Maintaining New Procedures Using Feedback to Staff, a Hierarchical Reporting System, and a Multidisciplinary Management Group

Abstract

Two studies are reported. In the f i s t it was shown that the introduction of activity period procedures by ward staff in a mental handicap hospital resulted in a marked increase in the level of residents' engaged behavior (mean 6.5% to mean 49.5%). with corresponding reductions in the incidence of neutral and inappropriate behavior. However, resident improvement alone did not result in the maintenance of these procedures during a 6 month follow-up period. The second study involved all levels of staff in the introduction of maintenance procedures, including private feedback to individuals, public display of resident engagement data, a reporting system using the existing hospital hierarchy, and a multidisciplinary management group. The introduction of this system in parallel with the reintroduction of the activity period procedures resulted in (a) further improvement in resident behavior (mean engagement levels increased from 19.1% to 6.16% and (b) consistency by the staff in following specified procedures. These high levels of resident engagement (mean 62%), and consistent staff practices were still maintained 30 weeks after the study ended.