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Table 2 Means and interquartile deviations of items

From: Creation of consensus recommendations for collaborative practice in the Malaysian psychiatric system: a modified Delphi study

 ItemRound 1Round 2
MeanIQDMeanIQD
TitleWorking Together: A Consensus on Collaborative Practice in the Malaysian Mental Health System4.40.54.20.5
Autonomy
 1.1The suggested process of collaborative problem solving and decision making should be considered as a way of empowering patients, carers and staff and improving the quality of decision making (as described in section 6 on previous page)3.814.70.5
3 disagree
 1.2All staff should be trained in assertiveness, validation*, empathy and giving feedback* appropriately4.704.80
 1.3Staff need to pay careful attention to furniture and subtle cues that may make people feel intimidated. In meetings we suggest that the seating should be as close as possible to circular, with no back row, if space allows4.40.6  
 1.4The chair of the meeting should play a facilitator role and take care not to dominate4.40.54.70.5
1 disagree
 1.5The chair of the meeting should be someone who has good meeting skills and skills in listening and validating, understands the topic and the context of the meeting and should be chosen with the agreement of the other members of the meeting. The chair should not be chosen purely on the basis of grade and profession  4.40.5
 1.6The meeting chair needs to create a non-judgmental, validating environment4.30.54.80
1 disagree
 1.7The meeting chair needs to pay careful attention to power imbalances and make a special effort to elicit and validate opinions from people that may be feeling intimidated4.50.54.60.5
1 disagree
 1.8Providing paper to people who might normally feel intimidated can encourage them to express themselves4.30.54.30.5
1 disagree
 1.9Breaking up into smaller groups in larger meetings helps more voices to be heard and allows people to speak that normally feel intimidated4.40.54.40.5
1 disagree
 1.1Staff in leadership roles should be mentored and trained in democratic and transformational leadership styles4.60.5  
 1.11All staff should be given some leadership opportunities appropriate to their skills and experience. Junior staff should be given opportunities to chair meetings and mentored in this by more senior staff  4.70.5
 1.12The people involved in a meeting should be asked if they have any questions or feedback at the end of a meeting  4.80
Relatedness
 2.1Systems should be designed so that there are as few transitions between healthcare providers as possible. If possible patients should see the same doctor on each visit4.70.1  
 2.2A “primary nurse” system should be used for inpatients (see Additional file 2: Appendix S1)4.80  
 2.3Systems should be designed in ways that optimize relatedness between staff4.90  
 2.4Representatives (people that represent longer term committee members) should only be sent to patient care planning meetings or other hospital meetings when they are aware of the issues or are planning to join a hospital committee in the long term4.40.5  
Resources
 Resources: staff competence and education
  3.1All staff should be trained in the following areas: [insert list    
   aInterprofessional working4.60.5  
   bMeeting skills4.60.5  
   cAssertiveness skills4.80.1  
   dValidating other people’s opinions and giving feedback4.80.1  
   eReflective practice4.60.5  
   fCollaborative decision making and problem solving4.60.5  
  3.2Training in collaborative competencies should be skills based and include role playing sessions and reflective components4.50.5  
  3.3Most nursing and other professional staff working in psychiatric institutions should be interested in working in psychiatry and either have post-basic training in psychiatry or be undergoing this training4.80  
  3.4Staff should be mentored. Staff with post-basic psychiatry training can mentor staff that do not have post-basic training4.90  
  3.5Specific staff should be allocated to work in psychiatry in district hospitals and primary care, to allow these staff to develop the required competencies4.60.5  
  3.6Higher authorities in the health service should ensure that there is an appropriate skills mix, i.e. that there are adequate numbers of all professional groups, including clinical psychologists and social workers4.60.5  
 Resources: service user competence and education
  3.7The use of the Ministry of Health’s “Patient’s Unvoiced Needs” program, is recommended4.60.5  
  3.8Each patient should have a written care plan, which they can share with all people involved in their care4.60.5  
  3.9Education and support groups should be set up for patients and carers, including groups led by patients and carers. Brochures and promotional materials about existing groups should be made available in clinics and wards to ensure that patients, carers and staff are aware of their existence4.80  
  3.10Patients and carers who are able and willing to help others should be trained to work as peer support workers and educators  50
  3.11Peer support workers and educators should be paid an honorarium for the time spent doing the work  4.40.5
  3.12Education for both the public and professionals should involve patients and carers as educators  4.80
  3.13Written materials should be available in doctor’s rooms or waiting room for patient and carer education, which should also be available on line. Patients and carers should be invited to write some of these materials if they are interested in doing this4.70.1  
  3.14Information displayed on the wall of the clinic should be related to mental health, particularly ways to improve mental health and wellbeing. Information displays need to be clear, positive and sensitive to what patients may find distressing4.60.5  
  3.15Mental health education videos should be shown in the waiting area of the clinic as well as being available online. These videos should show positive, hopeful, non-stigmatising views of mental illness4.60.5  
  3.16A resource room or area should be available near the waiting room, which contains educational materials (brochures, books, videos). This should be staffed by someone capable of giving education to patients and carers, e.g. a staff member or peer educator4.30.5  
  3.17We recommend that patients be given a clinic book. This book can be used for the following: Individualised care plans, recovery goals, relapse plans, education, psychological work—e.g. CBT formulation, pages to write down things that they would like to discuss with the doctor4.70.1  
 Resources: time
  3.18Staffing calculations and rotas should take account of the time needed for collaboration4.40.5  
  3.19Psychiatric appointment time should be at least 30 min for a follow up appointment and 90 min for a new patient appointment  4.50.5
  3.20Care needs to be taken in deciding how to use multi-professional meeting time. Topics of discussion should be limited to the things that concern most of the people attending the meeting4.40.5  
  3.21Each member of staff should participate in only a limited number of hospital committees and junior staff should sometimes be appointed as committee members4.60.5  
 Resources: infrastructure
  3.22Better physical resources are likely to improve collaborative practice3.90.5  
Collaborating with people outside the hospital
 4.1The bureaucratic processes should encourage collaboration, rather than create barriers to collaboration4.50.5  
 4.2A ‘Friends of the Hospital’ group should be set up, together with a directory of services outside the hospital4.40.5  
 4.3Specific mental health staff should form relationships with other people outside the hospital that help our patients4.50.5  
 4.4Existing collaborative networks between primary care and people in the community should be used to help plan care for our patients (see Additional file 2: Appendix S1)4.70.0  
 4.5Patients who are not directly under the psychiatric hospital, should be given the option of being treated in primary care (rather than district hospitals)4.30.54.90.0
2 disagree
 4.6First-responder training programs in mental health should be provided for other people that help our patients4.60.5  
4.7Other people that help our patients need to know referral pathways and who to call if they are uncertain about what to do4.70.3  
The decision-making process
 5.1Inviting to take part in problem solving and decision making4.70.5  
 5.2Identifying stakeholders4.70.4  
 5.3Defining the problem  4.80.0
 5.4Finding common goals and values  4.80.0
 5.5Sharing of knowledge, opinions and concerns4.60.4  
 5.6Making the final plan4.40.44.50.5
2 disagree1 disagree
Consensus reached round 3: Mean 4.6, IQD 0.5
 5.7Implementing the decision and making clear that the decision can be reviewed4.80.0  
  1. There are no round two results, where consensus was reached in the first round
  2. IQD interquartile deviation