Cost and impact of a quality improvement programme in mental health services.
OBJECTIVE
To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities.


METHODS
Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles.


RESULTS
The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes.


CONCLUSIONS
Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.
Personal Social Services Research Unit, London School of Economics, London WC2A 2AE, UK. J.Beecham@lse.ac.uk
Jennifer
J
Beecham
Angus
A
Ramsay
Kate
K
Gordon
Sophie
S
Maltby
Kieran
K
Walshe
Ian
I
Shaw
Adrian
A
Worrall
Sarah
S
King
D019538:Health Care Surveys; D006801:Humans; D007407:Interviews as Topic; D008605:Mental Health Services / Q000592:standards*; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000191:economics* / Q000458:organization & administration; D006113:United Kingdom