Prospective Risk Assessment in a Mental Heath Trust

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

2. 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.

3. Initial Goals Aim To test whether two closely related methods for identifying risk prospectively (both frequently used in industry) can be efficaciously adapted to a mental health environment. Goal 1. To verify and validate the use of these tools in a mental health setting. 2. Ideally, to 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. Timescale Managerial PHA sessions to be held in January, April and July 2012; Clinical staff data collection to begin in February and continue through May 2012. Final data analysis to be performed July – August 2012

4. Aim of the Study Prospective Hazards Analysis Quality Assurance Data Collection • Compare and contrast • Classify problems using • WHO patient safety • classification system • Add or change • categories as needed 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)

5. Main Study Flowchart (Engineering Diagram) 2011 2012 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep • Project Setup • Project Protocol • QA Tool Design • CPFT Permissions • Peer Reviews • Ethical Review • PHA Arm • Consists of a management workshop • Takes place early in this period Blinding (as far as practicable) Routine Quality Indicators Setup | Collection and Monitoring  Blinding (as far as practicable) • PHA Eval. • Objective 1 • QA Arm - Control • Cambridgeshire North • No Intervention • Out-of-Hours Service • CR&HT Service • QA Arm - Intervention • Cambridgeshire South • QA Intervention • Out-of-Hours Service • CRHT Service • QA Intervention Evaluation • Objective 2 • Project Reporting • Formal • Objectives 1, 2 and 3 • QA Arm - Control • Cambridgeshire North • No Intervention • Out-of-Hours Service • CRHT Service = MaPSaF Timings are indicative

6. Gantt Chart 1 (September 2011)

7. Gantt Chart 2 (May 2012)

8. Gantt Chart 3 (Current)

9. Main Study Flowchart (Engineering Diagram) 2011 2012 Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep • Project Setup • Project Protocol • QA Tool Design • CPFT Permissions • Peer Reviews • Ethical Review • PHA Arm • Consists of a management workshop • Takes place early in this period Blinding (as far as practicable) Routine Quality Indicators Setup | Collection and Monitoring  Blinding (as far as practicable) • PHA Eval. • Objective 1 • QA Arm - Control • Cambridgeshire North • No Intervention • Out-of-Hours Service • CR&HT Service • QA Arm - Intervention • Cambridgeshire South • QA Intervention • Out-of-Hours Service • CRHT Service • QA Intervention Evaluation • Objective 2 We have additionally written a Literature Review And thoroughly researched our evaluation methodologies • Project Reporting • Formal • Objectives 1, 2 and 3 • QA Arm - Control • Cambridgeshire North • No Intervention • Out-of-Hours Service • CRHT Service = MaPSaF Timings are indicative

10. Barriers to Project Completion Is Your Project Research? • Service Improvement Project (SIP) vs Health Services Research (HSR) • Ethics approval, Sponsorship, Peer review, Indemnity/Insurance, Grant Contracts, Feasibility, Commercial charges, Service Support Costs, Identification of PI, Letters of access/Honorary Research contracts Limit Growth - Project size and goals Collaborator buy - in Ethical approval - Appropriate venue • University Ethics Boards vs LREC Service Provider Buy-in as a moving target • Changes initiated by people other than you

11. Hard-to-Measure Work Learning the ropes • Reviewing current literature • Studying new methodologies • Appreciating the process steps necessary for study approval Spreading the word: Creating a positive feel for the project • Project documents (including PHA) to: • Medical director • Head of Service Improvement • Clinical Directors • Risk Assessment department • Clinical staff who are likely participants • Discussions at RCPsych Faculty Conferences • Literature Review article submission to a peer reviewed journal

12. Suggestions for Future Projects • Limit project scope (and supervisor enthusiasm) • CLAHRC Resources webpage is very useful: • Research Governance Pathway Guidance http://www.clahrc-cp.nihr.ac.uk/resources/research-governance • Don’t forget to budget time for • Peer Review, Letters of access/Honorary contracts for all involved, Indemnity/Insurance, Sponsorship • As well as Ethical Approval • Make sure you really enjoy your topic, because you will be dedicating a lot of time to it

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