Upscaling DIALOG+ through Quality Improvement and System Strengthening Workshops – Karachi, Pakistan
From May to September 2024, the PIECEs research team in Pakistan conducted a series of Quality Improvement (QI) training workshops with 14 participants from four local hospitals in Karachi (one public and three private). These workshops aimed to support the broader implementation of DIALOG+, an app-mediated intervention designed to improve patient outcomes through structured, personalized conversations while addressing challenges in its adoption and use.
The QI workshops focused on empowering healthcare professionals with practical tools to drive small but impactful changes in their facilities. Over a total of five sessions, each lasting three hours, participants explored QI methodologies and their real-world applications.
A Step-by-Step Approach to Quality Improvement
The initial sessions introduced participants to the basics of QI, including the ELFT sequence and the Model for Improvement. During these workshops, participants:
- Identified specific problems in DIALOG+ implementation.
- Selected measurable outcomes, such as the number of completed DIALOG+ sessions.
- Applied analytical tools like the 5 Whys and Fishbone Diagram to uncover the root causes of challenges.
Building on these foundations, participants worked in seven groups to develop their own QI projects. Each group was tasked with defining a SMART aim and creating a stakeholder team at their respective facilities. These teams met fortnightly to refine their projects based on feedback and progress.
Practical Applications: Tools for Change
To deepen their understanding, participants engaged in practical exercises like process mapping, flow charts, and Pareto charts, which helped them visualize challenges and prioritize solutions. By the end of the training, healthcare professionals from Karwan-e-Hayat, Jinnah Postgraduate Medical Centre (JPMC), Lady Dufferin Hospital, and Karachi Psychiatric Hospital had developed tailored QI projects, each targeting key areas for improvement as follows:
- Workplace Improvement Initiatives: 4 QI projects aimed to enhance job satisfaction among healthcare staff and students by leveraging DIALOG+ sessions to address workplace stressors and improve the “job satisfaction domain.”
- Psychiatric Care: Two QI projects aimed to enhance mental health outcomes for patients and caregivers by using DIALOG+ sessions to improve ratings in the mental health domain. Another project focused on reducing average counselling time during follow-ups, particularly in high-volume community settings/psychiatric camps.
A Collaborative Path Forward
The collaborative efforts of local hospitals and the PIECEs research team underscore the potential of QI training to overcome DIALOG+ implementation challenges at health facilities. By equipping healthcare workers with the skills to analyze problems and implement targeted solutions, these initiatives are paving the way for more effective and sustainable use of DIALOG+ in Pakistan.
This journey demonstrates the power of small, consistent changes to drive significant improvements in mental health care delivery, offering a model that can be replicated across similar contexts.
Here are some key moments from QI workshops captured below:
QI participants from 3 private facilities, analyzing root causes using the “5 Whys” exercise
QI participants brainstorming sources of improvement ideas
PIECEs team demonstrating Fishbone exercise in a QI session
QI participants conducted a Fishbone exercise
QI Huddle with Project Stakeholders (Caregivers and Psychiatric Ward Staff)
Participants from the public hospital completing the QI workshops
PIECEs Week in London: Reflecting on Four Years of Mental Health Research Collaboration
This month, our research teams from India and Pakistan came together to mark the conclusion of the PIECEs project—a four-year research initiative funded by the National Institute for Health and Care Research (NIHR). Focused on enhancing the quality of life for individuals living with severe mental illnesses in India and Pakistan, the project has used innovative, community-based methods to foster resilience and improve mental health care delivery in these regions.
PIECEs week was a celebration of the collaborative work between research teams from the Schizophrenia Research Foundation (SCARF) in India and Interactive Research & Development (IRD) in Pakistan. Their visit to London brought together experts to discuss findings from PIECEs and to reflect on how arts-based and other participatory approaches have bridged gaps in mental health care. The three-day visit included planning new research grants and brainstorming ideas for future projects. The teams also developed detailed dissemination strategies to ensure that the findings from PIECEs reach a broad audience, including healthcare providers, policymakers, and community members.
