IHI Expedition Expedition: Making Mental Health Care Safer in the - - PDF document

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IHI Expedition

Expedition: Making Mental Health Care Safer in the Hospital Setting Session 5: Ensuring Staff Preparedness February 10, 2015 Amar Shah Charles Saldanha Kelly McCutcheon Adams

Today’s Host

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Dorian Burks, Project Coordinator, Institute for Healthcare Improvement, is a current coordinator for web-based Expeditions. He also contributes to the IHI work in the Triple Aim and Improvement Capability focus areas, as well as the Leading Quality Improvement series. Dorian is a member of the Diversity and Inclusion Council at IHI, where he and fellow staff members develop strategies to enhance IHI’s inclusive culture, both internally and externally. Dorian graduated from Massachusetts Institute of Technology in Cambridge, MA where he received his Bachelor of Science degree in Biology and humanities concentration in Anthropology.

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Audio Broadcast

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You will see a box in the top left hand corner labeled “Audio broadcast.” If you are able to listen to the program using the speakers on your computer, you have connected successfully.

Phone Connection (Preferred)

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To join by phone: 1) Click on the “Participants” and “Chat” icon in the top, right hand side of your screen to open the necessary panels 2) Click the button on the right hand side of the screen. 3) A pop-up box will appear with the option “I will call in.” Click that option. 4) Please dial the phone number, the event number and your attendee ID to connect correctly .

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Audio Broadcast vs. Phone Connection

If you using the audio broadcast (through your computer) you will not be able to speak during the WebEx to ask question. All questions will need to come through the chat. If you are using the phone connection (through your telephone) you will be able to raise your hand, be unmuted, and ask questions during the session. Phone connection is preferred if you have access to a phone.

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Expedition Director

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Kelly McCutcheon Adams, LICSW has been a Director at the Institute for Healthcare Improvement since 2004. Her primary areas of work with IHI have been in Critical Care and End of Life Care. She is an experienced medical social worker with experience in emergency department, ICU, nursing home, sub- acute rehabilitation, and hospice settings. Ms. McCutcheon Adams served on the faculty of the U.S. Department of Health and Human Services Organ Donation and Transplantation Collaboratives and serves on the faculty of the Gift of Life Institute in

• Philadelphia. She has a B.A. in Political Science from

Wellesley College and an MSW from Boston College.

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Today’s Agenda

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Welcome Action Period Assignment Debrief Ensuring Staff Preparedness Action Period Assignment Closing

Expedition Objectives

At the conclusion of this Expedition, participants will be able to: Explain the importance of partnering with patients and their families to improve safety for patients with mental health conditions Identify different areas to improve mental health care safety Describe examples of improvement efforts at other

• rganizations

Plan tests of change to begin or continue patient safety improvement

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Schedule of Calls

Session 1 – Partnering with Patients and Families Date: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time Session 2 – Making the Physical Environment Safer Date: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time Session 3 – Why Flow Matters Date: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time Session 4 – Medication Safety Date: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time Session 5 – Ensuring Staff Preparedness Date: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time Session 6 – Being Proactive and Avoiding Crises Date: Tuesday, February 24, 1:00 - 2:00 PM Eastern Time

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Action Period Assignment Debrief

Sharing examples of changing medication practices to improve mental health safety

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Ensuring Staff Preparedness

Charles Saldanha and Amar Shah

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Faculty

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Charles Saldanha, MD is an Assistant Clinical Professor of Psychiatry at the University of California San Francisco and a psychiatrist at Contra Costa Regional Medical

• Center. He completed medical school at the

Duke University School of Medicine, postgraduate training at the Brigham and Women's Hospital, UCSF, and Yale University School of Medicine. His interests include the interface of law and psychiatry and public psychiatry with an emphasis on acute care settings.

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Faculty

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Amar Shah, Associate Medical Director and Consultant Forensic Psychiatrist, East London NHS Foundation Trust, leads the large organizationwide quality improvement (QI) program, aimed at supporting the

• rganization in providing the highest quality mental

health and community care in the country. As part of the QI program, the organization is building the will and alignment for improvement at scale. East London has partnered with the Institute for Healthcare Improvement (IHI) in this work, with IHI providing strategic guidance and support in building capability at scale. Dr. Shah has experience with local QI within a number of NHS providers, and national improvement work while seconded to the National Patient Safety Agency in 2009-2010. He is an IHI-trained Improvement Advisor, has completed an executive MBA in health care management, a he earned a Masters in Mental Health Law and a postgraduate certificate in medical education.

