Table 1

The first two steps in quality improvement
Theory based steps In this case
1. Select target area
Frequency Large patient population [1], referral letters used whenever need for specialised health care.
Importance Large suffering, large impact on society [1]
Complexity Many stakeholders, inter-organisational
Insufficiently effective, efficient, accessible, acceptable/patient-centred, equitable, and/or safe care [28] Risk of incorrect prioritisation of patients and inappropriate care [7,8]
Expected improvement potential [13] Studies reveal that referral letters in general and within mental health care lack important information [4-6]
2. Determine/define recommended practice
Explore existing knowledge [13] Literature review revealed no evidence-based recommended standard for content of referral letters to specialised mental health care
If not sufficient knowledge: Define recommended practice Structured group interview using the method Language Processing [20]
A. Involve valid perspectives [9]: Including:
Professional Health professionals from primary care (GPs and mental health nurses) and from specialist mental health care (psychiatrist and trained psychologists)
Patient/client Patient representatives from Mental Health Patient Organisation
Organisational Operating managers within specialist mental health care.
B. Make feasible [13] Delphi process to determine the most important content. Exclusion of themes where less than 75% of participants have rated them as highly important [22].

The theoretical framework for the method employed in this study.

Hartveit et al.

Hartveit et al. BMC Health Services Research 2013 13:329   doi:10.1186/1472-6963-13-329

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