Slides from the session at the International Forum on Quality and Safety in Healthcare 2016 (Gothenburg) - Improving mental health through patient and professional partnerships

2. WIFI Network – International Forum
WIFI Password – forum2016
Join in the conversation on twitter and Sli.do
Twitter - #mhimprove
Sli.do code - mhimprove
Session M6 : Improving Mental Health Through Patient And
Professional Partnerships

4. World Cafés
World cafés –
• Service user engagement/Co-Production
• Data and measurement
• Violence and restraint reduction
• Trigger Tools/Deteriorating patients
• Improving physical health
• Suicide prevention/reduction
• Safer medicines (psychotropic as required)

5. Time Topic
1330 Welcome – Johnathan MacLennan and Amar Shah
1340 Safety and quality in mental health matters… - Paul Binfield
1350 Quick fire presentations from:
Intermountain Healthcare, USA
Quality & Safety GGZ Zorgnet-Icuro, Belgium
South London and Maudsley NHS Foundation Trust, England
Institute of Mental Health, Singapore
Devon Partnership Trust, England
East London NHS Foundation Trust
HSC Safety Forum, Northern Ireland
SPSP-Mental Health, Scotland
Danish Society for Patient Safety, Denmark

6. Time Topic
1440 World café introductions
1450 World cafés –
• Service user engagement/Co-Production
• Data and measurement
• Violence and restraint reduction
• Trigger Tools/Deteriorating patients
• Improving physical health
• Suicide prevention/reduction
• Safer medicines (psychotropic as required)
1520 Coffee Break
1540 World cafés (repeat of sessions)
1625 Feedback and Q&A
1645 Closing Remarks – Gordon Johnston

7. Mental Health Integration
Normalizing Team Based Care at Intermountain
Brenda Reiss-Brennan, PhD, APRN
Mental Health Integration Director
Primary Care Clinical Program

8. What is Mental Health Integration?
A standardized clinical and operational team process that incorporates
mental health as a complementary component of wellness & healing
Quality
Experience Cost

9. IMPROVING OUTCOMES &
BENDING THE COST CURVE
Evidence-based
Care Process
Models

10. N = 414,000 “My doctor was the first person to
treat me as a whole person…….” (Routinized MHI Team)
Life functioning better (p<.05)
Treated Normal (p < .001)
I am connected to a team that
talks to each other (p < .05)
They follow up and find we find a
solution (p < .05)
We are on same page & happier
(p<.05)

11. Team performance towards Routinization
Progression of Team-Based Care in the Intermountain Delivery System

12. -11%
-22%
-21%
+4%
+13%
-11%
1
Emergency
Visits
Hospital
Admits
PCP
Visits
Urgent
Care
Visits
Radiology
Tests
Avoidable
Visits and
Admissions
More Effective Utilization of Healthcare Services
An investment of $22 per-member-per year (PMPY)
decreased medical expenses by $115 PMPY

13. Multiple Team Touches
(p < .001)

14. Introduction in the Flemish Quality
Indicator Project for Mental Healthcare
Peter Cosemans

15. Challenge of Mental Healthcare
• Mental disorders are one of the
greatest public health challenges
• Strong focus on Quality of Care and
reform of mental healthcare
• Implementing a core set of quality
indicators for mental healthcare is
needed for enhancing QoC and
creating transparency.
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare15

16. Belgian Health System Performance
• Some mental health indicators
are alarming
• Number of suicides remains high;
• The number of admissions to
psychiatric hospitals is still
increasing;
• The use of antidepressants
increases;
• The waiting lists for outpatient
services remain long.
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare16

17. Quality Indicator project
• In 2012 Flemish mental Healthcare expressed an urgent need for
relevant and meaningful quality indicators to improve and monitor
the quality of care.
• Goals of this QI-Project
• Engagement of all stakeholders
• Enhancing the quality of care by stimulating the use of Quality Indicators
• Transparency
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare17

18. Developing QI in working groups
• 6 Working groups were founded in 2013;
• Each working group is chaired by a psychiatrist;
• All stakeholders are invited to participate in a working group
(Professionals, patients, Mental healthcare organisations);
• Goal: Development and validation of specific & relevant Quality
Indicators for Mental Healthcare around a specific domain in Mental
Healthcare.
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare18

19. 6 working groups for developing QI’s
• Coordination & continuity
of care
• Patients safety
• Patient participation
• Depression
• Behaviour disorders
• Patient perspectives on
Quality of Care
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare19
OW
Indicatorenforum
Bureau
OW OW OW OWC&C
Patient
Safety
PP Depression
Behavior
disorders
• Chairman: Psychiatrist
• Coordinator: professional with an
other professional background.

