Using SEIPS to focus codesign for improved Emergency Department care for adults with mental health crises: a qualitative study using sequential methods

Background Situating experience in the context of change is recommended in experience-based codesign for healthcare improvement but there are few examples using a systems framework that can be tailored to institutional work. Objectives To elicit the experiences of adults presenting to Emergency Department (ED) with mental health issues (patients) and the ED staff who care for them (providers) and target codesign activities. Methods Semi-structured interviews with patients and providers. Data was analysed thematically to identify areas of common concern (touchpoints) and desired outcomes. The Systems Engineering Initiative for Patient Safety (SEIPS) v2.0 was used to situate desired outcomes with ED work processes and system components. Results 29 low-acuity patient and 60 provider interviews were analysed: Patients wanted to feel cared for and kept safe while they waited for specialist MH teams; Providers wanted to be able to provide the level of care patients ought to receive and safeguard patients and staff from harm. Desired outcomes mapped within SEIPS to ED-nurse led early therapeutic support for low-acuity presentations, and integrated care within a specialist behavioural assessment unit for patients with or at risk of severe behavioural disturbance. Conclusion Interpersonal care was the element patients regarded as most important, captured under ‘Collaborative Professional-Patient work’ in SEIPS v2.0. As ‘caring’ is a central virtue of healthcare professionals and fundamental to patient experience, we contend that making ‘Interpersonal Care’ more visible within SEIPS and other quality improvement frameworks may help prevent it being overlooked amid the drive for more efficient clinical processes.