PROGRESS: the PROMISE governance framework to decrease coercion in mental healthcare.

Area of Science:

• Mental Health Care
• Patient Safety
• Healthcare Management

Background:

• Reducing physical interventions in mental health inpatient settings is a global priority due to patient and staff distress.
• Coercive practices in care necessitate culture change to improve patient well-being.
• The PROactive Management of Integrated Services and Environments (PROMISE) initiative aimed to decrease coercion in mental health services.

Purpose of the Study:

• To evaluate the impact of the PROMISE intervention on physical intervention rates and patient experience metrics.
• To propose an adaptable governance framework for implementing complex interventions in healthcare.
• To assess the effectiveness of a new care model in reducing restrictive practices.

Main Methods:

• Implementation of the PROMISE intervention based on core values: caring response, challenging the status quo, and coproduction.
• Development and application of a five-step governance framework: Report, Reflect, Review, Rethink, and Refresh.
• Analysis of physical intervention data and patient experience surveys over a defined period.

Main Results:

• Overall physical interventions decreased from 328 to 210 between 2014 and 2017.
• Prone restraints saw a significant reduction from 82 to 32 between 2015-2016 and 2016-2017.
• Patient satisfaction remained high at 87% across 4591 surveys from 2014-2017.

Conclusions:

• The PROMISE intervention, supported by a structured governance framework, effectively reduced physical interventions in mental health care.
• Maintaining high patient experience scores alongside reduced coercion highlights the success of the implemented changes.
• The PROactive Governance of Recovery Settings and Services framework offers a scalable model for continuous quality improvement in mental health services.