Defining Vision and Mission of a Medical Psychiatry Unit (MPU) for Older Adults: A Focus Group Study

Abstract

This study aims to determine the vision and mission of an academic hospital’s medical psychiatry unit (MPU) that exclusively treats geriatric patients. All healthcare providers working at an academic hospital’s geriatric MPU were invited to reflect on formulate the vision and mission of this ward. Twenty-two of them took part in the focus group interviews. The interviews focused on defining the MPU’s functioning, its objectives, how it will reach these objectives, and where the MPU aspires to go. The interviews were transcribed verbatim and analyzed according to the QUAGOL guide. The themes from the analysis emerged from these group discussions. The participants defined the MPU’s vision as to excel in integrated mental and physical geriatric inpatient healthcare, inspiring others to shed the stigma related to this vulnerable patient population. The mission that emerged from the focus group discussions is to provide patient-centered, integrated healthcare for older adults with combined mental and physical disorders. To achieve this, involving the patient’s network, interdisciplinarity, shared decision-making, clear communication between all stakeholders, and reintegration of patients into their communities emerged as important themes. This study provides a vision and mission of a geriatric MPU in an academic psychiatric hospital. Since there is no consensus in the literature about the characteristics of MPUs despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population.

• What do we already know about this topic?

• While recent research underscores the significance of integrated care for complex patients, literature on MPUs remains limited.

• How does your research contribute to the field?

• Our study takes a pioneering step by offering insights into the formulation of mission and vision statements for geriatric MPUs.

• What are your research’s implications towards theory, practice, or policy?

• These statements are poised to enrich the discourse on delivering exceptional healthcare to this vulnerable patient demographic.

Introduction

Persons with a mental disorder have a shorter life expectancy than the general population, mostly due to physical comorbidities. ¹ Having a mental disorder almost doubles the risk of cardiovascular diseases, diabetes, and obesity.^2,3 Moreover, patients with a chronic mental disorder have higher rates of hospitalization and emergency department use compared to patients with a chronic physical disease.^4,5

Taking care of older patients with a mental disorder is complex. More than two-thirds of older persons with depression have at least 1 physical disease. Over half of those with physical comorbidities have at least 2 physical diseases. ⁶ Furthermore, older people with a mental disorder face the dual stigma of being both a geriatric and psychiatric patient. ⁷

Traditional care for older adults with a mental disorder lacks an integrative approach. ⁸ Their care management requires a holistic strategy so that common risk factors, the bidirectional interaction between mental and physical disorders, and the treatment can be addressed together.^2,9 The integration of mental and physical healthcare is a top priority in national and international policy documents.^{3,8 -11}

A hospital ward where physical and mental issues are addressed together is called a medical psychiatry unit (MPU).^10,11 MPUs close the gap between psychiatric wards, that are usually not equipped to deal with more than minimal medical or surgical problems, and medical wards that have limited tolerance for patients with a psychiatric disorder or behavioral problems.^{12 -14} These units are complementary to psychiatric consultation services when biopsychosocial complexity is severe.^{14 -16}

There is no consensus about the admission criteria of MPUs. Shared criteria that define an MPU would make it more convenient to cross-check MPUs across different settings. ¹⁷ While some MPUs describe a highly specific target population,^18,19 others cater to a more general target population. ²⁰ There are also MPUs that do not apply any criteria at all.^21,22

A large university psychiatric center in Belgium aims to establish an MPU for geriatric patients. The reasons for setting up such a unit fall into several categories and are similar to the reasons why an MPU in Erasmus MC (Rotterdam, The Netherlands) was recently established: (1) managing the increasing complexity and behavior that is disruptive to physical treatment in an aging and more often multimorbid population, (2) improving the quality of care, and (3) the promise of cost-effectiveness by reducing length of stay and readmissions. ²³

Since the literature on care management in MPUs for older persons is rather limited, and the existing literature is inconclusive,^10,11,24,25 the aim of this study was to formulate the vision and mission of a geriatric MPU in the context of a large university hospital. Communicating a strategic vision has been defined as one of the key factors at organization level that contribute to providing patient-centered care.^26,27 Furthermore, through collaborative development of a mission and vision, we can address a common issue encountered in creating such statements. The challenge of lacking a shared vision and values—either due to the absence of a mission statement or a lack of deep understanding and commitment to the mission across all levels of the organization—can be overcome. ²⁸ We investigated how healthcare professionals would define vision and mission, since healthcare professionals need to be engaged in the process to make organizational changes succeed.^{29 -32} Such an assessment has not been described before. Our study contributes to the literature by providing insights into the formulation of mission and vision statements for geriatric MPUs. These statements have the potential to contribute to discussions on improving healthcare delivery for this vulnerable patient demographic.

