Marion set up Star Wards based on her own experiences as a detained psychiatric inpatient, and her appreciation of the support she got from staff and from other patients. Star Wards shared & inspired further great practice on mental health wards, so that being an inpatient would be therapeutic and often fun. Among the many many ideas celebrated by Star Wards, Marion's favourites included spacehopper races down ward corridors, having rabbits as ward pets and patients running their own ward community meetings.
Although Star Wards finished as a project during the Covid crisis of 2020, its resources are still freely available and include:
Animal Magic - lots of ways in which patients can have contact with animals on and off the wards
Wardipedia - an encyclopaedic feast of glorious ideas for making the most of all aspects of ward life, divided into these (forgive the pun) sections:
IMAGINATION –what’s it like for the patient?
MINDFULNESS –chilling out
ACTIVITIES –social, recreational, physical
GENEROSITY –sharing, kindness, giving
INVOLVEMENT –influence, information, independence
NEIGHBOURS –friends, family, fellow patients
EMPATHY –for self and others
Although Star Wards finished as a project during the Covid crisis of 2020, its resources are still freely available and include:
Animal Magic - lots of ways in which patients can have contact with animals on and off the wards
Wardipedia - an encyclopaedic feast of glorious ideas for making the most of all aspects of ward life, divided into these (forgive the pun) sections:
IMAGINATION –what’s it like for the patient?
MINDFULNESS –chilling out
ACTIVITIES –social, recreational, physical
GENEROSITY –sharing, kindness, giving
INVOLVEMENT –influence, information, independence
NEIGHBOURS –friends, family, fellow patients
EMPATHY –for self and others
Star Wards’ nickable practices
Mental health wards responded warmly, generously and creatively to Star Wards’ positive, realistic and appreciative approach. They adapted, adopted and contributed ideas so that wards all around the country could enable patients to have even more therapeutic and often fun experiences. These are the main lessons we learnt about how to work collaboratively with wards.
1. Structure
· voluntary involvement by wards; ideas and inspiration not standards and compulsion
· flexible framework for:
o shining light on, bringing together, celebrating and validating existing good practice
o structuring priority ward improvement developments
· membership:
o enables direct contact with ward
o sense of identification with project and other members
o contact with and inspiration from other members around the country
· Star Wards simply a catalyst, providing ideas and motivation which members convert into locally valuable practices
· Culture of generosity between wards – sharing of information and resources they create from germs of ideas Star Wards provides
2. Relationship between Star Wards and members
· unswerving emphasis on what’s going well in services – comparable to ‘appreciative enquiry’ approach, and infectious nature of this positivity and ‘can do’ approach
· it’s ‘social marketing’ – “the systematic application of marketing, along with other concepts and techniques, to achieve specific behavioral goals for a social good.” It’s the opposite of an oppositional campaign, and is based on mutually appreciative collaboration. Co-production.
· human not bureaucratic
· easy accessibility eg:
o membership, events, first set of publications all free of charge
o style (eg tone and look) of information, events etc very friendly, attractive and intelligible
· charity:
o patient-led initiative
o independence creates trust, warmth and credibility and removes potential resentment and resistance
3. Ideas
· all practical and most are easy and free or low-cost to introduce
· mix of core 75 ideas which most members use for benchmarking, and huge scope for staff and ward initiative and adaptation
· already in place to some extent in all wards so they get big boost right from start, especially if they do benchmarking exercise
· created from the strongest possible evidence base
4. Focus on ‘soft’ (but actually very hard) issues
· what patients do and feel day-to-day
· staff:patient relationships especially healthcare assistants
· relationships between patients, including:
o nurturing ward community
o value of mutual support
o avoidance of conflict
· conversation and communication
· carers and visitors, mainly in relation to patient but also in their own right
· holistic approach to treatment (i.e. biopsychosocial model)
· holistic approach to patient’s life
· patient self-management, autonomy, influence over daily experiences & treatment
· patients (including ex-patients and patients’ reps) involvement in service planning, delivery and assessment
5. Staff
· We believe strongly in frontline staff being trusted, supported and equipped to do the work they’ve been recruited to carry out, using all their professional skills, personal qualities and initiative.
· Managers’ main responsibility is to make this possible and to be a visible but not interfering presence and inspiration. Two books which have influenced us most are:
o Happy Manifesto by Henry Stewart (who wrote a wonderful piece in Star Wards 1 on Making Mental Health Wards Great Places to Work.
o If Disney Ran Your Hospital by Fred Lee.
· no ‘winner takes all’ awards – an expensive way of demoralising 99% of staff. Awards (eg Full Monty) equally accessible on basis of achievement rather than subjective competition.
6. Bright structure & organisation
· tiny = funding and time spent on resourcing wards rather than resourcing Bright
· can be unorthodox, innovative/risky, fun, personal/warm
· consistent tone, quality etc
· ability to make and implement decisions very quickly
· ability to get funding from a range of charitable, private and statutory sources
7. Specific approaches and ideas relevant to most hospital inpatient care
· importance of contact with nature including animals
· high quality information for patients
· promotion of volunteers’ involvement with patients
· culturally responsive wards
· importance of look and feel of physical environment including outdoor spaces
· patient feedback to staff and self-review of progress
· harnessing positive, informal relationships domestics often have with patients
· traumatic situations are soothed by not incompatible with appropriate fun
8. Social marketing influences
· Appreciative Inquiry – Focuses and builds on what is working well for an organisation, team, person, situation. Strengths/assets rather than deficits based approach.
· Frugal innovation - Jugaad is a Hindu term for cheap, ingenious invention using ingredients and lots of local knowledge, creativity rather than costly engineering.
· Influencer – Patterson et al. Six sources of influence
o personal motivation
o personal ability
o social motivation
o social ability
o structural motivation
o structural ability
People need to feel the change is worth it and that they can do it.
· Influence - Cialdini
o Reciprocity “I scratch your back, you scratch mine.”
o Commitment and Consistency “I did it before so I must do it again.”
o Social Proof “Everyone else is doing it...”
o Liking “I had to buy it, the salesman was so nice.”
o Authority “You should always listen to the experts.”
o Scarcity “I got the last one in the shop!”
· Diffusion of innovation theory – Rogers. The characteristics which determine an innovation's rate of adoption are:
1. perceived relative advantage: economic, social prestige, convenience, and satisfaction
2. compatibility with the existing values, past experiences, and needs complexity to understand and use
3. trialability
4. observability to others
9. Leadership
We’re strongly influenced by Henry Stewart and his Happy Manifesto. Staff need to be trusted, supported and equipped in order to perform at their best.
Fred Lee’s If Disney Ran Your Hospital is also excellent on appreciative, supportive leadership practices.
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