Table 1 Description of the essential features of the unit

Place – the physical place or places.

• The unit is L-shaped, and the staff have work rooms along two corridors. Everyone has their own office, and the manager’s office is at the far end of the shorter corridors.

• The dining room is in the middle of the long corridor opposite the medicine room.

• • Conference room B, found in the shorter corridor opposite the psychiatrists’ room, is the room used for most conferences; contains an oval table that fits about 10–12.

Actor – the people involved

• At this unit, about 25 people are employed, including treatment assistants, nurses, psychologists, psychiatrists, unit manager, medicine secretaries, curators, patient flow coordinators, and peer support.

• The unit only has permanent employees; there are no temporary workers or hourly employees and no relay/hired staff.

• Most clinicians had worked at the unit for a longer period, even when the working environment was alarming. Few were hired right at the end of that period; for example, the unit manager was hired when the report on an alarming work environment had just finished.

• The clinicians are divided into different teams; based on diagnosis, patient group, and treatment, e.g., DBT (dialectical behaviour therapy)

• Psychologists are responsible for psychological investigations and treatments, but other clinicians may also begin a neuropsychiatric investigation.

• The treatment assistants are trained assistant nurses; they see patients, make assessments of new patients based on suspicion of psychiatric disorders, and administer rating scales to estimate neuropsychiatric or various anxiety and depression conditions. They provide support calls, do drug and treatment follow-ups, and document all work.

• The nurses are further trained in psychiatric nursing. Their duties include, just like treatment assistants’ duties, follow-up and talk therapy but also medicine sharing and TeleQ (i.e., receiving calls when patients call in, but also checking messages via 1177 - Vårdguiden, a service from Sweden’s regions.)

• The psychiatrists specialize in psychiatry and are responsible for diagnostics and drug treatment. They have the ultimate medical responsibility.

Activity – a set of related acts people do

• Treatment and reassessment conferences allow clinicians to agree on patient matters. At least one person from each professional group is present. These conferences are not divided based on which team the clinicians belong to. The clinicians go if they have a matter that needs to be dealt with in these conferences.

• Regardless of profession, all clinicians on the unit assess the patient’s condition.

• Specific assessments, e.g., medical history, interviews, and assessment scales, can be made with the patient, but interviews with relatives are also conducted. The assessments are made based on a referral for a suspected diagnosis

• Team conferences are based on patient cases in the specific team. Team members participate.

Time – the sequencing that takes place over time

• Reassessment- and treatment conference on Wednesdays 13–17.

• Team conferences on Thursdays.

• Psychologist consultation time Tuesdays before noon.

• The patient is enrolled in psychiatric outpatient care as long as his/hers condition requires specialist psychiatric care, with the option that the patient chooses to end the care contact.

Object – the physical thing that is present

• All clinicians are dressed in private clothes; some are more dressed up than others.

• One psychiatrist wears scrubs (theatre blues - UK), while the other wears private clothes.

• The unit’s code of conduct is often discussed and written on a whiteboard in the conference room.

• There are name tags and a vacant/busy sign outside every office. Some clinicians always have the vacant sign visible, and some have the sign saying something between vacant and busy. Usually, the doors are open even when they are working on administrative assignments.

• The clinicians select paintings in the unit from a predetermined selection chosen by a person in the region. The reception is bright and not clinically sterile. The coffee room has a large plant, sofa, armchairs and usually a fruit basket on the table.

Goal – the things people are trying to accomplish

• The overall goal is to put the patient’s needs first, provide the right help, and do this by working efficiently.

• The code of conduct says that they should respect each other and each other’s opinions, listen to each other, cooperate and not be judgmental.