Materials and Methods

We opted for conducting focus group discussions with the understanding that consensus was not the intended outcome within the scope of this study.^33,34 Instead, our primary goal was to explore the diverse opinions of all levels of staff in a medical psychiatry unit, particularly those engaged in caregiving and unit management. Acknowledging their experiential expertise and attentively listening to their needs enabled us to attain a comprehensive understanding of the prominent themes in the vision and mission of an MPU.

We reported our study according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. ³³

Participant Selection

We recruited healthcare providers from a geriatric psychiatry ward in Belgium where patients with combined mental and physical disorders are admitted to since 2018. The researchers employed a purposive sampling approach characterized by maximum variation, considering factors such as gender, profession, and working experience to recruit participants, adhering to the guidelines outlined by Patton. ³⁵ Despite its shift to more complex and combined mental and physical disorders, the organization of the ward was not adapted, and the healthcare providers were not prepared for this challenging care. Because this team had a lived experience of caring for the target population, it was an excellent sample to reflect on a future geriatric MPU. All team members of this ward received information on the study’s aim and were invited to participate via e-mail. The team consisted of a supervising psychiatrist, a psychiatry resident, a general practitioner, nurses, certified nursing assistants, psychologists, an occupational therapist, a social worker, a physiotherapist, logistics and maintenance staff. In addition, the relevant hospital board members and members of middle management were also invited. All participants were asked to sign an informed consent form in duplicate. They did not receive any financial compensation for their participation.

Data Collection

Three homogeneous focus groups were conducted in June 2021 in the clinical setting of the hospital. Two focus groups were organized live in meeting rooms, 1 focus group was conducted online. Groups contained at least 4 participants and at most 10, ³⁶ as limiting group size may help participants to share their opinions more easily, yielding a diverse set of viewpoints. ³⁷ One investigator (KC) moderated the groups while a second investigator (MV) took field notes of participant dynamics and nonverbal communication. The question guide was developed based on existing literature and discussion among the research team (Annex A). All group discussions were videotaped and transcribed verbatim. Focus groups were convened until data saturation, that is, when no new themes were identified.

Data Analysis

In this study, the researchers used the Qualitative Analysis Guide of Leuven (QUAGOL), ³⁸ a method inspired by the Grounded Theory Approach. ³⁶ The QUAGOL method facilitates a comprehensive examination of qualitative interview data. The initial phase, termed “paper and pencil work,” precedes the coding process and serves as a preparatory stage. The subsequent phase involves coding using specialized software. ³⁸ Transcripts were entered into ATLAS.ti Web software for qualitative data analysis. LT and KC conducted line-by-line coding of the transcripts and inductively identified concepts related to vision and mission of a geriatric MPU. Preliminary themes were discussed and revised by MV, to ensure that the full breadth and depth of the data were captured in the analysis.

Member Check

After the analysis, a member check with the participants was conducted, as this is an important technique to ensure credibility.^39,40 Participants had the opportunity to confirm, reject or adjust the results. The researchers designed a poster (Annex B) that visualizes a brief synthesis of the results of the focus group interviews. An e-mail was sent to participants who indicated that they would like to be kept informed of the results of the study, accompanied by the poster, a cover letter, and the survey (Annex C) that was made in Qualtrics survey software. These questions assessed the extent to which participants agreed with the results and whether they wished to add additional information. The results of the member check were fully integrated into the results section of this paper.

