prospective risk assessment in a mental heath trust a study about ways to improve the quality of...
TRANSCRIPT
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Prospective Risk Assessment in a Mental Heath Trust
A Study About Ways to Improve the Quality of Care in Mental Health Services
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This research is a CLAHRC fellows project and the fellow is Dr Jenny Spencer.
The Project PI is Dr Terry Dickerson, Assistant Director of the University of Cambridge Engineering Design Centre.
The project Sponsor is Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) through the NIHR CLAHRC for Cambridgeshire and Peterborough.
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What We Did
AimTest whether two methods for prospectively identifying risk could be efficaciously adapted to a mental health environment.
Goal 1. Verify and validate the use of these tools in a mental health setting.2. Ideally, improve patient safety and the quality of clinical care in mental health settings.
Outcome measures
Primary – Comparison of managerial Prospective Hazards Analysis and clinical staff Quality Assurance Data Collection results.
Secondary – Change in Patient Safety Culture using MAPSAF. Change in the number and severity of reported near misses and SUIs.
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Aim of the Study
Hazards List
NumberBrief
SummaryDescriptio
n
Most likely worst case Consequen
ceProbabilit
y Severity
Current Layer of
protection l
Teams affected
Environments
Change required
Implemented
Hazard 001
Patients might..
Feel suicidal .. Death Likely Severe CPN, 6
years AO, Crisis Community
Hazard 002
Staff might..
assess a skin
condition ..
First aid Certain Minor Jr Dr (SHO)
Old Age, Adult Inpatient
.. .. .. .. .. .. .. .. ..
Hazards List
NumberBrief
SummaryDescriptio
n
Most likely worst case Consequen
ceProbabilit
y Severity
Current Layer of
protection l
Teams affected
Environments
Change required
Implemented
Hazard 001
Patients might..
Feel suicidal .. Death Likely Severe CPN, 6
years AO, Crisis Community
Hazard 002
Staff might..
assess a skin
condition ..
First aid Certain Minor Jr Dr (SHO)
Old Age, Adult Inpatient
.. .. .. .. .. .. .. .. ..
Compare and contrast
• Classify problems using WHO patient safety classification system
• Add or change categories as needed
Prospective Hazards Analysis Quality Assurance Data Collection
Health Services Research: Evidence Based Practice
Assess the Clinical Safety and Effectiveness of the Quality Assurance methods under study using Adequate and Appropriate Research techniques (Quantitative, Qualitative and/or Mixed Methodologies)
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Main Study Flowchart
QA Arm - Control• Cambridgeshire North
• No Intervention• Out-of-Hours Service
• CR&HT Service
2011 2013Oct Jan Feb Mar Apr May Jun
Jul Aug SepProject Setup• Project Protocol• QA Tool Design
• CPFT Permissions• Peer Reviews• Ethical Review Routine Quality Indicators
Setup | Collection and Monitoring
QA Arm - Intervention• Cambridgeshire South
• QA Intervention• Out-of-Hours Service
• CRHT Service
QA Arm - Control• Cambridgeshire North
• No Intervention• Out-of-Hours Service
• CRHT Service
PHA Arm• Consists of a management
workshop• Takes place early in this period
QA
Int
erve
ntio
n E
valu
atio
n•
Obj
ectiv
e 2
PH
A E
val.
•
Obj
ect
ive
1
Project Reporting• Formal
• Objectives 1, 2 and 3
= MaPSaFTimings are indicative
Blinding (as far as practicable)
Blinding (as far as practicable)
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The Challenges We Faced
Project size and goals (? too big)
Project Set up (1 year)
• Ethics approval, Sponsorship, Peer review, Indemnity/Insurance, Grant Contracts, Feasibility, Commercial charges, Service Support Costs, Identification of PI, Letters of access/Honorary Research contracts
Service provider buy-in
Staff engagement
Changes initiated by other people
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What We LearnedResults: Problem classification
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What We LearnedResults: PHA vs QADC concerns
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A - Path
ological
B - Rea
ctive
C - Burea
ucratic
D - Proac
tive
E - Gen
erative
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Manchester Patient Safety Framework Culture Assessment:
Results from all teams, pre-InterventionAll 'Team' results (n=40)All 'Organisation' (CPFT, n=40)
MaPSaF Levels
% o
f Vot
es C
ast
MaPSaF evalustion results from all services and all nine dimensions agglomerated.
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A - Path
ological
B - Rea
ctive
C - Burea
ucratic
D - Proac
tive
E - Gen
erative
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%Manchester Patient Safety Framework Culture Assessment:
Results from all teams, pre-InterventionResults for all teams (n=40)Results for all CPFT (n=40)
MaPSaF Levels
% o
f Vot
es C
ast
All MaPSaF evalustions results for dimension :5) Communications aglomorated.All MaPSaF evalustions results for dimension :5) Communications aglomorated.All MaPSaF evalustions results for dimension :7) Staff and safety issues agglomerated.
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Conclusion
• The success of the project is still being assessed• Use of the PHA tools revealed differences in safety
concerns between management and staff• Management concerns primarily revolved around
staffing issues• Frontline staff concerns included staffing issues
and other issues such equipment management• Culture assessment data revealed
• Concerns around patient and staff safety• Team safety was rated higher than
organisational safety• We plan to compare PHA results with trust safety
data
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“Design for Patient Safety” Department of Health 2003
Thank you for listening.