20. First Quality Indicators will be
implemented in 2016
Continuity &
coordination
Patient-
participation
Patient
Safety
Depression
Behavior
disorders
Patient
perspectives
• Peer Support
• Shared decission
making
• Completeness of a
medication prescription
• Completeness of a suicide
prevention policy
Timely ambulant contact after
discharge from psychiatric
hospital
• Treatment
guidelines
ADHD, ODD of
CD
• Involvement of family
• Patient survey on
experienced quality of
care
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare20

21. Cross sectorial participation in
initial measurements
21
Total PZ PAAZ CGG PVT REVA IBW
77
Patient survey on experienced quality
of care
25 15 9 7 9 11
57
Timely ambulant contact after
discharge from psychiatric hospital
29 19 8 1
70
Completeness of a suicide prevention
policy
30 17 10 9 2 1
47
Completeness of a medication
prescription
25 15* 7
51 Peer support 21 6 6 5 8 4
Total 32 22 14 11 9 12
(%) 91.4 64.7 70.0 45.8 100.0 26.7
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare

22. Lessons learned
Strengths
• It is possible to engage all
stakeholders in a well conducted
QI-Project;
• Creating openness, transparency
and accountability in MH
organisations;
• Sharing knowledge and best-
practices.
Attention needed
• Validity and feasibility of Quality
Indicators;
• More process- and outcome
indicators are needed;
• Need for transmural QI.
• Between mental & somatic
healthcare;
• Between all actors of mental
healthcare.
• Building a supportive context
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare22

23. Future development
• Further sustainably and structural
enhancing Quality of Care
• By reporting & benchmarking on QI’s
• Creating transparency
• Results of QI will be public available.
• Further development of
meaningful QI’s
• Participation of professionals and
patients
• New domains (e.g. link between
somatic and mental health care)
www.zorgkwaliteit.be
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare23

24. Partners in QI-Project
Vlaams Minister van Welzijn, Volksgezondheid en Gezin
12/4/2016Introduction Flemish Quality Indicator Project for Mental Healthcare24

25. Peter Cosemans
Prof. Dr. Dominique Vandijck
Prof. Dr. Geert Dom

26. Suicide Reduction Programme
Dr M Holland
Deputy Medical Director

27. What does this cover?
• 4 Boroughs in South London – Lambeth, Croydon, Southwark and
Lewisham
• Over 1 million population
• High Levels of deprivation
• Current suicide rate 7.0 per 100,000 population

28. Approach
• Population based approach drawn from Detroit
programme and Hong Kong programme
• Multi-agency collaboration with local Primary care
groups, Local Authorities, Police and Third sector
organisations

29. • Risk Identification and Planning
• Risk communication
• Physical health
• Alcohol and Substance Misuse access
• Treatment close to home
Internal Improvements

30. • Family and Carer Involvement
• Bereavement post-suicide
• Access in Crisis
• Data
Internal Improvements

31. Future
• Automated detection through EPR mining

32. Institute of Mental Health (IMH)
Singapore
Adj A/Prof Chua Hong Choon
Chief Executive Officer

33. Singapore’s ONLY Tertiary Psychiatric Institution
IMH Today

34. HOSPITAL-BASED SERVICES
• General Psychiatry • Child & Adolescent Psychiatry
• Community Psychiatry • Geriatric Psychiatry
• Forensic Psychiatry • Rehabilitation Psychiatry
• Early Psychosis Intervention • Addiction Medicine
• Psychotherapy • Emergency Psychiatry
• Allied Health
COMMUNITY-BASED SERVICES
YOUNG
Response, Early Intervention and Assessment
in Community Mental Health (REACH)
• Provides help for students with emotional, social and
behavioural issues and disorders
Support for Wellness Achievement Programme
(SWAP)
• Provides help for individuals between 16 and 30 with at-risk
mental states
Community Health Assessment Team (CHAT)
• Promotes mental health awareness among youths, and
encourages them to seek help early
ADULTS
Community Mental Health Team
(CMHT)
• Treats patients in the community and keeps
them well there for as long as possible
Job Club
• Assists individuals with mental illness obtain
and sustain employment, or provide support
as required in their work
GP-Partnership
• Joint collaboration between IMH and GPs to
manage patients with stabilised mental
conditions in the community
ELDERLY
Aged Psychiatry Community
Assessment and Treatment
Service (APCATS)
• Provides assessment and treatment
for homebound or frail elderly
patients with mental disorders
National Mental Health Blueprint Programmes
Clinical Services Overview