Results

Participants

The focus group sizes varied from 5 to 10 participants. A total of 22 persons participated. In focus groups 1 and 2, mainly healthcare professionals participated, while focus group 3 included mainly board members. Of all participants, 73% were female, and the mean age was 43 years. On average, participants had 12 years of work experience at the university psychiatric center. Nineteen participants, in particular, worked at the medical-psychiatry unit and received training in geriatrics and psychiatry through on-the-job experience or during their education (Table 1).

Table 1.

Demographics.

	Focus group 1 n = 10	Focus group 2 n = 7	Focus group 3 n = 5
Age Mean, Median, SD.	Mean: 42.30 Median: 44.50 SD: 11.05	Mean: 38.71 Median: 36.00 SD: 11.42	Mean: 50.00 Median: 53.00 SD: 6.93
Sex, % F	80%	86%	40%
Occupation participants	Nurse; occupational therapist; psychologist; resident psychiatrist; senior nurse; certified nursing assistant	Nurse; social worker; physiotherapist; certified nursing assistant	Chief medical officer; director; psychiatrist; geriatrician; director of nursing geriatric psychiatry
Number of years working within the geriatric MPU Mean, SD	Mean: 8.78 SD: 9.73	Mean: 13.45 SD: 10.46	Mean: 18.25 SD: 9.10

Vision and Mission

The participants identified relevant elements for both the vision (Figure 1) and mission (Figure 2) statements. They agreed that a mission statement should focus on elements that determine the identity of the ward and core values for day-to-day work, ⁴¹ while the vision should address long-term objectives of the ward, from a forward-looking perspective. ⁴¹

Figure 1.

Vision statement for a geriatric MPU.

Figure 2.

Mission statement for a geriatric MPU.

Vision

Excellence and expertise

Participants expressed that the MPU needs to function in accordance with the latest evidence-based guidelines. Furthermore, they claimed that having expertise in physical and mental healthcare is crucial to meet the patients’ complex care needs. They indicated that the MPU needs to be a pioneer in the field of psychosomatic care for older adults, and that they would like to be internationally recognized for their expertise in integrated care through contributing to the scientific community.

“Because you actually have to have expertise in both psychiatry and geriatrics. […] We also notice this now: either people have more psychiatric training, and then they can observe these things, or they have a background in geriatrics but then often fail to see psychiatric complications.” (Focus Group 3, 22/06/2021)

“That the MPU is a leader in complex care, in mixed psychiatric-somatic care, and is an example, or propagates this to other hospitals, and possibly countries.” (Focus group 3, 22/06/2021)

“We develop new care models, we implement new care models, we introduce new technology, we do research on new diagnostics.” (Focus group 3, 22/06/2021)

The MPU should be established in a large university hospital, requiring innovation and research in clinical work. Participants want to continue focusing on innovation in the future and expressed their desires to live up to their research assignments.

“Perhaps we should also put the ‘U’ of UPC in there. In one way or another, according to the most recent scientific insights, we should also strive to ensure that the care we offer is well-founded and has a decent scientific basis.” (Focus Group 3, 22/06/2021)

Stigma

The participants indicated that their patients suffer from a double stigma: being older and mentally ill. The future healthcare providers of the MPU must be committed to reducing this double stigma within the next years.

“Well, that’s that stigma. In geriatrics, in psychiatry, we feel that a little bit too, but even a little bit more in geriatric psychiatry than for adult psychiatry, so to speak, because you carry a bit of additional stigma.” (Focus Group 3, 22/06/2021)

“You have to face it, the stigma.” (Focus Group 1, 10/06/2021)

Mission

Heterogeneous identity

Participants described the MPU primarily as a ward for older patients with complex morbidity profiles, including both mental and physical problems, where healthcare is provided in an integrated way. From a hospital-wide perspective, the patient population is a particularly vulnerable group because they are often perceived by healthcare providers as challenging patients to treat in departments that focus mainly on physical or mental disorders separately.

“I think it’s about the simultaneous and integrated treatment of psychiatric and somatic issues.” (Focus group 3, 22/06/2021)

“I think the difficulty is that we are often that residual group; we get people here on the ward who don’t necessarily fit in other wards.” (Focus group 2, 11/06/2021)

Having the dual expertise to treat physical and mental illness simultaneously is what distinguishes the MPU from other hospital departments and is one of its key components. Participants stated that the workforce should be adapted to the care burden to provide optimal care. On the one hand, this means that the staff’s healthcare training should be adapted to the varying tasks at the ward. On the other hand, personal motivation to show flexibility in their daily work was described as a key asset at the MPU.

