Using Quality Improvement
Quality improvement aims to improve the
quality of care delivered to patients by bridging the gap between
known best practice and the routine delivery of care.
The College has established a Quality
Improvement Committee, chaired by Dr Amah Shah, to advise on
promoting quality improvement methods. Dr Amar Shah leads one of
the largest mental health improvement programmes in the world, with
the aim of providing the highest quality mental health and
community care in England by 2020.
What is Quality Improvement?
Quality improvement has three core components:
it's a systematic way to tackle complex problems,
it's continuous – always evolving and learning,
and it's about engaging people at all levels.
The Model for Improvement and Innovation is an
internationally recognised improvement tool that is designed to
provide a framework for developing, testing and implementing
changes that lead to improvement. The framework, which was developed by the Institute
for Healthcare Improvement (IHI) in the USA, includes three key
questions to ask before implementing a change, and is supported by
a process for testing change ideas using Plan, Do, Study,
Act (PDSA) cycles.
The Model for Improvement supports the process
of taking the time to plan change and testing it out in small-scale
cycles of change. Using this approach, we can see what is working
well and what is not, before we implement wholescale changes to
Case Study: The Partnership for Patient Protection
(P4P2) - Mersey Care NHS Foundation Trust
The Partnership for Patient Protection (P4P2) is a unique
collaboration between the Centre for Perfect Care and The Risk
Authority Stanford which aims to identify and mitigate key clinical
risks. The programme pairs leading edge software (Innovence Pulse)
and Design Thinking methodology to develop projects that will
improve quality of care.
The starting point for their Quality
Improvement project was to analyse five years of incident reports,
claims, complaints and investigation reports. After inputting this
information into Innovence Pulse, the Trust received an initial
risk identification report which highlighted the primary clinical
risks facing the organisation. From that report, the specific area
of ‘Violence Reduction’ was selected for further analysis.
Violence Reduction: Within
the Trust's Specialist Learning Disabilities Division, assaults on
members of staff was selected as the priority area. In 2015,
Calderstones NHS Foundation Trust, now Mersey Care Specialist
Learning Disabilities Division, had the highest rate of assaults on
staff in the country. Of 6700 incidents, some 2800 (42%) were
assaults on staff. The project team sought to reduce levels of
assault by 30% over a two-year period. Interventions included
restorative practice and strengthening preventative strategies in
Positive Behaviour Support (PBS) plans.
Cohort 1 – Enhanced
de-escalation workshops and summary PBS plans
- Every service
user now has a summary PBS plan, and they are exploring ways to
ensure they are shared widely within MDTs.
Cohort 2 –
- Entails a 'restorative
meeting' following incidents of assault, where service user and
staff member are brought together to reflect on how the incident
came about and the impact it had on those affected. The purpose is
to repair therapeutic relationships and agree a plan as to how
similar incidents can be avoided in the future. Over the past few
months, they have been ensuring service users have given their
consent, been risk assessed and approved by their MDTs.
So far there has been a 53% reduction in the
frequency of assaults on members of staff across all secure wards
since the first of the interventions were implemented. There has
also been an 85% reduction in the number of injuries sustained.
As seen in RCPsych Insight, Issue 2, Autumn 2017, Page
7 (A commitment to QI - Dr Amar Shah)
Quality Improvement Resources