Psychiatrists’ experiences of Safewards and quality improvement: a qualitative exploratory study with reflexive thematic analysis

Safewards is a theoretical model pioneered in 2013 to quell avoidable conflict, hostility, and restrictive practice on mental health wards. While successful in several Australian settings, its sustainability at some has gradually diminished over the last decade. Despite the ample evidence from nursing and operational management perspectives, there remains a paucity of literature on psychiatrists’ experiences of Safewards implementation and quality improvement (QI) in mental health wards, despite their roles as clinical leaders and drivers of QI. We conducted a qualitative, exploratory interview study, recruiting 11 psychiatrists working across a broad range of mental health wards at an Australian tertiary health service. Semi-structured interviews about the experiences of psychiatrists with Safewards and QI were held. We drew on a theoretically sensitised, inductive approach to reflexive thematic analysis. We developed six themes across two overarching themes: the professional role of the psychiatrist (clinical, and leadership roles), and the mental health ward environment (operational or system-facing, clinical or patient-facing, and work or staff-facing environments, and resources). The theme of the leadership role of psychiatrists bridged these two overarching themes. It and resourcing were of key salience to our participants. Our study is the first in the Australian context – and the first globally to use thematic analysis – to examine psychiatrists’ experiences with Safewards and QI, and factors influencing their engagement in these. Based on our six formulated themes, we offer guidance for further engaging psychiatrists in these initiatives.