35. Living Well Living with Illness Crisis Care Living with Frailty; End
of Life Care
Promote mental wellness
Increase resilience
Prevention of mental
health issues & dementia
Early identification
Skills & tools for self-
management
Rehabilitation recovery &
re-integration
Prompt, responsive
system
Access to ILTC services
Caregiver support
Living Well Living with Illness Crisis Care Living with Frailty;
Dying Well
Preventive Care Outpatient
Care
Primary /
Community
Support Care
Emergency
Care
Inpatient
Care
Intermediate-long Term Care
(ILTC) / Community Support
Care
Schizophrenia
Major Depressive Disorder
Generalised Anxiety Disorder
Neurodevelopmental Disorder
Dementia
Addictions
MOHNHG/IMH
Population Health Approach

36. Our Quality and Patient Safety Journey
(Adapted from National Healthcare Group)
Quality and Safety Framework Quality and Patient Safety Priorities

37. Functional
• Global Assessment Scale (GAS)
Clinical
1) Process
• % of tertiary patients (inpatient)
• % of tertiary patients (outpatient)
2) Outcome
• Clinical Global Impression (CGI)
• Service gaps for major mental
disorders
• Readmission within 30 days
• Adverse events
• Patient Mortality Rate
• Average Length of Stay
• Patients Life Expectancy
• Duration between discharge and
readmission
3) HPO
• Proportion of Short-stay subsidised
inpatients (with ALOS <4 days)
assessed by Specialist within
24 hours of Arrival in the Ward
• Proportion of Subsidised Inpatients
(with ALOS >= 4 days) assessed by
specialist within 24 hours of arrival
in the ward AND seen by specialist
at least once every 3 days thereafter
• Proportion of subsidised SOC patients
reviewed by specialist at first visit
• Proportion of subsidised SOC patients
reviewed by specialist at least once
every three visits
Satisfaction
• Patient Satisfaction Score
Cost
• Cost to patient – Bill Size
• Cost to organisation
How We Measure Up
Clinical Value
Compass

38. Using statistical process control chart in measurement
In the past…
Run chart
• Simple
• Incapable of showing if the process was stable and in
control
• Tends to cause over- or under-reaction to data
Now…
Control chart
• Slightly more complex
• Separates process variation attributed to assignable
causes from that caused by background noise
• Tells readers when actions need to be taken

39. Clinical Practice Improvement Programme
Challenges
• Sustainability of the improvements
• Spread
• Continued involvement in CPIP
Moving Forward
• Building expertise in facilitation
• Sustainability – integrate solution into
processes
• Spread – develop strategies; leadership
involvement
• Continued involvement in CPIP – simplify
project process; change end goal to
inspiring staff

40. A leader in mental health care
in Singapore, the region, and the world
A tertiary mental healthcare
centre of excellence
IMH Vision 2020
Population
Health

41. Thank You

42. Welcome to ELFT QI

43. Mental health services
Newham, Tower Hamlets, City & Hackney, Luton & Bedford
Forensic services
All above & Waltham Forest, Redbridge, Barking & Dagenham, Havering
Child & Adolescent services, including tier 4 inpatient service
Regional Mother & Baby unit
Community health services Newham
Urgent care centre
Newham
IAPT
Newham, Richmond and Luton
Speech & Language
Barnet

44. The culture we want to nurture
A listening and learning organisation
Empowering staff to drive
improvement
Increasing transparency and
openness
Re-balancing quality control,
assurance and improvement
Patients, carers and
families at the heart of all
we do