“We have the least homogeneous group, which makes it very complex because you have to be flexible all the time and have many different treatment pathways.” (Focus Group 2, 11/06/2021)

“Why isn’t that patient admitted to the oncology ward? Because the need for psychiatric care is at least as great as the need for somatic care. Therefore, they cannot be treated sufficiently by a liaison team or a consultation model.” (Focus Group 3, 22/06/2021)

Communication at the core

The core values of an MPU are designed by the complexity of care that needs to be provided. Communication seemed to be at the center of all core values that were discussed, both at the level of the work environment, including different settings, and at the level of individual patient care. Communication between all actors appeared of importance. Moreover, participants emphasized the value of open communication.

“Communication between everyone (. . .) we used to think in a rather paternalistic model: we decide what’s good, actually we don’t discuss it enough with the patient and family. Even if it’s about communication, what the plan is, what the goal is, what’s realistic, and I think that’s a very important aspect of good care. And I certainly think, in difficult situations, which you also see within geriatric psychiatry, that this is an important element, so actually open communication.” (Focus Group 3, 22/06/2021)

“We need to speak properly with each other (. . .) Communication!” (Focus Group 1, 10/06/2021)

To optimize patients’ care, participants expressed the need to work interdisciplinary. The more complex a patient’s situation becomes, the more healthcare providers are involved. Therefore, according to the participants, constructive interaction between disciplines and collaboration are indispensable at an MPU.

“. . .to look beyond one’s expertise and at a case as objectively as possible, consulting with as many colleagues and disciplines as possible.” (Focus Group 1, 10/06/2021)

“Communication between the settings is just bad, we do give a resignation letter, but that often doesn’t say anything about the person, or about the expectations, or about the objective, or… basically everything that happened around that integrated (. . .) But I think that is an important element of integrated care." (Focus group 3, 22/06/2021)

A strong focus on patient-centered care was expressed by the participants. They discussed the importance of individual goal setting with the patient and tailoring the continuity of care and day-to-day activities to the patient’s needs. Moreover, a systemic approach with involvement of the patient’s (formal and informal) network should be common practice within the MPU. This can be achieved through a structured conversation by the ward’s psychologist with the family at the time of admission and regular communication afterwards. Furthermore, participants also argued that it is important to remain vigilant as caregivers about the carrying capacity of the family.

“[moderator] But F. talked about goals per patient, and then I wondered: how do you set these goals? How does that work in an ideal medical psychiatry unit? [participant] Preferably with the patient, their environment, and loved ones. In consultation, having negotiated.” (Focus Group 3, 22/06/2021)

“So we can’t work with programs here (. . .) I think that’s the difference with other departments. It’s [care] always kind of individualized with us.” (Focus Group 1, 10/06/2021)

“Working around the system, the network. That’s stronger here than elsewhere.” (Focus Group 2, 11/06/2021)

Working towards a sense of meaningfulness was strongly linked to this systemic approach. The participants experienced that the patients’ sense of purpose and resilience often diminished due to their persistent mental and physical problems. The MPU could be seen as an opportunity to build an integrated care network with the patient and their family to ultimately reintegrate into the community and live a meaningful life.

“A common feature is not only the combination of psychological and physical problems but also patients experiencing a loss of meaningfulness in their lives. People with physical problems, psychological problems, and social problems experience a kind of emptiness and a lack of resilience. (…) That input; that we can all work together with the family (. . .) Like in society… so they can function again.” (Focus group 1, 10/06/2021)

Discussion

Summary of the Results

A large university psychiatric center in Belgium aims to establish an MPU for geriatric patients. Therefore, this study aimed to determine the vision and mission of such an MPU, by conducting focus group interviews with healthcare providers who have lived experiences in caring for the target population, and board members of the hospital. The vision was formulated as follows: “We strive for excellence in integrated healthcare for older adults with combined mental and physical disorders, while inspiring the world to shed the stigma attached to this specific population.” The mission statement that emerged from this study is: “Our mission is to provide patient-centered, integrated, and innovative healthcare for older adults with combined mental and physical disorders. We will reach these objectives by building a hybrid skilled workforce, focusing on interdisciplinary communication and collaboration, and fostering a culture where shared decision-making with patients and their families is a core value. By offering our patients warm and meaningful healthcare, we help them to reintegrate into society.”

