The Impact of Implementing Our 4Cs Philosophy and Culture
Lloyd Griffiths, Head Of Nursing, Cwm Taf Morgannwg University Health Board
Introduction
Ty Llidiard (TL), a 15-bed Child and Adolescent Mental Health (CAMHS) unit in Bridgend, faced significant challenges, including poor staff morale, high sickness and turnover rates, and excessive patient safety incidents. The unit was under intense scrutiny due to concerns about quality, safety, leadership, and culture, leading to short-term solutions for long-term issues.
Recruitment for key therapy roles was difficult, impacting patient care. Feedback indicated that young people and families felt uninvolved in their care. The aim was to establish a culture of exemplary leadership and psychological safety with high performing, dynamic teams driving evidenced-based care and treatment.
Methods
An executive-led improvement board was established to drive a "Ward to Board" mentality, focusing on whole-system improvement centred on young people's needs. The board, with three workstreams—Caring, Compassionate Safe and Effective Care; Calm, Confident Leadership; and a Fit-for-Purpose Environment—emphasised visible leadership and shared decision-making.
Engagement events and consultations with stakeholders, including patients, carers and staff, used QI methodology and the 4Ns tool for feedback. Over 60 staff members received QI training, and all improvements were coproduced with young people and their families, guided by the 4Cs principles: Caring, Compassionate, Calm, and Confident.
Outcomes
- Supportive, collaborative an inclusive environment.
- Lower sickness/turnover.
- Significant reduction in restrictive practices and patient safety incidents (down to 9 per month in 2023 from 87 in 2021).
- Reduction in young people needing care in high costing private hospitals outside Wales.
- Positive feedback with staff feeling empowered to make improvements.
- Co-produced care plans following the "not about me without me" culture.
- Senior management's open-door approach improved transparency, trust, and engagement with staff, patients, and families.
- 4Cs philosophy logo widely adopted, creating a sense of identity and pride among staff.
- Established a culture of delivering safe, effective, and compassionate care with calm and confidence.
Learnings
- Importance of being transparent.
- A calm, measured approach to create a safe and respectful culture allowed for meaningful, lasting improvements.
- The need for better planning in evaluating progress before changes are made.
- Importance of “Ward to Board”, a whole team approach.
What next?
- Open culture generates ongoing ideas for enhancements.
- Co-production group is developing staff training resources and pre-admission information.
- Lived Experience Framework created.
- Work is being shared via national events and publications.
- Collaborating with NWAS CAMHS on an all-Wales approach.
