Developing a service user centred co-designed patient safety intervention for acute mental health wards: A mixed methods process evaluation



This project aims to co-design an intervention that improves patient safety on acute mental health wards through the collection of daily data about the perception of safety from service users to support staff in monitoring and improving the safety of the clinical environment. The intervention will be tested, and its’ feasibility and acceptability explored.

To achieve these aims, we have the following objectives:

1) to co-design with service users and staff an intervention that will allow real-time monitoring of safety on acute mental healthwards;

2) to explore the feasibility and acceptability of capturing real-time feedback from service users about safety;

3) to explore how staff use this information when reported during daily handovers (or other mechanisms);

4) to explore how the resulting data is related to existing quality and safety metrics;

5) to explore how these data can be used longitudinally to promote safety;

6) to use the data collected within the study to directly inform the optimal design of future trials.


The project has three phases and uses different methods during each phase.

Phase 1 uses a co-design approach to developing the intervention, supported by an ‘environmental scan’ consisting of a scoping review and the collection and qualitative analysis of interview data.

Phase 2 will test and refine the intervention, examine available NHS data, and conduct further qualitative interviews.

Phase 3 will be a mixed-methods process evaluation. A focused ethnography will explore how staff communicate and use safety data supported by interviews with service users and staff to further understand feasibility and acceptability. We will simultaneously collect routine data including incidents, NHS mental health safety thermometer, workforce and ward occupancy. Measures of safety culture and ward atmosphere will be completed pre and post intervention. The synthesis of these data will assess the impact of the intervention on outcome measures; enhanced understanding of feasibility and acceptability and result in a draft trial protocol.


Evidence shows there are large numbers of safety issues on acute mental health wards, frequently involving violence and self-harm, associated with increased costs, physical and psychological harm. Safety data is currently only collected retrospectively and very little is collected from the service user perspective.


John Baker