Spotlight on quality - case study 4
Quality Improvement: a case
Last month the college’s Quality Improvement lead Amar Shah
brought you the third in a series of QI case studies, which we hope
will inspire ideas for quality improvement in your areas of
It focused on work done by the Adult
Learning Disability Unit in Durham.
This month we’re looking at a project which
took place at Merseycare NHS Foundation Trust, focusing on
The aim of the project
In 2015 Mersey Care NHS Foundation Trust (MCT)
announced its ambitious commitment to ‘Zero Suicide’ and the
aspirational goal of no suicides of service users in our care.
Four areas were initially identified for quality improvement
- Service user and Partner
- Safe and effective care and
- Competent workforce
- Research and Evaluation
Under the ‘safe and effective care’ heading it
was agreed to test the potential impact of the introduction of
individual safety plans.
The ‘Safety Plan’ is a psychologically
informed, risk management and reduction tool co-designed by
Consultant Psychologist, frontline staff and service users. It is
evidence based and built to national guidance standards.
Recovery orientated, it’s a key component of
NCI safer services requirements. It supports skill enhancement,
problem solving, generates hope and includes opportunities to learn
from and prevent future crisis.
The Model for Improvement was used
consistently to learn and refine the plan and a number of
PDSA cycles were completed prior to implementation.
Another PDSA was carried out with the aim of
assessing the feasibility, acceptability and safety of implementing
the safety plan into business as usual practice across four
A thorough service evaluation was carried out
exploring potential impact on locus of control (MHLOC) for service
users, impact on emotional coping (DERS), impact on working
alliance and any adverse effects to ensure safety.
Focus groups pre and post implementation were
conducted and a thematic analysis completed to capture themes and
- The Safety Plan (SP) was
successfully implemented in three out of the four sites.
- Operational management
support was imperative for implementation
- Service User (SU) engagement
was influenced by the attitudes of staff
- Staff initially candid about
participation due to fear of administrative burden but once engaged
became keen advocates
- SP is appropriate for all
service users but timing of when to engage is important
- SUs found the safety plan
emotionally challenging but very welcomed
- Benefits included validation
of feelings, improved self insight, hopefulness, self reliance and
affirmation of support networks
- Staff were doing something
- Engaged staff noted improved
job satisfaction and working alliances
- SP considered to provide an
intensive, collaborative and personalised intervention over
existing clinical practices
- SP provided a defensible,
formal structure to their clinical practice which they valued
- Staff felt adequately
prepared following training and several suggestions for
- No adverse effects were
reported by service users.
Broader implementation, monitoring and
evaluation systems illustrate the following.
The SP is an evidenced based tool that
enhances service user skills, staff engagement, confidence and
satisfaction. Data included 0% readmission rate across a 90 day
timeframe for service users supported by a safety plan compared to
4% readmission rate for those without. Also a reduction in the
number of complaints relating to poor staff engagement noted post
implementation. Broader implementation was indicated.
Contact details, Project Lead
Dr Claire Iveson
Consultant Clinical Psychologist (Clinical
Lead Safety planning)
Tel: 0151 473 2907
article with graphs (PDF).