Scottish NHS Mindfulness Network

 

 

NHS Mindfulness Network

Implementing Mindfulness Based Programmes in the NHS

 

Distribution: Mindfulness leads and therapists

 

Implementation can be seen as “a process and a journey” which is unique in each area and which may take many years to establish and maintain in any sustainable format. Six interdependent themes have been identified which  influence whether or not implementation is successful.

 

1. The presence of an implementer is seen as essential: someone with passion and drive and the ability to skillfully engage stakeholders at all levels of the organisation. Things are more likely to succeed with more than one implementer holding a variety of skills and levels of seniority.
2. Making it fit. Things are most successful if MBCT fits with the healthcare context and local service strategy, priorities and care pathways.  MBCT is not a straightforward “fit” and there may be a need to widen inclusion criteria (for example with active depression, rather than people currently in remission).
3. Context. This includes the financial, practical, human and organisational culture. In order to get the “top-down” support in strategy and investment there is  a need to cultivate support and awareness from middle and senior management. An organisation culture shift towards wellbeing may support mindfulness based programmes whereas an emphasis on the medical model may not.
4. Drive. There needs to be both a “bottom up” and a “top down” approach or the passion, commitment and drive of the implementers will only reach a certain point and could crash if those individuals leave the service.
5. Adherence to good practice. This provides the strength and sustainability of any service, that approved pathways of training, supervision and CPD are adhered to and that any intervention is not inappropriately “diluted”
6. Pivot points. These are often organisational forces which are beyond our control which result in a shift in priorities, structure or conditions.  They can result in mindfulness services becoming stronger or more fragile. Whilst they may be beyond our control, how we relate to them can make a huge difference. 

 

 

 

 

 

 

These themes can lead to some reflective questions we can engage with:

 

Who are the key implementers in my context? What work are they doing? What skills, passions and characteristics do they have? What support do they need?   What are the systems and structures within which my MBP sits? How do these facilitate or pose barriers to development? How can I work with these skillfully?   What barriers and facilitators are presented in the current context? How can I influence these? How can I fit our MBP into this context with integrity?   Are there ways of widening the engagement with the MBP to make it more sustainable? How do I continue to resource myself and my team to continue to drive implementation?   How well are we adhering to the principles of good practice and ensuring that these are not eroded by service or organisational pressures? How do we support this and argue its case?   What have been the pivot points in my service and what impact have they had? How am I relating to the bigger organisational dynamics that influence the development of my MBP?

 

The above points were taken from the ASPIRE project which explored the implementation of MBCT in the Health Service in the four nations of the UK. The project explored the varied provision of MBCT through scoping and case studies and built some understanding of the primary facilitators and barriers to implementation.

 

There is a summary of its findings in the chapter on Implementation in Essential Resources for Mindfulness Teachers, edited by Rebecca Crane and the details of the ASPIRE project is found at https://implementing-mindfulness.co.uk including practical pointers and materials to support implementation. 

 

The resources on the ASPIRE website may be of assistance if you are implementing  or reestablishing a mindfulness based programme in your health care area or working upon maintenance and sustainability. There may be a need to “make it fit” the service you are working in, build a culture to support its delivery, get top-down “buy in”, as well as strengthen the network of support to assist in the bottom-up driving force.  You will find on their website resources for different stages of your journey, case examples of “making it fit”, building networks and how to make a case for your programme. Of course, in addition, we have a lot of experience here in Scotland and through the network we can gain support from one another, share resources and experiences. 

 

Implementing and developing Mindfulness Based Programmes is never going to be a “quick fix”. It requires persistent diligence, creativity and resourcefulness  in developing and sustaining a service effectively and in responding to the “curve-balls” which are thrown our way.  In essence, it requires all of our mindfulness qualities and strength of practice to maintain equanimity and inspiration as well as to stay connected to our intentions, which is to offer something which can be of value and reduce the amount of suffering in the world.