Table 2 Perceived Impact categorised by Proctor et al.’s (2011) taxonomy of Implementation Outcomes
Taxonomy | Findings | Example quotes |
|---|---|---|
Acceptability | - High rates of reported acceptability for staff, with positive feedback reported across sites - One site reported having improved spaces resulted in staff feeling safer at work, another reported a more positive working environment - One service noted staff reported lower acceptability due to the complexity of the digital approach needed to deliver it which required outside staff to provide expertise to sustain the service - Generally, staff perceived high acceptability for service users, based on anecdotal reports | “Having their own building and control over staff brought in has offered teams more control, stability and created a sense of ownership over their workplace - teams no longer have to worry about being moved on.” (Project ID 1) |
Adoption | - Increased uptake of services offered reported by several sites - One site reported regular attendance from staff from an outside organisation who can support service users with housing/benefits etc. - A few sites reported engaging well over the target number of service users, indicating successful uptake | “High uptake from service users - regularly 10–15 people attending each night.” (Project ID 35) |
Appropriateness | - Staff reported positive views of working for an “innovative” service - Allowing for for a more collaborative approach to patient care and to look at service users’ holistic needs - More appropriate setting for someone in crisis than A&E, or being picked up by the police - One service noted challenges to the acceptability for service users noting that from their experience some diagnoses may make the use of a digital place of safety as less appropriate | “Seen as an asset to the crisis teams offer, known and referred to by outside partners e.g. police” (Project ID 35) |
Feasibility | - Better environment, nicer building, more accessible - Able to offer out of hours support: one service reported being able to provide online out of hours support to help reach people who could not access other support, or who lived far away. - Allowing care to be more integrated across different services | “This allowed us- and continues to allow us, to provide that support in a way that gave more equality of access, and again, safety of discussions, safety of conversations without people needing to physically come down to the building.” (Project ID 41) |
Fidelity | - Overall, the majority of services reported that the set up and delivery of the project had good fidelity with their original plan - One service was an exception, reporting that due to policy and guideline changes in relation to Psychiatric Decision Units meant the original project was no longer feasible | “All aims achieved and fidelity to the funded proposal apart from receiving accreditation.” (Project ID 09) “Information came from the CQC, RCPsych, and from the National NHS England team around a shift away from recommending psychiatric decision units, the type that we had put into the original bid.” (Project ID 09) |
Implementation Cost | - The majority of services reported the implementation being within budget - For the two sites which came in over budget, the extra cost was met by the NHS Trust - A further two sites reported being within budget but had some limitations e.g. recurring costs not being covered | “…we couldn’t, as a charity, have invested £40,000 in that building, to have done the work to enable us to do this. So, to be fair, yes, we probably wouldn’t be where we are now, without that funding…” (Project ID 42) |
Penetration | - Several sites reported high penetration, with new initiatives integrating well into the existing care pathway - In some cases, this led to decreased pressures and demand for other services - Some services mentioned wanting to increase the roll out further, for example bringing it to remote areas via ‘pop-up’ centres | “Good usage, integrates across the pathways to relieve pressures across the directorate” (Project ID 25) |
Sustainability | - All sites reported that the service would be sustained in the future - In some cases, adjustments to the existing model were being planned for the future service - All but one site reported that further funding had been secured to allow for the continuation of the service | “Increased demand allowed investment to fund further nights and sustain for 3 years as they saw the value” (Project ID 35) |