title: Loss of relational continuity of care in schizophrenia: associations with patient satisfaction and quality of care.
abstract: BACKGROUND
  Users of mental health service are concerned about changes in clinicians providing their care, but little is known about their impact.
  
  
  OBJECTIVE
  To examine associations between changes in staff, and patient satisfaction and quality of care.
  
  
  METHODS
  A national cross-sectional survey of 3379 people aged 18 or over treated in secondary care for schizophrenia or schizoaffective disorder.
  
  
  RESULTS
  Nearly 41.9% reported at least one change in their key worker during the previous 12 months and 10.5% reported multiple changes. Those reporting multiple changes were less satisfied with their treatment and less likely to report having a care plan, knowing how to obtain help when in a crisis or to have had recommended physical health assessments.
  
  
  CONCLUSIONS
  Frequent changes in staff providing care for people with psychosis are associated with poorer quality of care. Greater efforts need to be made to protect relational continuity of care for such patients.
  
  
  BACKGROUND
  M.J.C. was co-chair of the expert advisory group on the NICE quality standard on Service User Experience in Adult Mental Health. S.J.C. has previously been a member of the Health and Social Care Board Northern Ireland Formulary Committee. D.S. received a speaker's fee from Janssen Cilag in 2011. He is a topic expert on NICE guideline for psychosis and schizophrenia in children and young people and a board member of National Collaborating Centre for Mental Health.
  © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
authors.affiliation: MD, Centre for Mental Health, Imperial College London, London, UK.
authors.forename: Rahil
authors.initials: R
authors.lastname: Sanatinia
authors.affiliation: , BSc, Centre for Mental Health, Imperial College London, London, UK.
authors.forename: Violet
authors.initials: V
authors.lastname: Cowan
authors.affiliation: , PhD, Centre for Mental Health, Imperial College London, London, UK.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Barnicot
authors.affiliation: , BSc, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
authors.forename: Krysia
authors.initials: K
authors.lastname: Zalewska
authors.affiliation: , MBChB MRCGP, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Shiers
authors.affiliation: , MD, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Cooper
authors.affiliation: , MD, College Centre for Quality Improvement, Royal College of Psychiatrists, London, UK.
authors.forename: Mike J
authors.initials: MJ
authors.lastname: Crawford