Lean Melanie, Leavey Gerard, Killaspy Helen, Green Nicholas, Harrison Isobel, Cook Sarah, Craig Thomas, Holloway Frank, Arbuthnott Maurice, King Michael
Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
The Bamford Centre for Mental Health and Wellbeing, University of Ulster, Magee Campus, Londonderry, BT48 7JL, UK.
BMC Psychiatry. 2015 Sep 2;15:209. doi: 10.1186/s12888-015-0592-9.
We undertook a cluster randomised controlled trial to assess the effectiveness of a staff training intervention to improve patient engagement in activities in inpatient mental health rehabilitation units. Concurrently, we undertook a qualitative study to investigate the experiences of staff within the intervention units and the contextual issues that may have influenced the effectiveness of the intervention.
We conducted focus groups with staff working in the inpatient units that received the intervention, sampled using a maximum variation strategy.
The intervention was accepted by staff. However, the skills gained, and changes to the unit's processes and structures that were agreed with the intervention team were not sustained after they left. The main reasons for this were a) external factors (economic recession, resource limitations); b) organisation level factors (lack of senior staff support; competing priorities); c) limitations of the intervention itself (length of intensive training period; reinforcement of skills).
This study illustrates some of the inter-related factors which operate at different levels within and outside of NHS organisations that may impact on the success of complex interventions. These factors need to be considered when designing interventions to ensure adequate buy-in from senior staff.
Current Controlled Trials ISRCTN25898179 (Registered 23 April 2010).
我们进行了一项整群随机对照试验，以评估一项员工培训干预措施在提高住院精神卫生康复单元患者活动参与度方面的有效性。同时，我们进行了一项定性研究，以调查干预单元内员工的经历以及可能影响干预效果的背景问题。
我们对接受干预的住院单元工作人员进行了焦点小组访谈，采用最大差异抽样策略。
工作人员接受了干预措施。然而，他们离开后，与干预团队商定的所获得的技能以及单元流程和结构的改变未能持续。主要原因包括：a）外部因素（经济衰退、资源限制）；b）组织层面因素（缺乏高级工作人员支持；相互竞争的优先事项）；c）干预措施本身的局限性（强化培训期的时长；技能强化）。
本研究阐明了一些在国民保健服务（NHS）组织内外不同层面起作用的相互关联因素，这些因素可能影响复杂干预措施的成功实施。设计干预措施时需要考虑这些因素，以确保获得高级工作人员的充分支持。
当前受控试验ISRCTN25898179（2010年4月23日注册）。
