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Table 5 Inner setting: themes and examples from each innovation group

From: Factors influencing the implementation of mental health recovery into services: a systematic mixed studies review

Innovation group Theme* Example
E-innovations The importance of organizational and policy commitment to recovery-transformation An e-innovation was welcomed by leaders because they saw it as helping the organization progress towards their policy goals of measuring and increasing user involvement in care plans [85].
Interpersonal relationships Service users were excited to use the e-innovations but disappointed and frustrated when their providers did not participate in and support them as much as they expected them to. Some providers felt their clients’ expectations were difficult to fulfil [85, 88]. A positive learning climate was thought to be linked to good pre-existing working relationships between service users and service providers, particularly ones that were open and adaptable [85, 88].
Family-focused innovations Information gaps about new roles and procedures The need for establishing guidelines, protocols, and procedures to help staff implement family-focused innovations was highlighted [91, 92]. Nurses in the family rooms innovation were unsure if they should or should not stay with families during visits, and what their role was during visits, which left them feeling uncertain and having to navigate as best they could [92].
Interpersonal relationships The fact that the group members and the facilitator already knew each was thought to have helped establish the trusting relationships and cohesive group dynamic that were key to successful implementation [93].
Peer workers Traditional biomedical vs. recovery-oriented approach Peer workers often felt that other staff, primarily mental health professionals and doctors, valued their own knowledge (gained through formal degrees) more than peer workersʼ knowledge (gained through lived experience) [94, 104, 108, 115], with some describing feeling “blown-off” [108] and treated like a “kid”, an “idiot”, or a “moron” [99] in the workplace, and that any change in mood or any day off work was assumed to be related to their mental health problems [99, 108].
The importance of organizational and policy commitment to recovery transformation If there was a lack of compatibility between the peer worker philosophy and the existing paperwork, treatment plans, and requirements for stating goals and demonstrating progress that they were asked to use, peer workers could feel uncomfortable with, and critical of, the service they provided their clients [94, 99].
Information gaps about new roles and procedures Peer workers often lacked information about their roles and tasks [104, 108]. A commonly reported issue was the lack of training and information for non-peer staff about the peer worker role, recovery, and how to work with (or supervise) peers workers [94, 97, 100, 102, 108]. This could lead to the underutilization or misutilization of peer workers [97, 108], and role confusion and conflict [102, 108].
Interpersonal relationships Building good interpersonal relationships between peer workers and non-peer staff was important for increasing respect and acceptance of the peer worker role [98, 108], ensuring the peer workers' role and skills were fully utilized [105], and facilitating the transition of the peer worker from service user to service provider [106, 114]. Hiring peer workers from within an organization’s own client population came with certain challenges due to pre-existing relationships [99, 102].
Personal recovery planning Traditional biomedical vs. recovery-oriented approach Traditional mental health services espouse independent and distinct responsibilities whereas recovery planning requires cooperative and collaborative teamwork that shares responsibility among staff [119].
The importance of organizational and policy commitment to recovery transformation Personal recovery planning can risk becoming just another skill to acquire or just another care plan to complete in a formulaic and non-individualized way if wider organizational change does not occur [115, 119, 124].
Staff turnover Difficulty retaining staff and filling key positions meant that building a continued vision for recovery planning as part of wider organizational change was difficult [119].
Lack of resources to support personal recovery goals Service providers perceived there to be a lack of resources for supporting clients’ individually-determined goals in a hospital setting because there was limited programming available [119].
Information gaps about new roles and procedures Service users and service providers need access to clear information about the role of the service provider, the purpose of personal recovery planning and benefits for service users, and how the recovery plan will be communicated to others on the team and physically stored [119, 122].
Interpersonal relationships Positive relationships were characterized by respect and mutual esteem and negative ones as being told what to do and being patronized [109, 117, 122]. When staff were disinterested in recovery plans or had negative attitudes towards the training and additional paperwork needed, clients perceived this lack of buy-in and felt disappointed, concerned, or equally dismissive of aspects of recovery planning [119, 121, 122].
Recovery colleges Information gaps about new roles and procedures Guidance was needed for service provider students about how to manage boundaries in co-learning environments and whether they should or should not disclose their status as a member of staff to others [128].
Interpersonal relationships Achieving good rapport between practitioner and peer tutors paired-up to teach courses may be more difficult to achieve if the practitioner tutor is normally the peer tutorʼs service provider [126].
Service navigation and coordination Traditional biomedical vs. recovery-oriented approach Overcoming existing traditional work culture involved dispensing with hierarchical structures, competitiveness, and defensiveness that can silo or make invisible scarce community resources [129], working in a more intensive and individualized way with service users [132], and pre-empting challenges inherent to a historical separation between behavioural and physical health [132].
Staff turnover Turnover could cause unclear leadership and inefficiencies since what staff are required to do may keep changing as people in leadership roles change [130].
Lack of resources to support personal recovery goals Service navigation and coordination depends implicitly on the availability of external services to coordinate, but the lack of services to actually coordinate can threaten its purpose [130, 132,133,134].
Information gaps about new roles and procedures Lack of access to information and training around the new service navigation and coordination programs and the role of its staff (processes, referrals, expectations, goals, outcomes, funding, philosophy) was mentioned across studies and was associated with stress, concerns, confusion, difficulties with service navigation, and more difficult relationships with other service providers [110, 130, 131, 133, 134].
Interpersonal relationships Trusting, supportive and caring relationships seemed to be a central factor for service user satisfaction and positive change in service navigation and coordination innovations [130, 133].
Staff training Traditional biomedical vs. recovery-oriented approach Recovery training was occurring in an organizational culture characterized by hierarchies and unequal power relations (between different staff, and staff and service users) [133, 136], and one in which self-reflection was a rare occurrence [134].
The importance of organizational and policy commitment to recovery-transformation Staff supported the view that organizational culture (mission, policies, procedures, record-keeping, staffing) needed to change in order for implementation of a recovery training program to be successful [135].
Staff turnover In one study staff turnover was 21% during the training program [135], and in another study, 15% of staff in one site, and 37% in another site left their jobs during the training intervention [139].
Lack of resources to support personal recovery goals Outside of hospital settings, there may be a lack of resources to draw on to help service users meet their full potential [18], including community resources such as appropriate placements and accommodation [135].
  1. *If the studies in the innovation group did not contribute data to a theme, that theme is not listed under the innovation group and no example is provided