Implementing HoNOS: An eight stage approach

Abstract

AbstractThe Health of the Nation Outcome Scales (HoNOS) were developed as a brief way to quantify progress towards the national target of improving significantly the health and social functioning of mentally ill people (Wing et al., 1998). As an instrument, HoNOS was regarded as adequate for this purpose and so field testing was deemed to be the next task. However, the implementation of an outcome measure such as HoNOS under routine service conditions represents a significant implementation challenge. Therefore, we conducted an eight stage approach to implementation, with a sample of multi‐disciplinary care managers from one county in the UK (N = 30). The results of shadowing and initial interviews indicated that significant barriers to implementation were insufficient staff and the high level of routine demands on staff for the completion of paperwork. These barriers outweighed the perceived boosters, including the favourable responses of colleagues and the benefits of data feedback from HoNOS. More staff, standardized training in the use of HoNOS, regular feedback and less paperwork were amongst ten suggestions for facilitating implementation. During a pilot period, staff received training, used HoNOS and were given graphical feedback of the HoNOS results. They were then re‐interviewed, at which time they reported becoming fairly positive about the use of HoNOS and definitely valued the implementation approach. However, it is concluded that the routine use of HoNOS will require continued effort from staff and their managers (e.g. refresher training courses) and alternative or additional outcome measures may be necessary to provide useful clinical information. Copyright © 2001 John Wiley & Sons, Ltd.