Prospective Risk Assessment in a Mental Heath Trust A Study About Ways to Improve the Quality of Care in Mental Health Services

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.

What We Did Aim Test 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.

Aim of the Study Hazards List Number Brief Summary Descriptio n Most likely worst case Consequen ce Probabili tySeverity Current Layer of protectio n l Teams affected Environme nts Change required Implemen ted Hazard 001 Patients might.. Feel suicidal.. DeathLikelySevere CPN, 6 years AO, Crisis Communit y Hazard 002 Staff might.. assess a skin condition.. First aidCertainMinor Jr Dr (SHO) Old Age, Adult Inpatient.. Hazards List Number Brief Summary Descriptio n Most likely worst case Consequen ce Probabili tySeverity Current Layer of protectio n l Teams affected Environme nts Change required Implemen ted Hazard 001 Patients might.. Feel suicidal.. DeathLikelySevere CPN, 6 years AO, Crisis Communit y Hazard 002 Staff might.. assess a skin condition.. First aidCertainMinor 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 AnalysisQuality 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)

Main Study Flowchart QA Arm - Control Cambridgeshire North No Intervention Out-of-Hours Service CR&HT Service OctJanFebMarAprMayJunJulAug Sep Project 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 Intervention Evaluation Object ive 2 PHA Eval. Objective 1 Project Reporting Formal Objectives 1, 2 and 3 = MaPSaF Timings are indicative Blinding (as far as practicable)

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

What We Learned Results: Problem classification

What We Learned Results: PHA vs QADC concerns

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

“Design for Patient Safety” Department of Health 2003 Thank you for listening.