The 15 Steps Challenge
Within 15 steps of entering a ward you can tell what it is like
We were contacted by the involvement worker at our local mental health trust asking us if we would be interested in getting involved with a new project called the '15 Steps Challenge.'
In an initial meeting it was explained what the 15 Steps Challenge was about. It originated from a mother who, after visiting her daughter in hospital, claimed that she could tell what the ward was like within 15 steps of entering the ward.
As people with lived experience of mental health services, either as a carer or service user, we both felt that this 'fresh set of eyes' approach would be much more than a tick box exercise.
Throughout these '15 steps inspections' we felt valued and, as a result, committed to the project. We believed we could make a positive difference to service users and carers' experiences. We discovered many examples of good practice, and some negative issues, that could be easily changed, which would improve the service user and carer experience. An example of this is staff being challenging to identify due to wearing their identification badges on their waists and not wearing a uniform. Since we gave our 15 Steps feedback, the staff are much more aware of the importance of being identifiable and are wearing their identification more prominently.
The initial meeting set the tone for the project as it was friendly, well organised and had a clear purpose. It was led by a strong team from the organisation and they were vital to empower us as service users and carers to do this project.
We felt very enthusiastic about getting involved in this project. Previously we had both been involved within the trust as service user and carer representatives, mainly sitting on interview/discussion panels, and attending various meetings. However, this was something different – this gave us the opportunity to get involved in a project that would see us able to get on to the wards, and meet the staff, service users and carers at ground level.
We divided the work up geographically and this meant we were able to work together and offer lifts to each other, particularly useful as a couple of us didn’t have access to a car.
It was agreed the rehabilitation units would be an ideal place to start piloting the inspections. None of us had direct personal experience in this speciality, and the units were generally smaller and quieter than the larger, busier acute units. It would give us a chance to build some confidence and reflect on what we could do differently.
We were astounded when we arrived at the assigned rehabilitation unit. It was as though the scene had been set for us as we were immediately confronted with a broken pane of glass from a greenhouse and a rotary washing line obstructing the pathway to what we thought was the front door - it turned out to be the back door. Thankfully, impressions improved after these initial threee negative observations, and we discovered that the important aspects of care and the environment were generally positive.
This expeience did underline the importance of those initial ’15 Steps’ to a person who is unfamiliar with the environment. Small, easy adjustments can make all the difference to an individual's first impression.
The next step for us was to reconvene with the project group to feedback from our visits. We identified some issues with the way our notes were written up, so we changed the format slightly to make the report writing clearer. This teamwork and being able to adapt the process was essential to its success.
Our next challenge was to review the eight acute admission wards. Our opinions and thoughts were always respectfully listened to. During visits, we would regularly reconvene to debrief, reflect on what we had observed and have coffee or lunch. Alongside this, we were always promptly given expenses forms and paid for our time and travel. Following visits the written reports were always sent to us for approval prior to being finalised. Our next step will be to inspect the later life wards.
We are involved in the planning of a dedicated ‘15 Steps conference’ where we will have the opportunity to fully feedback our findings to ward managers and other professionals, where we hope to move forward with some positive changes.
From our service user and carer perspectives, we highly recommend using the 15 Steps model to evaluate your mental health services.
About the authors
Trisha Long (carer) and Judith Mott (service user), who have lived experience, wrote the article.
They were supported by Lisa Marrett, lead nurse, and Louise Curtis, standards and compliance nurse, both at Avon and WIltshire Mental Health NHS Partnership Trust