Evaluation of a peer-led quality improvement network

INTERVENTION: Services randomised to the intervention group will go through an annual peer‐review cycle set up by the managers of the forensic quality network. During this review cycle the services are asked to complete a review of the care they provide according to nationally agreed standards. They will then receive a visit from a peer‐review team who will check the self‐review document and prepare a report highlighting areas of achievement and areas that need to be improvement if the service is to meet agreed standards of care. The final stage of the cycle involves action planning for the services, dissemination of a National Report amongst members and attendance at the Annual Forum. The National Report provides a helpful list of good practice and people to contact for advice on specific issues, while in the Annual Forum services will be able to share the lesson learnt. The services in the control group instead will continue to use other methods to review and improve the quality of care they provide as normal including local audits, internal reviews and inspections from statutory authorities. CONDITION: Compliance ; Not Applicable PRIMARY OUTCOME: The services? compliance with a selection of key standards of care measured with an environmental checklist. The checklist covers the following standards:; 1. Whether the service has an external perimeter that meets the standards for security; 2. Whether there are separate, accessible and appropriately furnished facilities for visitors; 3. Whether all visitors, staff and patients access the unit via airlock; 4. Whether there are any ligature points on the ward(s); 5. Whether the service has a multi‐faith room accessible and appropriate for use by all patients; 6. Whether the service has a seclusion room; 7. Whether the service has a de‐escalation room; 8. Whether patients? bedrooms are designed to maintain safety; 9. Whether there is a variety of recreational facilities accessible to patients; 10. Whether there is a variety of occupational facilities accessible to patients; The maximum total score for the environmental checklist is 100. The higher the score on this checklist the higher the compliance of the services with the key standard of care assessed; ; All outcomes are measured at baseline and at 12 months. INCLUSION CRITERIA: 1. All stand alone low secure services in England and Wales 2. Participating patients are both male and female individuals above 18 years old detained under the Mental Health Act (1983) in a stand alone low secure service SECONDARY OUTCOME: 1. Safety of the service measured by number of violent incidents and people absconding; 2. Levels of patient satisfaction measured with a shorter 4‐items version of the Quality of Care Questionnaire (QOCQ). The items are scored with a Likert scale ranging from '4' (very satisfied) to '0' (very unsatisfied). The higher the total score the higher the level of patient?s satisfaction; 3. Patients? mental well‐being measured with the Short Warwick‐Edinburgh Mental Well‐being Scale (SWEMWBS). Each question is scored with a Likert scale ranging from '1' (none of the time) to '5' (all the time). The higher the total score the higher the level of mental well‐being of the patients; 4. Levels of staff burnout measured with the Maslach Burnout Inventory (MBI). The 22 items of this survey create three general subscales assessing: emotional exhaustion, depersonalization and personal accomplishment. The items are scored on a 7‐points Likert scale which ranges from 0 = 'Never' to 6 = 'every day'. High scores of emotional exhaustion and depersonalization together with low scores of personal accomplishment indicate high levels of burnout; 5. Costs of service provision (e.g. cost per bed); ; All outcomes are measured at baseline and at 12 months.