DVDS in the ward, with up to date magazines , we also have an information

    stand and a health promotion area for patients, we have updated our board games and jigsaws and havea new Nintendo wii

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    The joint project with the hospital league of friends transformed a neglected and overgrown area into a

    pleasant environment to sit in and relax and created a therapeutic area to nurture and grow plants. It has

    provoked lots of interest from people who pass the area and become a talking point within the patient

    group. The fruit and vegetable growing has been a hit, with lots of fresh strawberries, gooseberries,

    apples and runner beans available for patients and relatives to keep and for use in cooking sessions. We

    run a structured gardening session on a weekly basis but people have been free to attend to general

    garden maintenance on an individual basis. Next year we are hoping to grow a wider range of vegetables

    and fruit, grow lots more plants from seed and have a party for the hospital volunteers to show them

    how things are progressing a year on.

    I began by looking at resources and activities available to the patients on our ward. As the Occupational

    Department is located in a different building the patients had no access to board games, materials, books

    etc. I trawled charity shops, car boot sales and asked family members and friends to kindly donate their

    unwanted items. As a result the patients now have access to a wide and varied selection of games and

    books on the ward at all times.

    Creation of resource room with supervised internet access, Wii console and games and resource library.

    (Staff raised funds for above by completing sponsored canoe race).

    We have an activity co-ordinator and so need to increase the amount of resources and choice to the

    patients - in terms of one-to-one therapy time - this has been successful so far.

    The use of the Day Hospital facilities in the evenings and at weekends. The Recreational Hall made

    available for every Saturday and also two evenings per week. This further developed our range of

    activities to now include basketball, indoor soccer, badminton, table tennis, Wii, bocca, Velcro archery,

    curling and pool.

    There has been an increase in activities for patients on the ward. Due to the ward just being refurbished

    we have been able to obtain Play Station, Wii Nintendo, Snooker/Pool table and a table tennis table

    We now have a group room (thanks to Star Wards) where we play games, e.g Wii, take part in talking

    therapies, etc. This has led to many more activities taking place and increased patient involvement

    New equipment for our Gym

    Bought electric guitar

    Supper & evening relaxation started. Ward laptop purchased recently, PAT dog visits.

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    6. Patient Activities

    Welcome Bags

    The idea for the Welcome Bags came about from the information we received for the Star Wards Festival

    Celebration Bags which we actively took part in. A group was formed whereby the Festival Bags were

    made by service users from the East and West Willows wards and were sent away to London.

    During the festival bag activity group one of our patients asked if they could make their own bags to give

    to new patients on their ward to help them feel more welcome and dispel their own fears about being ill

    and away from home. The idea for Welcome Bags was adopted.

    It was suggested that we could scale down the original festival bag. Inside the bag would be placed a

    written information leaflet about the ward, a kind word greeting card, a timetable for on/off ward

    activities. Some patients would also put in a small sachet of hand cream, shampoo and hair conditioner,

    etc, thus making the bag a more personal item. The idea for the Welcome Bags were created.

    These bags are given to new patients from existing patients forming a patients mutual support system.

    This has helped with the well-being of patients who have been attending the welcome bag activity

    group. From the feedback that has been received they feel they are contributing not only to their own

    well-being but are showing the new patient that they care.

    Since starting this welcome bag activity group we have had patients approach us who have received awelcome bag and have requested to participate in creating their own bag to give to someone else who

    has just arrived on the ward.

    Many new ideas continue to pour in from patients as to what could be put into the bags. Important

    telephone numbers, i.e. PALS, Carers Support Groups, and appointment cards.

    During one of our groups one of our patients had finished their bag and was so happy and proud of her

    achievement that it was suggested she keep the bag for herself. No she replied, Ive made this for

    someone else to help them feel better.

    The message we are simply saying from these bags is WELCOME!

    We have only been a Star Wards wardnow for a few weeks and already the ward is a very different

    place. We have already introduced an art group, a DVD group, a walking group, a music and poetry group,

    we do karaoke evenings and have table tennis competitions. The project is about making sure we occupy

    the days of our inpatients with meaningful activities. We did some of this before anyway, but now it is

    much more structured as we have a planned weekly rota of activities which the service users have

    welcomed with open arms. It has helped us to manage aggression on the ward and is helping to increase

    engagement between staff and patients.

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    I looked at devising a questionnaire to seek patients opinions on activity provision on the

    ward....Through this we discovered a wide varied range of future activities that would become part of

    the weekly timetable. Interests included aromatherapy, dance, keep fit, art and crafts, non baking groups,

    walking groups, beauty classes, pampering and relaxation classes.

    We started a Walk and Talk group each morning between 9.30am-10.00am on our grounds so all clients

    could attend. This was a success during the summer but the sessions have stopped in the winter. The

    clients who are not on 1:1 observations have fed back that this was a great time for them to have a

    conversation and attention from staff. Any issues they had could be talked through and hence by

    10.00am they were no longer upset or anxious over the issue. This proved to help clients settle for the

    rest of the day.

    Patient who attended one event (Olympic torch relay) stated it was the best day of his life!! In same

    group, service user was expressed her gratitude for being given the opportunity to watch the torch relay

    as she had taken the day off work several months ago (prior to becoming unwell) to watch this in her

    community and reported to have accepted he was going to miss it after being detained.

    Another idea which was client led was the monthly News4U newspaper. It was felt that there was a lack

    of communication between everyone at what was going on at [our hospital]. Achievements were not

    being recognised and no one knew what each other had been up to. The paper started as a team of two

    clients but soon nearly all the clients were contributing a page each to the paper. The paper contains

    information such as; what Education certificates have been awarded during that month, new clients that

    have joined us, clients who are moving on, clients pre-vocational adverts (e.g. advertising cards that they

    make for sale), sports, history and geography pages, puzzles and word searches and one month we even

    have a page dedicated to Klingon language! The paper is placed on every unit, in our library and a copy in

    reception. It has allowed clients to support each other in their achievements and to feel proud of stepsthey are taking in their recovery.

    Our Journey started about a year ago. We began by looking at the 75 ideas, and seeing which ones we

    were achieving or almost achieving. We spent time with the service user group who were here at that

    time, and asked them for their thoughts and ideas, from this we were able to identify and prioritise those

    areas that needed addressing first. Primarily these were the ones involving the resources we had in terms

    of DVDs books etc, and from the service user perspective relating to activities. From this two staff

    volunteered to co-ordinate the activities. So we now offer a number of activities that can be run as a

    group or individuallyMusic, Gardening, Photography, Exercise/walking groups, Single gender groups,

    Arts and crafts, DVD nights, Healthy eating, healthy lifestyle (smoking cessation, alcohol awareness,

    healthy sleep, weight management), as well as specific activities for individuals, - swimming, cycling,

    introducing people to local facilities, day centres et


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