As a consultant psychiatrist at Midpark Hospital in NHS Dumfries and Galloway, and as the National Clinical Lead for the Scottish Patient Safety Programme’s Mental Health Programme, I’ve seen the benefits at local and national level of Scotland’s increased focus on improving mental health.
Reflecting on the progress we’ve made is timely. Throughout 2018, Healthcare Improvement Scotland is celebrating the 10th anniversary of its Scottish Patient Safety Programme (SPSP), delivered via the Improvement Hub (ihub).
I’m delighted that one of the key success stories within SPSP has been within mental health.
SPSP supports a ‘bottom-up’ approach in acute admission wards and intensive psychiatric care units and the collaboration between staff, service users and carers means we are now helping to deliver significant reductions in self harm, seclusion, violence and restraint in mental health units. Some NHS boards are reporting reductions in restraint of up to 57%, reductions in the percentage of patients who self-harm of up to 70% and 15 mental health wards have also shown a reduction in the rates of violence of up to 78%.
“As a consultant psychiatrist at Midpark Hospital in NHS Dumfries and Galloway, and as the National Clinical Lead for the Scottish Patient Safety Programme’s Mental Health Programme, I’ve seen the benefits at local and national level of Scotland’s increased focus on improving mental health.”
Recent media reports surrounding the use of restraint in mental health units demonstrates that there are still challenges in some areas of the current mental health system in Scotland and that there is still much work to do. However, both locally and nationally I’ve seen a decade of real progress.
Cultivating learning among those delivering and in receipt of care, and using that knowledge to improve safety for patients, are core values of SPSP. The engagement of frontline workers and the support of NHS boards ensures staff feel empowered to make necessary changes and they are helping to foster a culture of willingness to learn from mistakes, to build upon their own existing knowledge and skills, and to share these experiences throughout national forums.
“Some NHS boards are reporting reductions in restraint of up to 57%, reductions in the percentage of patients who self-harm of up to 70% and 15 mental health wards have also shown a reduction in the rates of violence of up to 78%.”
One of the crucial elements which have contributed to the success of the SPSP Mental Health Programme has been the involvement of service users in helping to shape services, and the development of resources such as the Patient Safety Climate Tool. The tool encourages constructive engagement between clinical staff and patients. With over 800 patients consulted to date, it is designed to help frontline staff to understand what it’s like to be a mental health patient and helps to provide a clear guide for organisations on how they can improve on the culture of safety and the overall patient experience.
In addition, the Staff Safety Climate Survey and Analysis developed by SPSP enables teams to gain information on the perceptions of front-line clinical staff about safety and management’s commitment to safety. This helps to provide information about the varying perceptions across different departments and disciplines as teams test and implement changes to improve the culture. The survey can be repeated over time, and continually assesses the impact of any changes that are implemented.
“One of the crucial elements which have contributed to the success of the SPSP Mental Health Programme has been the involvement of service users in helping to shape services, and the development of resources such as the Patient Safety Climate Tool.”
SPSP works by engaging frontline staff and it’s essential that they understand the vital role they help to play in ensuring and improving patient safety. Only by continuing to work together to instil a genuine culture of reflective learning when things go wrong, and a collective willingness to improve, can we create a positive and strong patient safety environment.
I’ve experienced real examples of this at Midpark Hospital where we introduced a hospital-wide huddle on a daily basis after seeing the positive effect they had after being introduced at ward level. You could say we did a small test of change and then scaled up. There were some things we anticipated that would happen when we introduced the huddle such as improved communication at transitions and improved identification of risks. But there were other positive outcomes that we didn’t expect such as being able to reduce the number of bank nurses, as we now know across the hospital where staff are and can move them to different wards where extra staff are needed. Another positive outcome is that Midpark has been highlighted by medical training authorities as having excellent medical handover which has helped our trainee doctors. In true SPSP style we have never stopped tweaking the huddle – we now hold an extra one on a Friday afternoon to ensure we are ready for the weekend; we include email updates from staff unable to attend which includes staff working in the community and after the huddle an email is issued informing staff of what was discussed.
The huddles, the patient safety climate tool, the staff safety climate survey, and other tools that we have implemented, have all contributed to making the reductions in self harm, seclusion, violence and restraint.
But, there is always more that we can do and further improvements that can be made.
However, small, incremental changes supported by SPSP, have ensured that we are saving lives, reducing harm and improving the quality of healthcare for people accessing mental health services throughout NHSScotland.
David Hall is National Clinical Lead for Mental Health at the Scottish Patient Safety Programme.
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