Coproducing Cultural Change and Improvement at our Adolescent Mental Health Inpatient Unit Using our 4Cs Philosophy and Visual Identity

Synopsis

Ty Llidiard: 15-bed Child/Adolescent Mental Health (CAMHS) regional admission hospital unit in Bridgend.

• 2019: went into level 4 enhanced monitoring (‘special measures’ highest level) over quality, safety, leadership and culture concerns.
• Undertook intensive 4Cs work programme to change the unit’s culture and physical environment to address concerns and improve staff and young people’s (YP) mental health and wellbeing.
• 2023: de-escalated to level 0 care group monitoring.

Challenges

• Meaningful engagement with demoralised and demotivated staff, following intense scrutiny/investigation for 4 years, and Covid-19.
• Coproducing with YP aged 12-17 with wide range of behavioural/emotional/health needs.
• Very large, hexagon-shaped building with mostly white, cold-looking, segmented clinical spaces.
• Funding – no models/precedent for similar transformation programme in health board.

Ingredients for success

• Unit lead trusted by health board, able to define and communicate vision and commission specialist delivery team. Worked with Scarlet Design creating visual identity and 4Cs philosophy: Caring, Compassionate, Calm, Confident.
• Genuinely coproduced – engagement events, including on-site event with 65+ people, extensive consultation with past and present service-users, carers, staff and stakeholders, collecting 300+ survey responses.
• Unit lead understood the amount/type of physical environment change required to achieve aims.
• Building transformation plan created at start, delivered in stages to evidence impact, build trust and source funding.
• Visual identity that could extend across large unit.

Impact

4Cs identity, rainbow tree with birds logo and woodland scene applied across unit:
• Giant 4Cs scenes in connecting corridors, waiting spaces, meeting rooms
• External/internal entrances redesigned, providing welcoming environment, improving ‘first impressions’.
• Staffroom and outdoor spaces redesigned
• Ward office relocated to building centre creating a central square, improving interaction and observation for staff and YP – graffiti wall requested by YP.
• on YP door name-plates, office/lift doors, staff uniforms/lockers.

Staff feel valued, with improved retention and sickness reduction; YP feeling listened to and empowered, with improved outcomes.