Comparison With the Literature

The participants indicated that defining the target group of the MPU is challenging. As stated in the introduction, there is no consensus in the literature concerning the admission criteria of MPUs. ¹⁷ Kathol et al ¹⁵ categorized medical psychiatry units by the level of acuity of medical and psychiatric illness. He distinguished 4 categories. Type I units serve mainly psychiatric care and a low level of medical acuity. Whereas type II units provide general medicine and a psychiatric liaison service, this unit provides a lower level of psychiatric care. Type III and IV units serve patients with more severe medical and psychiatric problems. ⁴² Primary care medical specialists and psychiatrists work closely together at these units. Caarls et al ²³ found that MPUs in general are the most effective in providing care for high-level psychiatric and medical patients with complex conditions in particular. Previous studies described a gap between managers and nonmanagers concerning mission statements in a hospital setting. However, this was not encountered by the researchers in this study.^43,44

Shared decision making and patient-centeredness were also mentioned by the participants as key elements of the mission of an MPU. A recent study mapped the organizational elements of existing MPUs. ⁴⁵ The authors conclude that the main focus of the MPUs lies in the horizontal integration of mental and somatic services within the hospital. However, MPUs should focus more on integration across settings for example, primary care, community, residential and tertiary care services (vertical integration). ⁴⁶ In doing so, more attention can be paid to other elements of integrated care for example, continuity of care, shared decision making, case management, and training of professionals.^{47 -49} Participants emphasized the need for an integrated care approach for the MPU’s specific population. The literature confirms that their care management requires a holistic approach so that common risk factors and the bidirectional interaction between somatic and mental health disorders, and the treatment for each, can be addressed together.^2,9 Moreover, to provide high-quality care, healthcare professionals require expertise in somatic as well as psychiatric healthcare fields. ²⁰ According to van Waarde et al, ⁵⁰ healthcare specialists should be educated by undertaking compulsory internships at wards that treat high acuity psychiatric and somatic patients. Moreover, healthcare professionals should be educated on the importance of approaching the patient from a holistic perspective.^50,51

During the focus group sessions, participants argued that there is a stigma hanging over older adults with mental illnesses. This dual stigma of ageism on the one hand and mental illness on the other hand has been briefly touched upon in the literature. ⁷ Shulman et al described how this stigma may lead to not recognizing the need for mental health care, or even to resistance to referral.

Strengths and Limitations

This research contributes to the gap in the literature on defining a vision and mission statement for a geriatric MPU. Since there is no consensus in the literature about the characteristics of an MPU despite the international call for integrated care for older persons with combined mental and physical disorders, these vision and mission statements can feed the discussion on how to install excellent healthcare for this vulnerable patient population. Moreover, summarizing shared characteristics of MPUs can facilitate comparison of effectiveness and cost-effectiveness of this care approach. ¹⁷ As discussed earlier, the focus groups were recorded. Unfortunately, background noise interfered with the recording of one entire session. This was partly compensated by one of the researcher’s field notes, although some words remained incomprehensible. However, after the analysis, the researchers contacted all participants via e-mail to perform a member check. The benefit of this approach is that it ensures the credibility of the study’s findings. All respondents who completed the member check generally agreed with the outcome while deviating or additional comments were added to the results section. We used a leaflet as a member check, ensuring participants understood its contents. Not all details in the leaflet related directly to our research question, explaining the variance between the leaflet and our results. However, it’s important to note that any information in the leaflet directly addressing our research question was carefully included in the results section.

