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 DidAim

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 measuresPrimary – 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

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)

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

Inte

rven

tion

Eva

luat

ion

• O

bjec

tive

2

PH

A E

val.

•

Obj

ecti

ve 1

Project Reporting• Formal

• Objectives 1, 2 and 3

= MaPSaFTimings are indicative

Blinding (as far as practicable)

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-inStaff engagementChanges initiated by other people

What We LearnedResults: Problem classification

What We LearnedResults: PHA vs QADC concerns

A - Path

ological

B - Rea

ctive

C - Burea

ucratic

D - Proacti

ve

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.

A - Path

ological

B - Rea

ctive

C - Burea

ucratic

D - Proacti

ve

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.

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.