BackgroundCOVID-19 has caused acute changes in healthcare delivery; this may impact mental health and wellbeing needs of healthcare professionals (HCPs). AimsWe aimed to identify the causes of anxiety in HCPs during the COVID-19 pandemic, to assess whether HCPs felt they had adequate mental health and wellbeing support and to identify their unmet support needs. MethodWe used a web-based survey utilising an online tool circulated to UK HCPs over 5 weeks. Self-perceived anxiety levels prior to and during the COVID-19 pandemic were measured on a 10-point Likert-type rating scale. ResultsThe survey was completed by 558 HCPs. During the pandemic, self-perceived anxiety scores significantly increased from a median of 2 to 7 (paired Wilcoxon signed-rank test; p<0.001). The main reasons were concerns about exposure to SARS-CoV-2 and lack of personal protective equipment. Other wide-ranging reasons were identified. Only 41% of respondents felt there was adequate support. Thematic analysis of what support HCPs wanted identified 13 wide-ranging themes; including effective leadership and peer support. ConclusionAnxiety levels in HCPs significantly increased during the COVID-19 pandemic and the main causes were identified.

BackgroundLength of stay and bed occupancy are important indicators of quality of care. Admissions are longer on older adult psychiatric wards as a result of physical comorbidity and complex care needs. The recommended bed occupancy is 85%; levels of 95% or higher are associated with violent incidents on inpatient wards.MethodsWe aimed to reduce length of stay and bed occupancy on Leadenhall ward, a functional older adult psychiatric ward serving a population of just under 40 000 older adults in two of the most deprived areas of the UK.At baseline in October 2015, the average length of stay was 47 days, and bed occupancy was at 77%. We approached the problem using quality improvement methods, established a project team and proceeded to test a number of changes over time in line with the driver diagram we produced.ResultsIn 12 months, length of stay was reduced from an average 47 to an average 30 days and bed occupancy from 77% to 54%.At the end of 2016, the closure of some beds effected this calculation and we added an additional outcome measure of occupied bed days (OBD) better to assess the impact of the work. OBD data show a decrease over the course of the project from 251 to 194 bed days (a reduction of 23%).ConclusionThe most effective interventions to address length of stay and bed occupancy on an older adult functional mental health ward were the daily management round and the high-level management focus on longer-stay patients. The work depended on an effective community team and on the support of the quality improvement programme in the trust, which have led to sustained improvements.

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Staff wellbeing is increasingly linked to good outcomes for service users in healthcare. Therefore, it is important for organisations to find ways to focus on wellbeing and staff experience at work. This article shares learning from 5 years of using the Institute for Healthcare Improvement's joy in work framework, coupled with quality improvement methods to enhance staff experience and wellbeing. This demonstrates how teams were brought together in a collaborative learning system to apply quality improvement to enhance joy in work. Key steps are shared for other organisations wanting to undertake this work, including the application of improvement methods to empower teams locally to develop, design and test change ideas, and measure their impact. The design of systems and structures required to meaningfully bring teams together and the type of leadership that enhances this work are also considered. Key learning points for other organisations include the need for improvement principles to iterate the organisational approach, make measurement simple, encourage a bias to action and make the work fun.

Long waiting times for Child and Adolescent Mental Health Services (CAMHS) have been linked to poorer outcomes for those seeking care. CAMHS teams in England have seen recent increases in referrals, resulting in challenging waiting times nationally. Although recent health policy has brought an increase in funding and staffing, it is believed that only 25% of those needing care receive it. Between trusts, there is considerable variation in waiting times, leaving many waiting longer than others waiting for care. East London Foundation Trust has been seen to have higher waiting times for CAMHS than other organisations across the country between June 2017 and September 2018, seven CAMHS teams were supported to use quality improvement (QI) as part of a collaborative learning system with the aim of improving access and flow. Each team was encouraged to understand their system using basic demand and capacity modelling alongside process mapping. From this teams created project aims, driver diagrams and used Plan Do Study Act cycles to test changes iteratively. Measurement and data were displayed on control charts to help teams learn from changes. Teams were brought together to help learn from each other and accelerate change through a facilitated collaborative learning system. Of the seven teams that began the collaborative learning system, six completed a project. Across the collaborative learning system collectively there were improvements in average waiting times for first, second and third appointments, and an improvement in the number of appointments cancelled. For the individual teams involved, three saw an improvement in their project outcome measures, two just saw improvements in their process measures and one did not see an improvement in any measure. In addition to service improvements, teams used the process to learn more about their pathway, engage with service users and staff, build QI capability and learn together.