46. AIM:
To provide
the highest
quality
mental
health and
community
care in
England by
2020
Build the will
Build
improvement
capability
Alignment
QI Projects
1. Newsletters (paper and electronic)
2. Stories from QI projects - at Trust Board, newsletters
3. Annual conference
4. Celebrate successes – support submissions for awards
5. Share externally – social media, Open mornings, visits, microsite,
engage key influencers and stakeholders
1. Build and develop central QI team capability
2. Online learning options
3. Pocket QI for those interested in QI
4. Improvement Science in Action waves
5. Develop cohort and pipeline of QI coaches
6. Bespoke learning, including Board sessions & commissioners
1. Embed local directorate structures & processes to support QI
2. Align projects with directorate and Trust-wide priorities
3. Support staff to find time and space for QI work
4. Support deeper service user and carer involvement
5. Support team managers and leaders to champion QI
6. Align research, innovation, improvement and operations
Reducing Harm by 30% every year
1. Reduce harm from inpatient violence
2. Reduce harm from pressure ulcers
3. Other harm reduction projects (not priority areas)
Right care, right place, right time
1. Improving access to services
2. Improving physical health
3. Other right care projects (not priority areas)

47. 155
Active
Projects
REDUCE HARM BY
30% EVERY YEAR
9
PHYSICAL
HEALTH
ACCESS TO
SERVICES
PRESSURE
ULCERS
VIOLENCE
REDUCTION
3 19 18
26
REDUCE HARM BY
30% EVERY YEAR
129
Our QI Projects

48. 0
10
20
30
40
50
60
05-…
07-…
14-…
02-…
07-…
14-…
24-…
10-…
11-…
20-…
22-…
15-…
18-…
06-…
24-…
13-…
18-…
23-…
01-…
05-…
11-…
23-…
26-…
14-…
11-…
06-…
27-…
16-…
22-…
04-…
17-…
28-…
12-…
05-…
18-…
16-…
14-…
30-…
03-…
02-…
23-…
05-…
21-…
14-…
Timebetweenevents/days
3 days
8 days
5.8 2.4
UCL
LCL0
2
4
6
8
10
12
14
16
06-Jan-14
20-Jan-14
03-Feb-14
17-Feb-14
03-Mar-14
17-Mar-14
31-Mar-14
14-Apr-14
28-Apr-14
12-May-14
26-May-14
09-Jun-14
23-Jun-14
07-Jul-14
21-Jul-14
04-Aug-14
18-Aug-14
01-Sep-14
15-Sep-14
29-Sep-14
13-Oct-14
27-Oct-14
10-Nov-14
24-Nov-14
08-Dec-14
22-Dec-14
05-Jan-15
19-Jan-15
02-Feb-15
16-Feb-15
02-Mar-15
16-Mar-15
30-Mar-15
13-Apr-15
27-Apr-15
11-May-15
25-May-15
08-Jun-15
22-Jun-15
06-Jul-15
20-Jul-15
03-Aug-15
17-Aug-15
31-Aug-15
No.ofIncidentsper1000OBD
MHCOP service
Tower Hamlets collaborative
Time between incidents of physical violence on an inpatient
adult mental health ward (Globe ward) – T chart
Time between incidents of physical violence on three older
adult mental health wards – T chart
Rate of incidents of physical violence across all four adult
inpatient mental health wards in Tower Hamlets – U chart

49. 67.8
51.1
UCL
LCL
25
35
45
55
65
75
85
95
06-Jan-14
20-Jan-14
03-Feb-14
17-Feb-14
03-Mar-14
17-Mar-14
31-Mar-14
14-Apr-14
28-Apr-14
12-May-14
26-May-14
09-Jun-14
23-Jun-14
07-Jul-14
21-Jul-14
04-Aug-14
18-Aug-14
01-Sep-14
15-Sep-14
29-Sep-14
13-Oct-14
27-Oct-14
10-Nov-14
24-Nov-14
08-Dec-14
22-Dec-14
05-Jan-15
19-Jan-15
02-Feb-15
16-Feb-15
02-Mar-15
16-Mar-15
30-Mar-15
13-Apr-15
27-Apr-15
11-May-15
25-May-15
08-Jun-15
22-Jun-15
06-Jul-15
20-Jul-15
03-Aug-15
17-Aug-15
31-Aug-15
14-Sep-15
28-Sep-15
12-Oct-15
26-Oct-15
09-Nov-15
23-Nov-15
07-Dec-15
21-Dec-15
04-Jan-16
18-Jan-16
01-Feb-16
No.ofIncidents
Incidents resulting in physical violence (Trust-wide) - C Chart
VIOLENCE REDUCTION
150
200
250
300
350
400
450
500
550
2013 2014 2015
No.ofIncidents
Physical violence to patients (per 100,000 occupied
bed days)
300
400
500
600
700
800
900
2013 2014 2015
No.ofIncidents
Physical violence to staff (per 100,000 occupied bed
days)
25% reduction

