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National and local policy supports the involvement of patients at all levels in the design, delivery and improvement of health services. Whilst existing approaches to support involvement have been described and disseminated, including the 4Pi National Involvement Standards, their application in quality improvement is rarely reported. The paper aims to discuss this issue.

A quality improvement initiative within a mental health trust was developed with a multi-disciplinary team, including those with professional experience of delivering or improving care and those with lived experience. The aim of the initiative was to improve the physical health of inpatients within an acute mental health unit. This case study aims to describe how the integration of concepts from the 4Pi National Involvement Standards (Principles, Purpose, Presence, Process and Impact) provided a framework for engaging and involving service users. The case study also aims to describe how co-design was included within the 4Pi approach and supported the development of a tool to aid improving physical healthcare.

The 4Pi National Involvement Standards provided a guiding framework for the involvement of service users within a quality improvement initiative. Value of the approach was realised through the co-design of a tool developed by service users, along with healthcare professionals, to facilitate discussion and support shared-decision making about inpatients’ physical health.

Identifying “ways that work” for service user involvement is crucial to move beyond the policy rhetoric or tokenistic involvement. Involvement in quality improvement initiatives can bring benefits both to services and the service users themselves.

Whilst the 4PI approach is recognised as a useful framework for involvement, few examples exist of its practical applications within a quality improvement setting.

In the present chapter, we argue that Black college women's experiences with microaggressive racial discrimination are best understood through the lens of intersectionality, which emphasizes the interrelations between race and gender. We use a focus group method with 20 Black female students (mean age=20) from two different settings: a four-year university and a community college both located in the same college town. This qualitative approach allows us to understand Black women's experiences in more detail and to gain insight into how microaggressions are lived on a daily basis during college. Our findings affirm that in and around college campuses, many Black female students regularly encounter microaggressive forms of discrimination unique to being Black and female, which communicate messages of inferiority, criminal status, abnormal cultural values, and rigid stereotypes. We conclude with suggestions for what colleges and universities should do in order enhance support services and create a more inclusive environment.