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Table 1 The first two steps in quality improvement

From: Recommended content of referral letters from general practitioners to specialised mental health care: a qualitative multi-perspective study

Theory based steps

In this case

1. Select target area

Frequency

Large patient population [1], referral letters used whenever need for specialised health care.

Importance

Large suffering, large impact on society [1]

Complexity

Many stakeholders, inter-organisational

Insufficiently effective, efficient, accessible, acceptable/patient-centred, equitable, and/or safe care [28]

Risk of incorrect prioritisation of patients and inappropriate care [7, 8]

Expected improvement potential [13]

Studies reveal that referral letters in general and within mental health care lack important information [46]

2. Determine/define recommended practice

Explore existing knowledge [13]

Literature review revealed no evidence-based recommended standard for content of referral letters to specialised mental health care

If not sufficient knowledge: Define recommended practice

Structured group interview using the method Language Processing [20]

A. Involve valid perspectives [9]:

Including:

Professional

Health professionals from primary care (GPs and mental health nurses) and from specialist mental health care (psychiatrist and trained psychologists)

Patient/client

Patient representatives from Mental Health Patient Organisation

Organisational

Operating managers within specialist mental health care.

B. Make feasible [13]

Delphi process to determine the most important content. Exclusion of themes where less than 75% of participants have rated them as highly important [22].

  1. The theoretical framework for the method employed in this study.