Creating a culture, not just a space—A qualitative investigation into reflective practice groups in inpatient mental health settings from the perspectives of facilitators and attendees

Pui Lok Joshua Yiu; Abbie McDonogh; Harpreet Gill; Jo Billings

doi:10.1371/journal.pone.0316030

Peer Review History

Original SubmissionApril 25, 2024
31 Jul 2024 Decision Letter - Faten Amer, Editor PONE-D-24-15162Creating a Culture, Not Just a Space – a Qualitative Investigation into Reflective Practice Groups in Inpatient Mental Health Settings from the Perspectives of Facilitators and AttendeesPLOS ONE Dear Dr. Yiu, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 14 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Faten Amer, PhD in Health Sciences Academic Editor PLOS ONE Journal requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. 3. We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Please update your Data Availability statement in the submission form accordingly. Additional Editor Comments: Dear Dr. Pui Lok Joshua Yiu, The reviewers have requested revisions for your manuscript. Please address each point and send the revised manuscript along with a detailed reply to the reviewers' comments point by point by 15 August 2024. Regards [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: This was a well written paper that maps onto an identified gap in the literature and makes a useful contribution. Since inpatient mental health settings are often where people report their worst outcomes, interventions that lead to potential better experience and quality improvement are very important to research and evaluate. The comments are therefore focused on improving and strengthening the existing paper. Minor concerns: 1) Line 123 – the reference number is missing. 2) Line 160 onwards – the section on data analysis needs underpinning, please provide citations linked to the specific approach to thematic analysis and reflection you used here to support transparency. 3) Line 224 – I am assuming these are codenames for the interviewees not actual names but could you please address pseudoanonymisation or anonymisation in the methods explicity? Major concerns: 1) There is a lack of specificity when writing, that leads to doubt about veracity of the claims being made. This could be removed by tightening up the writing style. For example, the background paragraph opens with “some literature suggested”. What literature? Please use clear citations or try and be more specific and tie the claims made to supporting evidence. I would restructure the entire background section to start with the known problems in the setting, then the claims about the intervention in the setting, before getting to the sentence about what this paper contributes as it will flow better and build the line of argument. 2) When setting the scene and context for reflective practice groups, is there any research showing that these groups are harmful or unhelpful? If you are looking at a particular setting with significant challenges around power imbalances, safety etc. then has this been considered in the literature? Linked to this, in line 405 – are those assumptions or evidence based reasons for hinderance of staff engagement – just be clear when you are writing where the claims are coming from. 3) When reflecting on the number of interview participants, under results – could you please contextualise this i.e. this is average for these types of research or for this topic area/this is a smaller sample because of X or Y reason etc. 4) I think in the discussion and limitations – having nuance around the missing groups or the significance of holding these groups with particular clusters of staff members would be helpful i.e. we do not know if professional background/seniority or what mix of staff facilitates the best outcomes for these groups; we do not know if the mix of staff is as important as the setting and resources to support such groups etc. I think you do have tentative conclusions in there but it would be helpful to indicate more clearly proposed directions for future research. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0316030.r001
Revision 1
12 Sep 2024 Author Response Dear Editor, In response to PLOS ONE's decision for the manuscript "Creating a Culture, Not Just a Space – a Qualitative Investigation into Reflective Practice Groups in Inpatient Mental Health Settings from the Perspectives of Facilitators and Attendees" (Decision: Revision required [PONE-D-24-15162] - [EMID:6d0df5fac996c06d]), we would like to thank the editor and reviewer for carefully reading our manuscripts, offering their valuable comments, as well as appreciating the contribution of this manuscript. All comments have been thoroughly considered and incorporated into this refined version of our manuscripts, leading to the following changes. We have listed the points raised by the academic editor and reviewer and our response to them. We believe the above changes have addressed the shortcomings in the previous submission. We hope that the new version elicits a positive response. Best Wishes, Dr Jo Billings Dr Harpreet Gill Pui Lok Joshua Yiu Abbie McDonogh Editor's comment #1: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf Authors' response: Thank you for providing the templates. The file names, cover page, and titles in the main body have been updated. Editor's comment #2: Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. Authors' response: Thank you for raising this. I have now included the full name of the ethics committee that approved our study. We have also indicated how we obtained informed written consent under the Methods section (lines 141-143, 159-161, 176-178). Editor's comment #3: We note that you have indicated that there are restrictions to data sharing for this study. For studies involving human research participant data or other sensitive data, we encourage authors to share de-identified or anonymized data. However, when data cannot be publicly shared for ethical reasons, we allow authors to make their data sets available upon request. For information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. Please see http://www.bmj.com/content/340/bmj.c181.long for guidelines on how to de-identify and prepare clinical data for publication. