Closing the Gap In Patient Safety Programme

1. Closing the Gap in Patient Safety Programme Safer Care Pathways in Mental Health: Project Overview Presented by Tim Bryson Project Manager

2. Closing the Gap In Patient Safety Programme • The Health Foundation is an independent charity working to improve the quality of healthcare in the UK • Two priority areas: i) patient safety and ii) person-centred care • CtGPS - £4 million to support ten projects to implement and evaluate tested, evidence-based patient safety interventions at scale • Substantial two year projects

3. Project partners • Hertfordshire Partnership University NHS FT (lead) • All mental health trusts in East of England • Engineering Design Centre, Cambridge University • University of East Anglia • University of Hertfordshire

4. Safer Care Pathways in MH – Project Aims • To address patient safety hazards and create safer and more reliable MH care pathways • To enable sustainable learning and capacity in patient safety skills and tools • Five project sites: one in each mental health trust in East of England • Project sites to include dementia care pathway and adult and older adult mental health care pathways

5. Safer Care Pathways in MH – Project Focus • Shifting the balance towards prospective • Focus on people, culture and systems • Avoidable deaths and harm – suicide, self-harm, falls, medication errors, harm from aggression • Improved safety communication between staff, service users and carers • Risk enablement

6. Project Intervention Package • Prospective hazard analysis (PHA) tool (CLAHRC – Cambridge University EDC) • Human factors training & implementation (L&D NHS FT/Hertfordshire University approach) • Service improvement methods (e.g. PDSA cycles)

7. Project Sites

8. Project Timetable

9. Project Evaluation Evaluation questions Evaluation data Key informant interviews Patient safety data – risk registers, datix and patient experience reports Safety culture survey questionnaire Training experience questionnaire Reflective diaries Observations • How mature is the risk management approach ? • What is the safety culture ? • How useful and useable are the interventions ? • What is learnt ? • What is the Impact on patient safety and outcomes ?

10. Project Benefits • Completed PHA for each care pathway (links to ‘Sign Up to Safety’ assessment) • Creation of a cohort of PHA trained, and human factors trained, patient safety champions in each trust • Implementation of a minimum of 1 service improvement project within each care pathway site • Safety culture feedback, and strengthened safety culture in the care pathway • Shared learning across region and nationally

11. Project Governance • Project board involving all partners, and including service user and carer advisers, and EoE Strategic Clinical Network • PID approved by project board • Six monthly and final reports to Health Foundation

12. More information • Website = http://mentalhealthpartnerships.com/project/safer-care-pathways-in-mental-health-project/ • Twitter - #safercarepathways • Health Foundation – www.health.org.uk • Tim Bryson – Project Manager - 07767354620 • tim@brysonconsultancy.co.uk • Jeremy Wallman – Project Officer - 07719555412 • Jeremy.wallman@ntlworld.com • Charlotte Copley – Project Administrator - 07540294317 • charlotte@brysonconsultancy.co.uk