Wilson Ceri, Wakefield Rachel, Prothero Louise, Janes Gillian, Nolan Fiona, Fowler-Davis Sally
Anglia Ruskin University, Chelmsford, UK
NHS England, Cambridge, UK.
BMJ Qual Saf. 2025 May 19;34(6):389-403. doi: 10.1136/bmjqs-2024-017746.
Allied health professionals (AHPs) in inpatient mental health, learning disability and autism services work in cultures dominated by other professions who often poorly understand their roles. Furthermore, identified learning from safety incidents often lacks focus on AHPs and research is needed to understand how AHPs contribute to safe care in these services.
A rapid literature review was conducted on material published from February 2014 to February 2024, reporting safety incidents within adult inpatient mental health, learning disability and autism services in England, with identifiable learning for AHPs. 115 reports/publications were included, predominantly consisting of independent investigations by NHS England, prevent future deaths reports and Care Quality Commission reports.
Misunderstanding of AHP roles, from senior leadership to frontline staff, led to AHPs being disempowered and excluded from conversations/decisions, and patients not getting sufficient access to AHPs, contributing to safety incidents. A central thread 'organisational culture' ran through five subthemes: (1) (lack of) effective multidisciplinary team (MDT) working, evidenced by poor communication, siloed working, marginalisation of AHPs and a lack of psychological safety; (2) (lack of) AHP involvement in patient care including care and discharge planning, and risk assessment/management. Some MDTs had no AHPs, some recommendations by AHPs were not actioned and referrals to AHPs were not always made when indicated; (3) training needs were identified for AHPs and other professions; (4) staffing issues included understaffing of AHPs and (5) senior management and leadership were found to not value/understand AHP roles, and instil a blame culture. A need for cohesive, well-led and nurturing MDTs was emphasised.
Understanding and recognition of AHP roles is lacking at all levels of healthcare organisations. AHPs can be marginalised in MDTs, presenting risks to patients and missed opportunities for quality improvement. Raising awareness of the essential roles of AHPs is critical for improving quality and safety in inpatient mental health, learning disability and autism services.
在住院精神卫生、学习障碍和自闭症服务领域，联合健康专业人员（AHPs）所处的工作文化环境中，占主导地位的其他专业人员往往对他们的角色理解不足。此外，从安全事件中总结出的经验教训往往缺乏对AHPs的关注，因此需要开展研究来了解AHPs在这些服务中对安全护理的贡献。
对2014年2月至2024年2月期间发表的资料进行了快速文献综述，这些资料报告了英格兰成人住院精神卫生、学习障碍和自闭症服务中的安全事件，并为AHPs总结了可借鉴的经验教训。共纳入115份报告/出版物，主要包括英国国民医疗服务体系（NHS）英格兰地区的独立调查、预防未来死亡报告以及护理质量委员会报告。
从高层领导到一线工作人员，对AHPs角色的误解导致AHPs被剥夺权力，被排除在对话/决策之外，患者无法充分接触到AHPs，从而引发安全事件。一个核心主题“组织文化”贯穿五个子主题：（1）（缺乏）有效的多学科团队（MDT）协作，表现为沟通不畅、各自为政、AHPs被边缘化以及缺乏心理安全感；（2）（缺乏）AHPs参与患者护理，包括护理和出院计划以及风险评估/管理。一些MDT中没有AHPs，AHPs提出的一些建议未得到落实，在需要时也并非总是会将患者转诊给AHPs；（3）确定了AHPs和其他专业人员的培训需求；（4）人员配备问题包括AHPs人手不足；（5）发现高级管理层和领导层不重视/不理解AHPs的角色，并灌输了一种责备文化。强调需要有凝聚力、领导得力且能提供支持的MDT。
医疗保健组织的各个层面都缺乏对AHPs角色的理解和认可。AHPs在MDT中可能会被边缘化，给患者带来风险，并错失质量改进的机会。提高对AHPs重要角色的认识对于改善住院精神卫生、学习障碍和自闭症服务的质量和安全性至关重要。