The teams also hosted a public event to showcase some of the most impactful elements of the PIECEs project. Attendees had the opportunity to learn how the use of storytelling through Theatre of the Oppressed and other participatory methods has enabled individuals with severe mental illness to express their experiences and challenges openly. This unique approach has been instrumental in improving mental health awareness in communities while also supporting system-level changes in India and Pakistan.
As the PIECEs project wraps up, the focus now turns to the future, with plans for ongoing research and continued partnerships across borders. This visit was a testament to the power of international collaboration in advancing mental health care, and we look forward to building on the project’s legacy in the years to come.
Take a look at some highlights from PIECEs Week captured below:
PIECEs teams from India, Pakistan and the UK
PIECEs public event at Clark Kenedy Lecture Theatre, Queen Mary University of London
Photovoice exhibition by Kasthuri Divya
A glimpse of Theatre of the Oppressed Performance at PIECEs public event
Showcasing the PIECEs Research: A Visual Journey at IConS XI
A glimpse of the PIECEs study was showcased at the International Conference on Schizophrenia (IConS) XI, organized by SCARF, India, documented through illustrations.
Prof. Victoria Bird, the principal investigator of the PIECEs project, delivered a talk during a symposium on psychosocial rehabilitation. At the same time, Dr. Mangala, India’s community engagement lead, highlighted SCARF’s outreach efforts over the past four decades. A dedicated hall displayed key aspects of the PIECEs study, including the clinical trial, community engagement, and small-scale research grants, led by individuals with lived experience associated with SCARF. The event also featured a Theatre of the Oppressed performance by SCARF’s theatre group, comprising individuals with lived experience of mental illness. The conference concluded with a lived experience panel, moderated by Dr. Suresh, where Mr. Anerudh shared his role as a peer support volunteer in the NIHR-funded peer support and small-scale research grants.
Illustrations by Parvathy (@prrrbutt)
Empowering Voices: Service Users Lead the Way at IConS XI 2024 – A Groundbreaking Dissemination of PIECEs Project
At the recent IConS XI 2024 conference, the PIECEs Project of SCARF (Schizophrenia Research Foundation) made a significant mark by showcasing their groundbreaking work. What made this dissemination particularly unique was that the service users themselves played a central role, actively engaging with delegates to explain the project’s various components.
As one walked into the exhibit space, the atmosphere was alive with interaction and conversations, but what truly stood out was seeing the service users confidently leading discussions. These individuals had been involved in different parts of the project, and now, they were in charge of presenting them. Whether it was the Randomized Control Trials (RCTs), Quality Improvement Workshops, or more creative aspects like the SALT (Stimulate/Share, Appreciate, Learn, and Transfer) workshops and the innovative use of community engagement through the Theatre of the Oppressed, the service users took ownership of their narratives. They eloquently explained each aspect, from the Namma Area initiative (a social hangout space for service users) to the visually powerful Photovoice Exhibit, engaging visitors with insights that only someone with lived experience could offer.
As part of their presentation, they didn’t just speak to the delegates—they also asked thought-provoking questions. These questions weren’t just about the project but aimed to spark deeper reflection among the visitors, such as how they might involve service users in their workplace settings, an idea that emerged from the service users. This exchange turned the exhibit from a one-way dissemination into an interactive, reflective dialogue.
When asked about their personal experience participating in the dissemination, the service users spoke of how transformative it had been. For many, it was the first time taking up a leadership role in such a public forum. They shared how explaining the project, answering questions, and even presenting challenges faced by people with mental health conditions had a profound impact on their self-esteem. This involvement, they said, boosted their confidence and gave them a renewed sense of purpose, showcasing not only their knowledge but also their resilience.
The PIECEs Project presentation wasn’t just about sharing information it was a living example of empowerment. It gave a voice to those who are often spoken for, and in doing so, it highlighted the importance of including service users in mental health initiatives. Through their participation, the service users transformed from beneficiaries to advocates and leaders, leaving both themselves and the delegates with a lasting impression of the true power of lived experience.
