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Header image for the current page Understanding the complexity and acuity of a female acute mental health ward

Understanding the complexity and acuity of a female acute mental health ward

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When Lincolnshire Partnership Foundation NHS Trust (LPFT) wanted to better understand the complexity and acuity of its female acute mental health ward, Arden & GEM’s Clinical Support team was tasked with undertaking a ‘discovery’ project.

The 12 week project, starting in September 2023, included stakeholder engagement, site visits, data collation and analysis to produce a final report of findings and recommendations. As a result, LPFT now has a series of suggested improvements for ward efficiency, staff capability and patient flow. The project has also positively impacted service user experience and psychological safety for the workforce.

The challenge

Female acute mental health wards provide a safe environment for women who are experiencing a crisis in their mental health and need immediate help from professionals in a clinical setting. Lincolnshire Partnership Foundation NHS Trust’s (LPFT) 19-bed female acute metal health ward aims to get to know patients as individuals while meeting their acute mental health needs.

LPFT commissioned Arden & GEM to develop a deeper insight into the complexity and acuity of the ward, including an exploration of the dichotomy between reported data and workforce narrative, and the factors behind this.

Project objectives included:

Our approach

Arden & GEM’s Clinical Support team identified two experienced mental health nurses – with knowledge of complex psychiatric presentations, staff wellbeing and clinical leadership – to deliver the project over a 12 week period. The project team worked closely with the Trust’s leaderships team, executive board and head of operational service improvement, alongside seeking feedback from the ward’s workforce, service users, carers and families.

Site visits
A total of 86 hours was spent on the ward to observe routines and meet staff, patients and the leadership team. This incorporated observation of all shift patterns including night shifts. Site visits were conducted to understand leadership capability, environmental factors and the collective aspiration of the ward team. Informal conversations were held with both staff and patients to capture their experience of and thoughts about the ward.

“Arden & GEM’s clinical skill and knowledge has shone through throughout this project. They have delivered the engagement with our patients and staff with compassion and expertise and as a consequence co-produced a tool that will meet our needs. Understanding our patient group in this way will help us better understand our ward environments and how we can best care for our patient group on the ward.”

Sharon Harvey, Director of Nursing and Quality at LPFT

Data collation and analysis
The following range of data was identified, collated, triangulated, themed and analysed:

An anonymous staff survey was also developed and circulated covering question on experience, training, incident management, communication and safety.

Atmosphere scale
A bespoke atmosphere scale was developed for the ward to provide a framework for daily debriefs and safety huddles. Suggested questions are grouped under four core areas of team, care planning, patient and environment to support ward staff teams in thinking about and measuring ward acuity and complexity.

Findings and recommendations
A final project report of findings and recommendations was produced and presented to the executive board and divisional management team.

"I’ve been delighted to sponsor such a unique piece of work that will help us improve our dialogue on the ward around complexity and acuity and how our patients and staff feel safe. We have been impressed with the tool developed and are now exploring ways to roll this out across our organisation to benefit not just the pilot ward, but other similar ward environments."

Chris Higgins, Director of Operations at LPFT

The evidence-based report was underpinned by clinical expertise, local policy and national strategic direction. A final site visit also took place to share feedback with ward staff and leaders.


Within a 12 week period, Arden & GEM was able to engage with stakeholders, collect and analyse data, and produce a thorough report of findings and recommendations.

The project’s initial objectives were all met and as a consequence LPFT now has a series of recommendations to improve ward efficiency, maximise staff capability, and improve patient flow and experience.

The project also had a positive impact on staff and service user experience. Staff felt that their feelings, views and experiences were validated and understood, and reported an improvement in ward culture and feelings of positivity.

An anonymous staff feedback survey found that:

“Amazing support to us when we were struggling with feelings of failings, helped us see our worth.”

“Thank you for listening and allowing us to be heard during difficult times.”

Service users felt included and that their views on ward practices had been heard and acted upon.

"This was a complex piece of work, that required pace and involved many stakeholders at different levels. The team did an outstanding job in delivering this project on time and helped us realise our original brief. They were able to adapt their presentations and findings to meet the different needs of many audiences and it has been a pleasure to have worked with the team on this project."

Claire Dilley, Head of Operational Service Improvement at LPFT