50. Medication safety

51. PRESSURE ULCERS
57.30%
73.10%
92.01%
UCL
LCL
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
28-Apr-14
19-May-14
09-Jun-14
30-Jun-14
21-Jul-14
11-Aug-14
01-Sep-14
22-Sep-14
13-Oct-14
03-Nov-14
24-Nov-14
15-Dec-14
05-Jan-15
26-Jan-15
16-Feb-15
16-Mar-00
06-Apr-15
27-Apr-15
18-May-15
08-Jun-15
29-Jun-15
20-Jul-15
10-Aug-15
31-Aug-15
21-Sep-15
12-Oct-15
02-Nov-15
11-Jan-16
CompletionRate/%
Waterlow Completion Rate - P Chart
3.5
2.5
UCL
LCL0
1
2
3
4
5
6
7
8
9
10
07-Apr-14
21-Apr-14
05-…
19-…
02-Jun-14
16-Jun-14
30-Jun-14
14-Jul-14
28-Jul-14
11-…
25-…
08-…
22-…
06-Oct-14
20-Oct-14
03-…
17-…
01-…
15-…
29-…
12-Jan-15
26-Jan-15
09-Feb-…
23-Feb-…
09-Mar-…
23-Mar-…
06-Apr-15
20-Apr-15
04-…
18-…
01-Jun-15
15-Jun-15
29-Jun-15
13-Jul-15
27-Jul-15
10-…
24-…
07-…
21-…
05-Oct-15
19-Oct-15
02-…
16-…
30-…
14-…
No.ofPressureUlcers
Grade 2 Pressure Ulcers - C Chart

52. ACCESSTOSERVICESCOLLABORATIVE
- Baseline data
32.21%
25.23%
UCL
LCL
19%
24%
29%
34%
39%
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
DNA/%
% of 1st face to face appts DNAs (Collaborative, 9/11 teams) - P Chart
1021.7
1213.1
UCL
LCL
700
800
900
1000
1100
1200
1300
1400
1500
1600
1700
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
No.ofReferrals
No. of referrals received (Collaborative, 9/11 teams) - I Chart
60.7
51.0
UCL
LCL
40
45
50
55
60
65
70
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
Jan-16
Feb-16
AverageWaitingTime/Days
Average waiting time from referral to 1st face to face appt (Collaborative, 9/11 teams) - X-bar Chart
ACCESS TO SERVICES
16% reduction
18% increase
7% decrease

53. PHYSICAL HEALTH

54. Little i
Regularly
consulted during
lifetime of the
project
Big I
Act as a full member
of the QI project team
Surveys
Focus
groups
Community
meetings
Service
user
forum
Service user input in projects

55. @ELFT_QI qi.elft.nhs.uk qi@elft.nhs.uk

56. Gothenburg
April 2016

58. Currently:
 Reviewing and renewing our Trust Quality Strategy (2016-
2020)
 Strategy will cover areas such as leadership, culture, strategy
and policy, structure, resource, capacity and capability,
communication etc
 Translation of Trust mission/Aim into Board to client side
objectives

60.  Workshops-Senior managers to identify key drivers and
priority areas and translate Board aims into Board objectives
 Staff/Service user meeting to develop question/prompts for
staff and service user/carers to input their ideas via survey
monkey/workshops
 Staff/Service user and carers to have a voice on what should
inform the strategy-survey monkey etc

61.  Review of the outputs from staff and service user engagement
events(our journey, staff forums, LIA)
 Directorate led workshops with staff to translate Board
objectives into Directorate and team level objectives

62.  4 strand programme of Quality improvement
 Address areas of avoidable harm
 Addressing major systems issues-Referral to assessment
times, referral to treatment
 Building staff and team capability
 Building team effectiveness-Observed team behavioural rating
scale, human factors and simulation

63. UCL
19.089
CL
9.731
LCL
0.373
0
5
10
15
20
25
30
35
Number
Apr-12 - Jan-16
All OPMH ward Exc BV Jan 16

64. UCL
118.503
CL
90.037
LCL
61.571
-9.05
10.95
30.95
50.95
70.95
90.95
110.95
130.95
percetnagereconciled
Apr-11 - Apr-15
Haytor Medication Reconciliation 72 hours

65. 0
5
10
15
20
25
30
35
Sep-15 Oct-15 Nov-15 Dec-15
Databycategory
Month
Holcombe safety cross
Green
Amber
Red

