EDUCATION & TRAINING The Scottish Health Advisory Service visit

A model for training in psychiatry Shiona Macdonald

The Scottish Health Advisory Service (SHAS) was also interviewed about their achievements, con established in 1970 to provide information to the cerns and plans for the future of the . Secretary of State for and the Health Like SHAS, at the end of this visit, a report of the Board on the management and running of observations made during the visit was com for the elderly and for patients with piled. This report was then discussed at a joint mental illness and learning disability. The Health meeting between MAG and the junior staff Advisory Service serves a similar purpose in involved. From this meeting arose 39 points of England and Wales. The purpose of SHAS is to concern to be considered further by the MAG to promote high standards of health care for these help improve patient care. patients. The SHAS achieves this in different The model of the SHAS visit used at the Argyll ways, but one of their main functions is to visit and Bute Hospital was different in many ways to the hospitals regularly to assess the quality and the real thing. It was used primarily as a training effectiveness of the service. experience for junior staff. The team was During a SHAS visit, four members of SHAS comprised of two senior house officers, a junior will visit wards, departments and community social worker, two E-grade staff nurses and a facilities and interview management and staff to secretary. This contrasts sharply with the usual obtain a comprehensive view of the service. At glut of experience, seniority and insight that the the end of the visit, a final SHAS report with SHAS demands from its members. This inexperi recommendations is published and submitted to ence made tackling management issues of policy, the Secretary of State and the Chief Executive of strategy and planning difficult, but the grass the National Health Service in Scotland. It was roots background meant that they paid attention decided to use this model of a SHAS visit as a to the smaller details. Unlike the SHAS, the team training experience for junior staff, including were insiders in the service which inevitably medical staff, to look at care provided within affected objectivity. Fortunately, staff took the Hospital, . visit seriously although maintaining a healthy The Argyll and Bute Hospital provides psy scepticism about the team's ability to effect chiatric in-patient services to the populations of change. While SHAS has to deal with the political Argyll and Bute district and, at the time of our repercussions from their reports, the team had to visit, Dumbarton district. The hospital has two deal with the personal repercussions of com acute assessment wards, an intensive care unit, menting on colleagues and superiors. an alcohol treatment unit, a rehabilitation unit Using this model of the SHAS visit not only and four wards for long-stay elderly patients. provided a training opportunity but also yielded Community services were not within the remit of useful information about the service. Despite the our visit. Other areas visited within the hospital obvious lack of power of the mock-SHAS team, included the occupational therapy department, the MAG took the findings seriously and put the electroconvulsive therapy suite, social work them as standing items on their agenda to follow department, the laundry and the patients' can through. A review of these standing items one teen. In the model of the SHAS visit, the above year later revealed that of the 39 items identified areas were visited over a two-day period by a as needing improvement, 18 had been satisfac team of six junior staff to examine many different torily resolved, 10 were actively under review and aspects of patient care, for example, ward fabric, the remaining 11 were part of longer term record-keeping, staff morale, quality of food, reviews of the service. Of the 18 items resolved, consultant availability, etc. the following are examples: During the two-day visit the Management Advisory Group (MAG), who are responsible for (a) Two of the units in the hospital could not the day to day management of the hospital, were be accessed via the house key, thereby

Psychiatric Bulletin (1999), 23, 547-548 547 EDUCATION & TRAINING

making entry in an emergency difficult. It gave the opportunity to develop essential The locks were changed to house keys. skills required for career development - (b) The Medical Records Office was left un research, planning and organisation were essen locked most of the day, potentially allow tial prior to the visit. Diplomacy, interrogation ing access for unauthorised persons. This and stamina during the visit and analysis and was reclined by the office being locked at collation of information afterwards. This infor all times. mation then had to be presented in a coherent (c) The new cafeteria had no non-smoking and convincing way to persuade the managerial areas. There is now no smoking allowed at audience of its validity. all in the cafeteria. Finally, working as a team allowed the oppor (d) There was a general lack of in-house tunity to explore leadership and team-building training for nursing staff. A Nursing issues both of which were important to success. Academic Programme was commenced The SHAS visit model could easily be repro nine months later. duced in other hospitals to their and their trainees' advantage. Support from the hospital (e) The crisis loan system for patients being admitted to hospital did not work out-of- management for this project was vital. This hours and at the weekends. A float is now filtered downline to the wards and departments held in the acute ward for this purpose. and helped give the mock-SHAS visit credibility. (f) The consultant on-call now carries a pager This support would be essential to the success of to enable easier contact with him. such a venture elsewhere. In our present climate, it is also important to note that this exercise was inexpensive - the only real cost was the time used in planning and Acknowledgements executing the visit by the junior staff involved. I would like to thank Dr A. V. P. Mackay for the The SHAS visit model was a valuable training original idea and his encouragement throughout experience for all those involved. Basic trainees and Dr Donald Rankine, then Medical Director of are strongly encouraged to perform audit which SHAS, for his helpful advice. The other team involves focusing in on specific areas of a service. members were Joanne Crawford, Jane Garrity, Rarely, however, is there an opportunity to get a feel for the 'bigger picture'. During this exercise, Dr Stephen Curling, Geraldine Hannan and Avril Lockhart. areas of the hospital that were previously unknown were visited and allowed discussion with staff to hear their views of the service. There was face to face contact with previously un Dr Shiona Macdonald, Specialist Registrar in known managers and patients in all the wards, General Adult Psychiatry. Hartßeld House who were interviewed to find out what life was Resource Centre, 1 Racecourse View, Ayr KA7 like outside the ward round. 2TS

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