The researchers intended to compose heterogeneous focus groups. However, due to availability, the groups were rather homogeneous. Particularly focus group 3, which consisted mainly of board members and physicians. In this focus group, participants put more emphasis on discussing the vision of the MPU, compared to focus group 1 and 2. An advantage of more homogeneous groups was that there was less hierarchy among the participants and that respondents were able to speak more freely. ⁵²

Lastly, the chosen methodology had a few limitations. It remains possible that some participants did not feel comfortable enough to express their views during the focus group sessions. Focus groups always involve the risk of groupthink. ⁵³ Hence, the moderator took initiative to address participants that were not very engaged in the discussion. In that way, all participants had the opportunity to share their opinion during the discussion.

Implications for Practice and Further Research

In the literature it is clear that there is a high need for a ward where complex somatic and mental illnesses can be treated simultaneously. However, none of the existing hospital wards are suitable. ²³ Another option to treat patients is through consultation-liaison psychiatry. Patients with medical-psychiatric comorbidity admitted at a general hospital ward receive treatment from visiting mental health specialists. ⁵⁴ Nonetheless, MPUs are more suitable in treating patients who need high acuity mental and physical therapy. ⁵⁵ Expertise in psychiatric and medical issues is a key asset in making an MPU work. In 2017, researchers conducted a study on the functioning of MPUs in the Netherlands. ⁵⁶ The study concluded that in order to improve the quality on the unit, MPUs need to invest in: education, multidisciplinary collaboration and availability of somatic expertise on every unit. ⁵⁶ The lack of permanent somatic expertise was also described in our study as a current pitfall. As were other organizational barriers, such as the limitation in pharmacy opening hours, and a lack of medical equipment. These are practical considerations which should inform the decision about physical locations for an MPU. Further research should explore this by looking into the effectivity of, for example, organizing specific training courses at work.

Furthermore, attention is warranted to facilitate communication between professionals and with patient systems. Future projects could focus on the added value of involving family members in the patient’s daily care or evaluate the quality of care with regular follow-up consultations.

Creating optimal conditions is vital to achieve the foreseen vision statement. Therefore, future research should focus on the barriers and facilitators regarding the implementation of a vision and mission statement within an MPU.

Facilitating the exchange of results among various MPUs is crucial for fostering capacity building. Through collaborative efforts and shared data, researchers and clinicians can collectively discern the patient and unit characteristics that yield the greatest benefit. ⁵⁷ Given the importance of communicating a strategic vision as a key factor at the organizational level for providing patient-centered care, as highlighted in the introduction,^26,27 there is an opportunity for future research to delve deeper into the impact of collaborative mission and vision development. Exploring this approach may offer insights into overcoming challenges related to the absence of a mission statement or a lack of deep understanding and commitment to the mission across all levels of the organization, as indicated in previous studies. ²⁸

Conclusion

A geriatric MPU is a hospital ward for older adults with combined mental and physical disorders. A mixed group of healthcare providers and board members defined a vision and mission statement for such a ward. Excellent and integrated care, shared decision-making, a hybrid skilled team, and interdisciplinary collaboration were identified as core values. By establishing a geriatric MPU, participants hope to shed the stigma from this vulnerable patient population. Future studies should build upon our pioneering work by delving deeper into the formulation of mission and vision statements for geriatric MPUs. Investigating the practical implementation and impact of these statements will contribute to advancing the discourse on providing exceptional healthcare to this vulnerable patient demographic.

Appendices

A. Interview Guide

At the start of each focus group, the moderator explained the session’s goals while also informing participants that they were able to stop at any time. The moderator started with an icebreaker unrelated to the research topic to put the participants at ease. Afterward, the moderator proceeded to more substantive questions. The moderator started by announcing a fictitious case centered around a patient named Marie, a 72-year-old woman with a combination of severe mental and physical conditions. Then, the participants were invited to describe the patient’s ideal treatment. Afterwards the concept of a mission statement was explained, accompanied by questions exploring the MPU’s mission, including discussions on core values, identity, and primary functions.

Several detailed aspects were explored, such as the reason for Marie’s referral to the MPU, her fantasized conditions, the referral source, the arrival process at the MPU, her expectations and goals during the stay, and the impact of the MPU admission on Marie.