69.  Are the targets and measures right?
 What other social media processes could we use to improve
the level of feedback-ensure people have a voice
 Are there any glaring gaps in our approach to developing the
strategy

70. Establishing an improvement
collaborative in
mental health services.
Dr GG Lavery & Ms Janet Haines-Wood
HSC Safety Forum
Public Health Agency, N.Ireland

71. Unscheduled
Care
Community
Care
Maternity
Care
Paediatric
Care
Mental
Health
Primary
Care
Scheduled
Care
HSC SAFETY FORUM
QUALITY IMPROVEMENT FRAMEWORK

72. What do we do?
Promote Quality Improvement (QI)
 Engage staff
 Help design reliable processes & systems
 Facilitate standardisation/reduce variation
 Use data to uncover the real story

73. C/Section rate by month
0
5
10
15
20
25
30
35
40
45
Aug-09
Oct-09
Dec-09
Feb-10
Apr-10
Jun-10
Aug-10
Oct-10
Dec-10
Feb-11
Apr-11
Jun-11
Aug-11
Oct-11
Dec-11
Feb-12
Apr-12
Jun-12
Aug-12
Oct-12
Dec-12
Feb-13
Apr-13
Jun-13
Aug-13
Oct-13
Dec-13
Feb-14
Apr-14
Jun-14
Aug-14
Oct-14
Dec-14
Feb-15
Apr-15
Jun-15
Aug-15
%

74. 0
20
40
60
80
100
120
BMI
Collaborative began early 2014

75. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
BP
PHYSICAL HEALTH MONITORING
Blood Pressure

77. 0%
10%
20%
30%
40%
50%
60%
70%
Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15
HPP given out
HEALTH PASSPORT (HPP) ON TRANSFER

78. *
*

79. Male suicide in NI:
30% between 15-29 yrs

80. KEY THEMES:
Communication
Care Planning
Policy Adherence
Record Keeping
Risk Assessment

81. RECOMMENDATIONS (synopsis):
Role of Team Manager
 Teams need to be given time to reflect
on their practice and Team Leaders/Ward Managers
should facilitate their staff at team meetings
to reflect on practice
Patient Journey
 Services need to be organised to minimise the number
of handovers, ensure continuity of care and clarity of roles
and responsibilities. All patients should have a named
nominated person, who will be a constant, to co-ordinate their care
Quality of Investigation Reports
 Teams should follow root cause analysis process to address
systemic, contextual and cultural contributors to care as
well as individual practice

82. AIM:
To improve
the culture of
learning and
reflective
practice
in mental
health
services
CULTURE
COMMUNICATION
(with patients, family,
carers & friends)
COMMUNICATION
(between HSC staff,
teams and with other
agencies)
LEADERSHIP
• Agree core components for QI training
• Train the trainers
• Human Factors Training
• SBAR/SBARD training
• Build confidence in communication
• Mentoring
• Information provided to families & carers
• Family /carer engagement
• Measurement of current strategies
• Involve families in all SAI reviews
• Transitions of care/Handovers
• Safety briefings
• Named co-ordinator for all complex cases
• Safety plans and appropriate sharing of
same (regional work ongoing in this)
• Leadership - support for QI work
• Transformational leadership training for key
staff
• Measurement of safety and quality
• Review what is currently measured
• Support for reflective practice
• Debriefings
COMPETENCE
• Staff Safety Climate Survey
• Patient Safety Climate Survey
• Positive risk taking
• Followership
Ver 8

83. PROPOSED MEASURES
• Staff Safety Culture Survey
• Safety Briefings/SBARD
• Reflective practice

84. Description
What
happened?
Feelings
What were
you thinking
and feeling?
Evaluation
What was
good and bad
about the
experience?
Analysis
What sense
can you make
of the
situation
Conclusion
What else
could you
have done?
Action Plan
If it arose
again what
would you
do?
REFLECTIVE PRACTICE
Definition
Process
Measurement

85. LEARNING
 Early QI work allowed teams to become familiar with
collaborative model and QI methods
 Time out to network, learn & reflect - permission to test
 Involvement with Commissioners and QI linked to
strategic drivers has improved traction
 Involving both community and in-patient teams facilitates
communication and learning across interfaces