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. Authors' response: Due to the personal nature of the participant accounts shared in the interviews, and in line with the ethical approval granted for this study, the full data set of interviews has not been made publicly available. In response to prompt (a), excerpts of interviews can be made available on reasonable request to the corresponding author via the UCL Research Ethics Committee: ethics@ucl.ac.uk. Reviewer's comment #1: Line 123 – the reference number is missing. Authors' response: Thank you for pointing this out. This information, alongside the research ethics committee that approved this study, has been added (lines 141-142). Reviewer's comment #2: Line 160 onwards – the section on data analysis needs underpinning, please provide citations linked to the specific approach to thematic analysis and reflection you used here to support transparency. Authors' response: That's a great reminder. We have now explained the specific approach to thematic analysis we employed, including citation, justification, and our stance on epistemology (lines 183 onwards). Reviewer's comment #3: Line 224 – I am assuming these are codenames for the interviewees not actual names but could you please address pseudoanonymisation or anonymisation in the methods explicitly? Authors' response: We appreciate this feedback. We have now explained the process of pseudoanonymisation more explicitly (lines 178-179, 199-200). Reviewer's comment #4: There is a lack of specificity when writing, that leads to doubt about veracity of the claims being made. This could be removed by tightening up the writing style. For example, the background paragraph opens with “some literature suggested”. What literature? Please use clear citations or try and be more specific and tie the claims made to supporting evidence. I would restructure the entire background section to start with the known problems in the setting, then the claims about the intervention in the setting, before getting to the sentence about what this paper contributes as it will flow better and build the line of argument. Authors' response: That's a pertinent suggestion. We have now re-examined not just the background section but also other sections to ensure specificity when writing. We have also re-structured the background section following your suggestion - explaining the challenges of working in an inpatient mental health setting, then claims about the utility of reflective practice groups, and what are they, followed by a critique of the limitations of current literature and how our paper could contribute to this literature gap. Reviewer's comment #5: When setting the scene and context for reflective practice groups, is there any research showing that these groups are harmful or unhelpful? If you are looking at a particular setting with significant challenges around power imbalances, safety etc. then has this been considered in the literature? Linked to this, in line 405 – are those assumptions or evidence based reasons for hinderance of staff engagement – just be clear when you are writing where the claims are coming from. Authors' response: This is a fresh and useful perspective. Indeed, to date, we are not aware of any literature that has suggested the negative impacts of reflective practice groups. Our data do not directly suggest any either. However, our data do imply settings or conditions (e.g., uncontained power imbalances) under which reflective practice groups may not be productive, or even potentially harmful. In the background section, we have now noted that potential negative impact has not been suggested in any current literature (line 109 onwards). In the discussion section, we reflected on the implications of our data on the potential negative impacts of these groups, as well as how our sampling method might have limited our collection of data that might suggest unhelpful effects of these groups (lines 664-673). Reviewer's comment #6: When reflecting on the number of interview participants, under results – could you please contextualise this i.e. this is average for these types of research or for this topic area/this is a smaller sample because of X or Y reason etc. Authors' response: Thank you for this. We have now included the range of sample sizes of existing research in this field and why we consider our sampling was diverse enough to generate new insights, which was linked to our thematic analysis approach (lines 651-657). Reviewer's comment #7: I think in the discussion and limitations – having nuance around the missing groups or the significance of holding these groups with particular clusters of staff members would be helpful i.e. we do not know if professional background/seniority or what mix of staff facilitates the best outcomes for these groups; we do not know if the mix of staff is as important as the setting and resources to support such groups etc. I think you do have tentative conclusions in there but it would be helpful to indicate more clearly proposed directions for future research. Authors' response: This is a very helpful direction that sparked some further reflection. The mix of staff is unfortunately an aspect that we were not able to directly explore. This is also likely a controversial one which might imply that certain factors interact and determine whether a mix of staff (e.g., including ward managers or not) is helpful. These factors might include areas we had explored (e.g., the facilitator's ability to contain power imbalance, the reflectiveness of senior staff in the ward, etc.) and other factors (e.g., time for the team to build a sense of safety with each other). This may also extend to other approaches of these groups, such as whether to have an external facilitator or not. We have therefore suggested that future studies could try to develop a theoretical model that explains how different factors interact to determine the best outcomes of these groups, which might be a phase-based or process-based model (lines 628-641). Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0316030.r002
4 Dec 2024 Decision Letter - Alejandro Botero Carvajal, Editor Creating a Culture, Not Just a Space – a Qualitative Investigation into Reflective Practice Groups in Inpatient Mental Health Settings from the Perspectives of Facilitators and Attendees PONE-D-24-15162R1 Dear Dr. Billings, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Alejandro Botero Carvajal, MD Academic Editor PLOS ONE Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: N/A ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Thank you for addressing the comments thoroughly. I am happy to accept this article for publication. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes: Dr Sarah-Jane Fenton ******** https://doi.org/10.1371/journal.pone.0316030.r003
Formally Accepted
12 Dec 2024 Acceptance Letter - Alejandro Botero Carvajal, Editor PONE-D-24-15162R1 PLOS ONE Dear Dr. Billings, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Alejandro Botero Carvajal Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0316030.r004

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .