Implementation of High and Intensive Care (HIC) in the Netherlands: a Process Evaluation

A Laura Van Melle,Guy A M Widdershoven,Alida J Van Der Ham,Yolande Voskes

doi:10.1007/s11126-021-09906-x

A Laura Van Melle, Guy A M Widdershoven + Show 2 more

Open Access

https://doi.org/10.1007/s11126-021-09906-x

Copy DOI

Abstract

The High and Intensive Care model (HIC) was developed to reduce coercion and improve the quality of acute mental health care in the Netherlands. This study aimed to identify drivers of change which motivate professionals and management to implement HIC, and to identify facilitators and barriers to the implementation process. 41 interviews were conducted with multiple disciplines on 29 closed acute admission wards for adult psychiatric patients of 21 mental healthcare institutions in the Netherlands. The interviews were analysed by means of thematic analysis, consisting of the steps of open coding, axial coding and selective coding. Findings reveal three major drivers of change: the combination of existing interventions in one overall approach to reduce coercion, the focus on contact and cooperation and the alignment with recovery oriented care. Facilitators to implementation of HIC were leadership, involving staff, making choices about what to implement first, using positive feedback and celebrating successes, training and reflection, and providing operationalizable goals. Barriers included the lack of formal organizational support, resistance to change, shortage of staff and use of flex workers, time restraints and costs, lack of knowledge, lack of facilities, and envisaged shortcomings of the HIC standards. Drivers of change motivate staff to implement HIC. In the process of implementation, attention to facilitators and barriers on the level of culture, structure and practice is needed.

Highlights

Since the beginning of this century, the prevention and reduction of coercion in psychiatry has been a topic for debate in the Netherlands
We found three drivers of change: 1) High and Intensive Care model (HIC) combines existing interventions in one overall approach to reduce coercion; 2) HIC focuses on contact and cooperation; and 3) HIC is in line with recovery oriented care
HIC combines existing interventions in one overall approach to reduce coercion Many participants reported to see the HIC model as a culmination of efforts to reduce coercion in the past. They mentioned that HIC takes these efforts a step further by bringing attention to the urgency to keep working on the reduction of coercion, clearly linking these efforts to quality of care and by providing concrete guidelines for professionals

Summary

Introduction

Since the beginning of this century, the prevention and reduction of coercion in psychiatry has been a topic for debate in the Netherlands. In 2006, the Dutch branch organization for mental healthcare (GGZ Nederland) formulated the aim to reduce seclusion and other coercive measures by 10 % yearly. Supported by the Dutch government, several projects have been started in the Netherlands since 2006 to reduce coercion, and mainly seclusion [2]. As a result of the development of many interventions within these projects, considerable reduction of seclusions was achieved, albeit not as large as was aimed for. Some mental healthcare institutions did achieve a reduction in line with the aims, while others did not. One of the explanations is that the reduction of coercion is a matter of developing new interventions but requires a change in organizational structure, culture and practices, including stable and motivated management and support at all levels of the organization [22]

Objectives

Methods

Results

Discussion

Conclusion