86. Dr GG Lavery – Clinical Director
Miss J Haines–Wood – Regional Patient Safety Advisor
Mrs L Lamb – Regional Patient Safety Advisor
Dr J McCall – Clinical Lead
Ms N Cullen – Acute Delirium & QI
Dr K McCollum – GP QI/Safety Lead
@lavery_gg gavin.lavery@hscni.net

87. ‘Better has no limit’
Brent James, Intermountain

88. Scottish Patient Safety Programme-
Mental Health
12th April 2016
#SPSPMH2016 #mhimprove

89. Patients are and feel safe,
Staff feel and are safe
#SPSPMH2016

90. ‘The way I would want to be
treated....me and my family’
#SPSPMH2016

91. Safer Medicines Management Risk Assessment and Safety Planning
Violence, Restraint & Seclusion
Reduction
Communication at Transitions
Leadership and Culture
Safety
Principles
Data and
Measurement
Human
Factors
Human Rights
Legislation
Education
and training
Service User,
carer and
staff
engagement
Scale
All 13 boards with inpatient
facilities
31 separate sites
74 reporting wards (out of
124)
12 out of 13 boards have
one or more wards with an
improvement or sustained
improvement

93. Safer Medicines Management
• As required psychotropic monitoring, review and assessment
• High risk medicine monitoring and management – lithium/Clozapine
(no avoidable treatment breaks) and polypharmacy
• Patient, staff and carer education
• Medicines reconciliation
• Safer Prescribing and Administration processes – missed dose, correct
administration, error free
Risk Assessment and Safety Planning
• Training and refresher training
• Risk assessment timing and review – 2 hours on admission/72 hour review
• Live risk assessment – linked to goal setting
• Discharge
• Inclusion of sexual, physical, child protection, social and psychological risk
• Observation
Violence, Restraint and Seclusion
Reduction
• Training – right balance of theory and practical
with a trauma informed point of view
• Debrief following restraint/near miss
• Trauma Informed Care
• Restraint monitoring – techniques used, de-escalation methods, length
of restraint….
• Seclusion Policy and monitoring
Communication at Transitions
• Admission/Discharge- including discharge pause 24 hours in advance of
discharge
• Daily Goal Setting/What matters to you – developed in Person Centred
• Safety Briefings and Huddles
• Physical health at key transition points (and at all other times)
• Absconding/Missing Persons/Pass Plan
Leadership and Culture
• Patient safety climate tool
• Staff climate tool
• Leadership Walkrounds/safety
conversations
• Learning from adverse events

94. Safer Medicines Management
• As required psychotropic monitoring, review and assessment
• High risk medicine monitoring and management – lithium/Clozapine
(no avoidable treatment breaks) and polypharmacy
• Patient, staff and carer education
• Medicines reconciliation
• Safer Prescribing and Administration processes – missed dose, correct
administration, error free
Risk Assessment and Safety Planning
• Training and refresher training
• Risk assessment timing and review – 2 hours on admission/72 hour review
• Live risk assessment – linked to goal setting
• Discharge
• Inclusion of sexual, physical, child protection, social and psychological risk
• Observation
Violence, Restraint and Seclusion
Reduction
• Training – right balance of theory and practical
with a trauma informed point of view
• Debrief following restraint/near miss
• Trauma Informed Care
• Restraint monitoring – techniques used, de-escalation methods, length
of restraint….
• Seclusion Policy and monitoring
Communication at Transitions
• Admission/Discharge- including discharge pause 24 hours in advance of
discharge
• Daily Goal Setting/What matters to you – developed in Person Centred
• Safety Briefings and Huddles
• Physical health at key transition points (and at all other times)
• Absconding/Missing Persons/Pass Plan
Leadership and Culture
• Patient safety climate tool
• Staff climate tool
• Leadership Walkrounds/safety
conversations
• Learning from adverse events
http://www.scottishpatientsafetyprogramme.scot.nhs.uk/programmes/mental-health

95. What was the huddle focus?
The huddle will focus on 3 key areas:
 Look back
 Look ahead
 Follow up
By the end of the huddle each department will:
 Have a clear idea what is required over the next 24hrs
 Develop a clearer understanding of specific risks and pressures of each area
 Understand how other areas operate and how this makes the hospital work and contributes to the quality and safety of the
service
 Increase learning
 Develop a shared commitment
 Reflect on past activity
#SPSPMH2016

96. SPSP-Improving Observation Practice
Improvement programme to improve observation practice,
therapeutically engaging with suicidal, violent or vulnerable patients
to prevent them from harming themselves or others at times of
high risk during their recovery.
#SPSPMH2016

