title: Understanding Outcomes in a Randomized Controlled Trial of a Ward-based Intervention on Psychiatric Inpatient Wards: A Qualitative Analysis of Staff and Patient Experiences.
abstract: OBJECTIVE
  Team formulation is advocated to improve quality of care in mental health care and evidence from a recent U.K.-based trial supports its use in inpatient settings. This study aimed to identify the effects of formulation on practice from the perspectives of staff and patient participating in the trial, including barriers and enhancers to implementing the intervention.
  
  
  METHODS
  We carried out semistructured interviews with 57 staff and 20 patients. Data were analyzed using thematic analysis.
  
  
  RESULTS
  Main outcomes were: improved staff understanding of patients, better team collaboration and increased staff awareness of their own feelings. Key contextual factors were as follows: overcoming both staff and patient anxiety, unwelcome expert versus collaborative stance, competing demands, and management support.
  
  
  CONCLUSIONS
  Team formulation should be implemented to improve quality of care in inpatient settings and larger definitive trials should be carried out to assess the effect of this intervention on patient outcomes.
authors.affiliation: University of Manchester.
authors.forename: Katherine
authors.initials: K
authors.lastname: Berry
authors.affiliation: University of Manchester.
authors.forename: Gillian
authors.initials: G
authors.lastname: Haddock
authors.affiliation: University of Sheffield.
authors.forename: Stephen
authors.initials: S
authors.lastname: Kellett
authors.affiliation: University of Manchester.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Awenat
authors.affiliation: University of Manchester.
authors.forename: Karolina
authors.initials: K
authors.lastname: Szpak
authors.affiliation: University of Manchester.
authors.forename: Christine
authors.initials: C
authors.lastname: Barrowclough
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000534:rehabilitation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000523:psychology*; D017063:Outcome Assessment, Health Care; D011369:Professional-Patient Relations; D011566:Psychiatric Aides / Q000523:psychology*; D011567:Psychiatric Department, Hospital; D000067250:Psychiatric Rehabilitation / Q000523:psychology; D011618:Psychotic Disorders / Q000534:rehabilitation*; D036301:Qualitative Research; D016032:Randomized Controlled Trials as Topic; D012559:Schizophrenia / Q000534:rehabilitation*
keywords: formulation; psychiatric inpatient; psychosis; qualitative analysis; therapeutic relationships