Improving emergency care for people in mental health crisis: actions for change
Action two: Prioritise and protect improvement activity
Why this matters
Operational pressures will always compete with improvement work. Without protected time and clear prioritisation, even well-designed initiatives stall or fail to embed.
What works in practice
Across all roles and organisations, time and capacity were the most significant barriers to progress with improvement activity and routinely competed with urgent operational demands, particularly during winter pressures, limiting teams’ ability to test, measure and embed change.
“The challenges have been.. project progression in between sessions with people who are currently clinically delivering services and current pressures.”
Tips from the teams
While teams cannot remove system-wide pressures, the programme highlighted several actions that can help.
- Secure explicit leadership agreement for protected improvement time, even if limited.
- Focus improvement work on small, high-impact changes that align with operational priorities rather than sitting alongside them.
- Use structured improvement methods (such as clear aims, driver diagrams, simple PDSA cycles) to make best use of constrained time.
- Be realistic about pace, recognising that progress under pressure may be slower but still meaningful.
- Share the load of improvement activity, to ensure too much doesn’t fall on single individuals or roles, especially clinicians whose time can be understandably limited.
- Identify local project or improvement support teams/individuals whose roles can lead on this, bringing in others when available.
Improvement work in progress
Avon and Wiltshire
In Avon and Wiltshire, the interface team took the time to understand the problem and adapt their project once they had built a deeper understanding and perspective. They focused on delivering key foundations for testing change, including an agreed pilot design, shared outcome measures and staff engagement across teams. Early ‘quick wins’ have already been implemented, such as:
- securing ED IT access for Avon and Wiltshire Partnership Mental Health Liaison staff
- embedding joint attendance at ED morning huddles to improve shared situational awareness and communication.
The intended outcomes are to pilot and evaluate parallel triage, improve patient experience and flow, reduce delays and repeat assessments, and use learning from the PDSA cycle to inform adaptation, adoption or wider spread of the model.
Dorset
In Dorset, the team identified liaison psychiatry (LPS) presence in ED huddles as a quick win they could test quickly and easily. This would provide real-time psychiatric expertise, support decision-making, and enable early escalation of complex cases with the learning focus on the impact on timely escalation, patient flow, staff confidence and avoidance of patient deterioration. Identifying quick wins among larger scale areas to test enabled teams to see improvements immediately, as well as using these changes to improve relationships and shared understanding.
Key takeaway
Progress under pressure comes from focusing on what is achievable—and protecting time to do it.