Making Mental Health Safer in Hospital Settings: Ensuring Staff Preparedness

Charles Saldanha, MD February 10. 2014

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“It’s not safe here”

The most critical element to SAFETY in mental health is:

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People

CHALLENGING EXPECTATIONS

OF LEADERSHIP OF STAFF OF PATIENTS AND FAMILIES OF OUR FIELD OF SOCIETY

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ENSURING PREPAREDNESS- RECRUITMENT ENSURING PREPAREDNESS- ORIENTATION

SET THE TONE MENTORSHIP STANDARD WORK FOR ALL STAFF

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ENSURING PREPAREDNESS- EDUCATION AND TRAINING

ALL TEACH, ALL LEARN CREATE A LEARNING CULTURE

ENSURING PREPAREDNESS- ENGAGEMENT

OWNERSHIP OF PERFORMANCE IMPROVEMENT TRANSPARENCY JUST CULTURE CELEBRATE SUCCESS

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web qi.eastlondon.nhs.uk email qi@eastlondon.nhs.uk @ELFT_QI

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Mental health services

Newham, Tower Hamlets, City & Hackney

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

Challenges and

• pportunities

in East London

Cultural diversity Social deprivation Geographical diversity Commissioning arrangements Financial stability and strong assurance systems

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The strategic case for change

Make quality our absolute priority

• Improving

quality of care is our core purpose

• Of greatest

importance to all our stakeholders

• Build on the

excellent work already happening to improve quality National drivers

• The need to

focus on a more compassionate, caring service with patients first and foremost

• More

structured and bottom-up approach to improvement Enable our staff to lead change

• The desire to

engage, free and support

• ur staff to

innovate and drive change

• Engaged and

motivated staff leads to improved patient

• utcomes

The economic climate

• The need to do

more with less – improving quality whilst reducing cost

The culture we want to nurture

A listening and learning

• rganisation

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

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Assurance & performance management Research & innovation Continuous improvement

Our quality improvement programme

How?

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Long-term mission and stretch aims

The mission

To provide the highest quality mental health and community care in England

Quality improvement strategy

Reduce harm by 30% every year Right care, right place, right time

Two stretch aims

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. Launch event & roadshows
• 2. Microsite
• 3. Using the power of narrative
• 4. Celebrate successes
• 5. Network of champions / ambassadors
• 6. Learning events
• 1. Initial assessment of alignment & capability
• 2. Recruiting central QI team
• 3. Online training
• 4. Face-to-face training
• 5. Follow-up coaching on projects
• 6. Develop in-house training for 2016 onwards
• 1. Align all projects with improvement aims
• 2. Align team / service goals with improvement aims
• 3. Align all corporate and support systems
• 4. Patient and carer involvement in all improvement

work

• 5. Embed improvement within management structures

Reducing Harm by 30% every year

• 1. Reduce harm from inpatient violence
• 2. Reduce harm from falls
• 3. Reduce harm from pressure ulcers
• 4. Reduce harm from medication errors
• 5. Reduce harm from restraints

Right care, right place, right time

• 1. Improving patient and carer experience
• 2. Reliable delivery of evidence-based care
• 3. Reducing delays and inefficiencies in the system
• 4. Improving access to care at the right location

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AIM: To provide the highest quality mental health and community care in England by 2020

Build the will

QI microsite the

• nline hub for the

programme has 30,000 page views in 2014 qi.eastlondon.nhs. uk Staff and service user newsletter reaches 5000 people every month QI launch event and roadshows attended by over 1000 staff, service users and carers Bespoke QI learning events for staff, service users, commissioners, governors

AIM: To provide the highest quality mental health and community care in England by 2020 Build improvement capability

Face to face improvement training - hundreds of staff, services users, Governors to be trained over the next few years Support for improvement work from the Trust’s QI team IHI Open School online training resource available to all. Providing essential skills to support people leading quality improvement. Partnership with IHI on delivery of QI training to staff and Trust Board, and strategic guidance from IHI executive team

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Experts Front line staff Clinical leaders Directorate improvement leads Board

Estimated number = 3300 Requirement = introduction to quality improvement, identifying problems, change ideas, testing and measuring change Time-frame = train 10-20% in 2 years Estimated number = 250 Requirement = deeper understanding

• f improvement methodology,

measurement and using data, leading teams in QI Time-frame = train 30-50% in 2 years Estimated number = 25 Requirement = deeper understanding

• f improvement methodology,

understanding variation, coaching teams and individuals Time-frame = train 100% in 2 years Estimated number = 10 Requirement = setting direction and big goals, executive leadership,

• versight of improvement, being a

champion, understanding variation to lead Time-frame = train 100% in 2 years Estimated number = 5 Requirement = deep statistical process control, deep improvement methods, effective plans for implementation & spread Time-frame = train 100% in 2 years

Where are we?

On track to train over 500 people through 5 six-month waves of learning between 2014-16. First 3 waves delivered with the IHI On track. All senior staff being encouraged to join QI training over next 2 years New need recognised. Developing improvement coaches programme will train 30 QI coaches in 2015 On track. Most Executives will have undertaken the ISIA, and Board training has been delivered in 2015. Currently have 3 improvement advisors, with 1.5wte deployed to QI. Will need to build more capacity at this level.

Starting an Improvement Project At ELFT

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qi.eastlondon.nhs.uk

qi.eastlondon.nhs.uk

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qi.eastlondon.nhs.uk

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Key Ingredients for Success Success

Form a team Agree the quality issue to be tackled Ensure patient (and carer) involvement Find time to meet

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To assist in this process we have a Project Charter form that defines what we want to accomplish.

