NHSScotland Event 2015 LEADING INTEGRATION FOR QUALITY B:6 Safe and Sound for Integration – Successes and Next Steps

What does integration this mean to you ? Where are the big opportunities for us in relation to safety ?

Safer Use of Medicines HAI

Integration = opportunity

Singer, Burgers,Friedberg, Rosenthal, Leape, Schneider; Framework for Measuring Integrated Care, Medical Care Research and Review (1) There is a risk of conflating delivery processes and systems with their product – care for people and patients. Integration of organisations or organisational activities may not result in integration of care delivered.

A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013 Will care be safer in the future ? Anticipation and Preparedness Is care safe today ? Sensitivity to operations Are our clinical systems and processes reliable? Reliability Are we responding and learning and improving? Integration and Learning Has care been safe in the past ? Past Harm

A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013 Present Alison Hunter Angela Cunnigham

Reliability Able to be trusted; predictable or dependable (Collins English Dictionary) The concept of reliability has been transferred to the health system world wide from safety conscious industries like aviation and nuclear power. It is not a concept that sat comfortably in health, however it is transferable to any system.

So what does reliability have to do with safety? Reliability is not sufficient to ensure safety, it is however a essential foundation. Having the information or equipment you need every time you meet a service user makes it easier to do the right thing.(the system is reliable) Not having it involves workarounds and deviations, often causing no adverse outcome.( the system is unreliable) Over time we normalise deviations to the margins of safety until eventually something goes wrong and is then seen as reckless or negligent.(the system is unsafe )

So you think your system is reliable?

So did I!!! Then I discovered we did not have a working definition for the booking visit. For me it was the 1 st point of contact with a Midwife. For the Midwife it was the 1 st scan appointment, up to two weeks later. We also had not provided every Midwife with the tools to do the right thing, so we had a work around.

Every system is perfectly designed to deliver the results it produces (Deming) What level of reliability is your system designed to deliver? Is that sufficient to keep service users and staff safe?

Sensitivity to operations – ‘collective mindfulness’ The gathering of usable information Processes to support rapid action on information Examination of transient system features Staff behaviours and attitudes Perceptions of people receiving care Capacity of the system to respond

Present Safety - How are you already improving present safety What other opportunities do you have to think about and improve present safety

A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013 Present Alison Hunter Angela Cunnigham

A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013 Past and Future Jill Gillies David Hall

Past Harm

What are triggers... >3 consultations New high priority read code Allergy read code Repeat medication item discontinued OOH / A&E attendance Hospital admission Optional trigger(s)

Findings 54 (96.43%) of practices had completed at least one trigger tool review by January 2015 and a second trigger tool review by March % of TT reviews had 4 or more patient safety incidents 38% moderate or severe harm 50% preventable in Primary care NHS Forth Valley, June 2015

Seemed a bit intimidating when we first had it presented to a large group … much easier to use in practice … it’s a remarkably effective tool for reflective analysis on patient safety and other clinical issues.’ Gordon Cameron, General Practitioner, Edinburgh

Future Harm

Patients are and feel safe, Staff feel and are safe

Safer Medicines ManagementRisk Assessment and Safety Planning Restraint and SeclusionCommunication at Transitions Leadership and Culture

74% increase 54% reduction63% reduction 57% reduction

As noted in the Mental Health Strategy for Scotland , ‘…People with mental disorders have a much higher mortality than the general population, dying on average more than 10 years earlier. The Scottish Government made a commitment to take forward work on the physical health of people with mental illness in Delivering for Mental Health, where commitment 5 stated: Commitment 5: We will improve the physical health of those with severe and enduring mental illness by ensuring that every such patient where possible and appropriate has a physical health assessment at least once every 15 months.

Staff feel and are safe, patients are and feel safe

Present Safety - How are you already improving past and future safety ? What other opportunities do you have to think about and improve past and future safety

A framework for the measurement and monitoring of safety Source: Vincent C, Burnett S, Carthey J. The measurement and monitoring of safety. The Health Foundation, 2013 Past and Future Jill Gillies David Hall

Wrap Up