Moving forward, participants were prompted to reflect on the MPU’s primary function, identity, and purpose. Questions delved into the necessity of the department, potential consequences of its closure, the target audience it serves, distinctive features compared to other departments, and factors that unify the team.

The focus group then transitioned to the concept of a vision statement, contemplating the department’s long-term ambitions and its envisioned state in 5 years. Participants discussed the desired changes, their perceptible impacts, and the identity they aspired for the department to embody in the future.

Concluding the discussion, participants were asked to summarize key highlights, and the moderator sought to ensure that no crucial aspects were overlooked. Expressing gratitude for the participants’ presence and contributions, the moderator reassured them that the research results would be shared with everyone involved in the focus group study.

B. Poster

From left to right on the flyer

The quotes in italic are extracts from the focus group sessions.

Recognition MPU

The MPU is recognized by the participants as a department with the necessary expertise to treat elderly people with combined psychiatric and somatic problems and is an inspiration to other departments.

That the MPU is a leader in complex care, in mixed psychiatric-somatic care, and is an example, or propagates this to other hospitals, and possibly countries (Focus group 3, 22/06/2021).

Family/network

The focus groups show that the patient’s family and network are more involved in the MPU than in other departments. Nevertheless, it remains important to find a balance in the family’s ability to bear the burden and at the same time to involve the family sufficiently.

That there’s a total package. It’s not just the patient. The patient is in a context; they’re part of a family. So you always have to include them (Focus Group 1, 10/06/2021).

We also do this together. A consultation, and from there, we also get a lot of, what are the goals for her, the family (unintelligible) what can we help with, and what does she expect from us (Focus Group 2, 11/06/2021).

Availability

In order to provide good care, the availability at the MPU must meet the standards of a hospital. For example, a somatic physician and psychiatrist must be permanently available. In addition, pharmacy closing times should not restrict the provision of care.

That there is no doctor […] but actually there is no somatic doctor on duty in the hospital. For a department dedicated to somatic problems, that is a big problem, though (Focus Group 1, 10/06/2021).

Patient

Patients admitted to an MPU ward have a combination of psychiatric and somatic problems and require interdisciplinary care. The patient is always the focus of care.

That’s the ideal patient for us because that’s a case where psychiatric and medical issues are intertwined, which requires high-intensity care (Focus Group 1, 10/06/2021).

Evidence-based

The department will use techniques that have been scientifically validated and distinguishes itself by being innovative.

Somehow, according to the most recent scientific insights, to ensure that the care we offer is well founded, underpinned by sound scientific research (Focus Group 3, 22/06/2021).

Interdisciplinary care

Because of the complex target group, it is important to provide interdisciplinary care. This means that all care providers from different areas of expertise should work together and should coordinate their care.

I think we need to go from multi- to interdisciplinary, not to have our compartments next to each other (Focus Group 1, 10/06/2021).

Communication

Both patients and families know what the department stands for and the admission objective. There are no surprises for the patient when he or she is admitted. Attention is also paid to interprofessional communication.

Information could also flow better; for example, someone who has had physical therapy for a few weeks or had scans or ultrasounds, these often linger in their KWSⁱ (KWS = electronic patient record (https://www.uzleuven.be/en/about-us/investing-networks/digital-network-electronic-patient-record-mynexuzhealth) (Focus Group 2, 11/06/2021).

Digital health

The current digital platform is not user-friendly and is infrequently used. There is a need for an accessible platform that bundles the information from each expertise.

We will switch to using KWS in the future, so I suspect it will improve regardless (Focus Group 2, 11/06/2021).

Caregivers

Caregivers are expected to have in-depth expertise in somatic and psychiatric issues. The capacity of the staff is taken into account.

Because you actually have to have the expertise both on a psychiatric level and on a geriatrics level. And actually that combination, that’s a pretty difficult combination, to have that expertise (Focus Group 3, 22/06/2021).

C. Survey

Demographic data

Name:

Age:

Occupation:

Highest degree:

Number of years working within *:

Number of years working at the *:

Member check

• 1) What is your opinion on the results of this study?

• 2) To what extent do you agree with the synthesis of the results?

• 3) Would you like to add anything to this synthesis? If yes, what and why? If no, why not?