Highlights from the PIECEs Presentation at RC Psych Congress, Edinburgh
On June 19th, the PIECEs team presented at the RC Psych Congress in Edinburgh. The program began with a warm welcome from Professor Paul and Victoria Bird, Principal Investigators for PIECEs. They highlighted the significant work that IRD and SCARF have done in India and Pakistan to engage communities in mental health discussions.
The presentation featured a glimpse into the Theatre of the Oppressed, which illustrated the common challenges and opportunities in community engagement across these diverse regions.The team also used “The Great Game of Power” to prompt the audience to reflect on the key stakeholders and the role of oppressors within these communities. This interactive segment sparked meaningful conversations and allowed participants to share their perspectives.The session concluded with insights from representatives in India and Pakistan, followed by an open Q&A. The evening showcased the power of dialogue, creativity, and shared learning, leaving everyone inspired and eager for future collaboration.
Join Us on World Schizophrenia Day: A Day in the Life of “Dastan”
On World Schizophrenia Day, we invite you to step into the world of “Dastan” – a user-led theatre team in Karachi, Pakistan that is breaking the stigma surrounding psychosis. Through powerful storytelling, Dastan has been reshaping perceptions and challenging misconceptions about mental illness.
Watch here:
Scaling up DIALOG+in Karachi, Pakistan
In a concerted effort to improve mental healthcare in Karachi, three Dialog+ sessions were recently held across Karachi’s prominent hospitals, conducted by the IRD Team. Commencing on March 8 at the Karachi Psychiatric Hospital, the initiative brought together mental health professionals to engage in conversations about using DIALOG+. Subsequent sessions were held at Lady Dufferin Hospital on April 19 and Jinnah Postgraduate Medical Centre on April 27th to offer individuals a safe platform to learn about DIALOG+.
Community Engagement Initiative: Forum Theatre at MMM Nursing College, Chennai
Our community engagement initiative, conducted by the mixed arts group at SCARFindia, involved delivering forum theatre performances and workshops at the MMM Nursing College in Chennai. This initiative provided an excellent platform for students to engage in discussions regarding challenges in mental healthcare. Additionally, students had the opportunity to interact with service users and members after the session, fostering a deeper understanding of mental health issues within the community.
Empowering Healthcare Professionals: Scaling Up DIALOG+
In the fast-paced world of healthcare, innovation is key to improving patient care and outcomes. One such innovation making waves is DIALOG+, a platform designed to enhance communication and collaboration among healthcare professionals. As we approach the end of the trial phase, our teams are ramping up efforts to scale up the use of DIALOG+, empowering clinicians through comprehensive training sessions. Recently, the Interactive Development and Research Team in Pakistan took strides in this endeavour by conducting training sessions at Karwan-e-hayat and Karachi Psychiatric Hospital. These sessions were about fostering a deep understanding of its potential and integrating it seamlessly into routine practices.
At the heart of these sessions were meaningful discussions about the continued utilization of DIALOG+ in everyday clinical workflows. The aim was to equip healthcare professionals with the skills and knowledge needed to leverage this platform effectively. Through interactive sessions, clinicians explored the various features of DIALOG+ and learned how it could streamline communication, enhance collaboration, and ultimately improve patient care. By streamlining communication processes and reducing administrative burdens, clinicians will devote more time to patient care, enhancing patient and provider satisfaction.
As we continue scaling up DIALOG+, our commitment remains unwavering: to empower healthcare professionals with the tools they need to deliver quality mental healthcare. Through ongoing training and support, we are not just transforming workflows; we are revolutionizing the way healthcare is delivered, one interaction at a time.
Statistical Analysis Plan (SAP) for PIECEs
As we approach the end of this trial, the teams have worked to develop a statistical analysis plan to measure the impact of PIECEs. Read here: Statistical Analysis Plan for PIECEs