97. SPSP-MH beyond the current programme?
CAMHS Older People’s Services
Perinatal Community
In-Patient
#SPSPMH2016

99. Baseline Median
4.7
0
1
2
3
4
5
6
7
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
rateper1000beddays
Total rate of restraint for 21 of 59 wards which have
reportedconsistently from Jan '14 to Nov '15
Baseline Median
6.2
0
1
2
3
4
5
6
7
8
9
10
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
Dec-15
rateper1000beddays
Total rate of incidents of physical violence for 23 of 59
wards which have reported consistently from Jan '14 to
Dec '15
5 wards showing improvement
Baseline Median
2.96
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
Jan-14
Feb-14
Mar-14
Apr-14
May-14
Jun-14
Jul-14
Aug-14
Sep-14
Oct-14
Nov-14
Dec-14
Jan-15
Feb-15
Mar-15
Apr-15
May-15
Jun-15
Jul-15
Aug-15
Sep-15
Oct-15
Nov-15
%ofpatients
Total % of patients who experience self harm for 30
of 59 wards which have reported consistently from
Jan '14 to Nov '15
13 wards showing improvement
12 wards showing improvement

100. What advice can we give ourselves?
• Avoid duplication
• Start small, quick wins
• Build the will
• What can we take straight away
• Be nice……
• Be brave!

101. ‘We don’t really
call it SPSP, that’s
just what we
do......’
#SPSPMH2016

102. Danish Patient Safety
Program for Mental
Health
Vibeke Rischel
@VibekeRischel

103. • People with mental health disorders have
• A life expectancy 10 – 20 years lower than the rest of
the population
• Primarily comorbidity – physical health, e.g. cardiovascular
disease, metabolic syndrome, cancer, lung disease
• Mental health disorders are on the top 10 list of
diseases that causes loss of healthy life years
• 20 times at risk of committing suicide
• High rate of mechanical restraint compared to other
countries
103
Mental Health!?

104. Life expectancy
Blue: People with mental health disorders, Total pillar: All people
Source: Danish Regions, 2011

105. Collaborative aim
• Aim:
• Reduction in mortality
• Improving care within: medicines, physical comorbidity,
mechanical restraint, suicide prevention
• Engaging service users and their relatives
• Build a sustainable system for improvement
105

106. 9 teams

107. BTS Collaborative
Vælge
område
og
udarbejde
strategi
Faglig
følgegruppe
Udvikle
indhold
og mål
Vælge deltagere
forberedelse
LS
S
LS
Støtte
Email Besøg
Telefon Månedlig rapport
Drøfte med
stake-
holders
LSLSLS
Efterår
2014 2015 2016 2017
S
A D
P
S
A D
P
S
A D
P

109. Preliminary results - medicines

110. Preliminary results - medicines

111. Preliminary results - medicines

113. Time Topic
1440 World café introductions
1450 World cafés –
• Service user engagement/Co-Production
• Data and measurement
• Violence and restraint reduction
• Trigger Tools/Deteriorating patients
• Improving physical health
• Suicide prevention/reduction
• Safer medicines (psychotropic as required)
1520 Coffee Break
1540 World cafés (repeat of sessions)
1625 Feedback and Q&A
1645 Closing Remarks – Gordon Johnston

114. World cafe

115. • Each café table has one topic
• Each participant gets to visit 5 out of the 7 café tables
– choose
• The Facilitator guides the discussion
• Share experience on the topic
• Note the points you want to bring on
• When the whistle sounds, move to the next café
Process

116. • Listen to what is said and consider questions
• Contribute with your ideas and thoughts
• Listen to learn
• Be curious
Cafe - etiquette

117. • 10 min:
• Information on the world cafe process
• 95 min (including coffee break):
• 5 World Café visits of 15 min. Including transition
time
• 25 min:
• The facilitators present three learning points from
each cafe in plenary
Schedule

118. Time Topic
1440 World café introductions
1450 World cafés –
• Service user engagement/Co-Production
• Data and measurement
• Violence and restraint reduction
• Trigger Tools/Deteriorating patients
• Improving physical health
• Suicide prevention/reduction
• Safer medicines (psychotropic as required)
1520 Coffee Break
1540 World cafés (repeat of sessions)
1625 Feedback and Q&A
1645 Closing Remarks – Gordon Johnston