If you plan to implement CAPA, we strongly encourage you implement ALL 11 key components. Our experience is that many teams do not. They may talk about ‘using CAPA principles’ or call it CAPA-lite. We know this leads to problems – often a sense that CAPA “does not work” – with, frequently, internal or external waits and stress in staff. Plus service users do not experience a service that is truly transformed nor working collaboratively with them in a Choice framework of shared decision making, participation and a personalised service focused on their goals and choices.

Sometimes the reason for only applying ‘principles’ is rooted in a reluctance to change and a belief that things are working ‘well’ as they are. This is more likely when services do not have a problem with waiting lists and ignore the other gains of CAPA, including the most important one of a shift to truly collaborative practice.

When services have current ways of working that are embedded in core values that have high legitimacy and have been around for a long time these can result in significant challenges to accepting new insights, ideas and approaches (Novotná, 2012). This may not always be apparent – much anxiety about change in practice to a more collaborative way of working is couched in terms of ‘safety’, ‘not being professional’ and ‘loss of quality’ with no evidence for current service practice providing these things anyway. And, of course, this implies believing CAPA is not improving quality and may be unsafe (which is untrue). Other reasons may be a belief that the service is not quite like other teams or their clients are ‘not like those in other services’ (more deprived, or more demanding or more ‘complex’).

In the extensive experience we have in working with teams all around the world, we know that CAPA works in any setting, culture, health organisational system and language. However, we find that the key components of CAPA that teams find most challenging to implement are

  1. Working in a Choice framework
  2. Changing language
  3. Full booking from Choice to Partnership (including monitoring this)
  4. Small group peer discussion
  5. Team Job Planning (including doing a clinical skills mix analysis and keeping the team job plan up to date)
  6. Having Team Away days

Some services do not do any or some of these but still consider they are ‘doing CAPA’! We would say not…

Capa-ccino

Capa - ccinno

In one of our workshops a clinician said that we should call such CAPA-lite implementations, Capaccino because they have

Less coffee in them and

A frothy top that belies the lack of substance inside!

CAPA- lite does not work!

Your recipe

Having said this, we feel that implementing CAPA is like cooking. When you start you need to follow the recipe exactly – weighing everything, cooking for the exact amount of time and so on. Then you get more experienced and start to amend the flavours to your own taste. Eventually, you under- stand the chemistry of cooking and it becomes your own recipe. So with a CAPA implementation- start with the basic recipe and only when you are familiar start adapting it. The ‘chemistry’ is the 11 Key Components – you need them all for the dish but how exactly you combine them will vary!