title: Impact of peer-led quality improvement networks on quality of inpatient mental health care: study protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  Quality improvement networks are peer-led programmes in which members of the network assess the quality of care colleagues provide according to agreed standards of practice. These networks aim to help members identify areas of service provision that could be improved and share good practice. Despite the widespread use of peer-led quality improvement networks, there is very little information about their impact. We are conducting a cluster randomized controlled trial of a quality improvement network for low-secure mental health wards to examine the impact of membership on the process and outcomes of care over a 12 month period.
  
  
  METHODS
  Standalone low secure units in England and Wales that expressed an interest in joining the quality improvement network were recruited for the study from 2012 to 2014. Thirty-eight units were randomly allocated to either the active intervention (participation in the network n = 18) or a control arm (delayed participation in the network n = 20). Using a 5 % significance level and 90 % power, it was calculated that a sample size of 60 wards was required taking into account a 10 % drop out. A total of 75 wards were assessed at baseline and 8 wards dropped out the study before the data collection at follow up. Researchers masked to the allocation status of the units assessed all study outcomes at baseline and follow-up 12 months later. The primary outcome is the quality of the physical environment and facilities on the wards. The secondary outcomes are: safety of the ward, patient-rated satisfaction with care and mental well-being, staff burnout, training and supervision. Relative to control wards, it is hypothesized that the quality of the physical environment and facilities will be higher on wards in the active arm of the trial 12 months after randomization.
  
  
  CONCLUSIONS
  To our knowledge, this is the first randomized evaluation of a peer-led quality improvement network that has examined the impact of participation on both patient-level and service-level outcomes. The study has the potential to help shape future efforts to improve the quality of inpatient care.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN79614916 . Retrospectively registered 28 March 2014].
authors.affiliation: College Centre for Quality Improvement, The Royal College of Psychiatrists, 21 Prescot St, London, E1 8BB, London, UK. Lina.aimola@rcpsych.ac.uk.
authors.forename: Lina
authors.initials: L
authors.lastname: Aimola
authors.affiliation: Centre for Mental Health, Hammersmith Campus, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, W12 0NN, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jasim
authors.affiliation: Southview Low Secure Unit, Sussex Partnership NHS Foundation Trust, The Drive, Hellingly, Hailsham, BN27 4ER, East Sussex, UK.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Tripathi
authors.affiliation: Association of Group and Individual Psychotherapy, 1 Fairbridge Road, N19 3EW, London, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tucker
authors.affiliation: College Centre for Quality Improvement, The Royal College of Psychiatrists, 21 Prescot St, London, E1 8BB, London, UK.
authors.forename: Adrian
authors.initials: A
authors.lastname: Worrall
authors.affiliation: College Centre for Quality Improvement, The Royal College of Psychiatrists, 21 Prescot St, London, E1 8BB, London, UK.
authors.forename: Alan
authors.initials: A
authors.lastname: Quirk
authors.affiliation: College Centre for Quality Improvement, The Royal College of Psychiatrists, 21 Prescot St, London, E1 8BB, London, UK.|Centre for Mental Health, Hammersmith Campus, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, W12 0NN, London, UK.
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Crawford
keywords: Forensic mental health; Peer-review; Quality networks; Randomized controlled trial