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Assistance with your Driver Diagrams

The ELFT QI Team has created a page on their microsite which will assist you in filling out and completing your driver diagram. Please go to: http://qi.eastlondon.nhs.uk/driver-diagrams/

Complete Your Charter and Driver Diagram!

• Email to QI team
• qi@eastlondon.nhs.uk
• QI team will get in contact in a few days

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QI Team QI Resources Project Sponsor QI Forums

Prework Workshop 9/29-10/1 Webex 1 10/14 Webex 2 11/2 Supports:

• Listserve
• Assignments

AP-1 AP-2

Webex 3 11/30

AP-3

Project Planning Reliability Sustaining Gains Workshop (3 days) Webex #2 Webex #1

• Faculty consults
• Webex calls
• Coaching calls

Learning Set

Webex #3 Learning Set

AP-5 AP-4

The two learning sets will be focused on sharing the participants’ work on their projects and learning from each other. These sessions also will reinforce the content from the Webex calls and the ISIA workshop.

A 6 6 month lea earning pa path

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AIM: To provide the highest quality mental health and community care in England by 2020

A process is in place for teams to submit project ideas to the QI team, who will help with planning, structure and measurement, and ensure projects are aligned with our high- level aims.

Alignment

Quality improvement programme-project support structures

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AIM: To provide the highest quality mental health and community care in England by 2020

QI Projects

QI Projects – 110+ active projects across Trust Directorates, teams are working on improvement projects that support our ambition to Reducing Harm by 30% every year and deliver Right care, right place, right time Improving Physical Health Monitoring Following Rapid Tranquillisation Reducing violence on inpatient wards Improving the handover process for on-call doctors

Activity and Status by Directorate

2 1 2 1 2 2 11 8 6 9 12 9 4 7 7 8 14 2 3 2 2 5

Children's Services Community Health Newham and MHCOP City and Hackney Mental Health Corporate Forensics Newham Mental Health Other Specialist Services Tower Hamlets Mental Health

G = Actively testing O = Getting ready to go R= Stalled

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Reduce harm by 30% every year Right Care, Right Place, Right Time Violence Reduction Pressure Ulcers Physical Health Waiting Times TH Coll

MULTIPLE I/P WARDS

MHCOP

MULTIPLE I/P WARDS

CHN

EPCS MULTIPLE I/P WARDS

C&H

REHAB AOS CONNOLLY

Newham

MULTIPLE I/P WARDS

Newham

PSYCHOLOGY

MHCOP

TRAINING LODGE

Children’s

CDC x2 CAMHS x3

MHCOP

MEMORY SERVICE HACKNEY

C&H

ALL CMHTS

Reducing harm by 30% every year

0.1 1 10 100 1000

04/01/12 18/02/12 25/02/12 07/03/12 23/03/12 30/03/12 31/03/12 17/04/12 19/04/12 09/05/12 04/06/12 17/06/12 22/06/12 17/07/12 30/07/12 28/08/12 11/09/12 17/09/12 21/09/12 10/10/12 07/11/12 09/01/13 20/04/13 17/05/13 02/07/13 08/10/13 11/10/13 Days between incidents of physical violence

Days between incidents of physical violence

• Globe adult acute ward – (T Chart)

BVC introduced 0.1 1 10 100

17/08/13 18/08/13 27/08/13 09/09/13 24/09/13 24/09/13 15/10/13 18/10/13 22/10/13 24/10/13 01/11/13 04/11/13 06/11/13 11/11/13 15/11/13 29/11/13 26/12/13 13/01/14 20/01/14 11/02/14 25/02/14 25/03/14 27/03/14 04/04/14 11/05/14 22/05/14 30/05/14

Days between incidents of physical violence

• 3 older adult wards (T Chart)

Inpatient violence

Organisation level data

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UCL LCL

10 20 30 40 50 60 70 80 90 100

• No. of Prone restraints

Restraint in a prone position

UCL LCL

52 72 92 112 132 152 172

• No. of Restraints

All reported episodes of restraint

UCL LCL

50 70 90 110 130 150 170 190 210 230 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14

• No. of Physical Violence Incidents

All incidents of physical violence

UCL LCL

20 30 40 50 60 70 80 90

• No. of Incidents using seclusion

All incidents managed through the use of seclusion

UCL LCL

500 550 600 650 700 750 800 850 900

• No. of Reported Incidents

Reported Incidents

UCL LCL

75% 77% 79% 81% 83% 85% 87% 89% 91% 93% 95% Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14

Bed Occupancy

Bed Occupancy

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web qi.eastlondon.nhs.uk email qi@eastlondon.nhs.uk @ELFT_QI

Questions/Discussion

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Raise your hand Use the chat

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Action Period Assignment

Please think about times when you have made improvements in staff preparedness to increase safety for patients with mental health issues

– Share via information about these efforts via the

listserv before next session: MentalHealthSafety@ls.ihi.org

Expedition Communications

Listserv for session communications: MentalHealthSafety@ls.ihi.org To add colleagues, email us at info@ihi.org Pose questions, share resources, discuss barriers or successes

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Next Session

Session 6 Being Proactive and Avoiding Crises

Tuesday, February 24th, 1:00 – 2:00 EST

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