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TRANSCRIPT
4/27/2015
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IHI ExpeditionExpedition: Making Mental Health Care Safer in the Hospital Setting
Session 5: Ensuring Staff Preparedness
February 10, 2015
Amar ShahCharles SaldanhaKelly McCutcheon Adams
Today’s Host2
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 Broadcast3
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)4
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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WebEx Quick Reference
• Please use chat to “All Participants” for questions
• For technology issues only, please chat to “Host”
• WebEx Technical Support: 866-569-3239
• Dial-in Info: Communicate / Audio Conference (in menu)
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Enter Text
Select Chat recipient
Raise your hand
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7
When Chatting…
Please send your message to
All Participants
Expedition Director8
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 Agenda9
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 organizations
Plan tests of change to begin or continue patient safety improvement
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Schedule of Calls
Session 1 – Partnering with Patients and FamiliesDate: Tuesday, December 2, 1:00 - 2:30 PM Eastern Time
Session 2 – Making the Physical Environment SaferDate: Tuesday, December 16, 1:00 - 2:00 PM Eastern Time
Session 3 – Why Flow MattersDate: Tuesday, January 13, 1:00 - 2:00 PM Eastern Time
Session 4 – Medication SafetyDate: Tuesday, January 27, 1:00 - 2:00 PM Eastern Time
Session 5 – Ensuring Staff PreparednessDate: Tuesday, February 10, 1:00 - 2:00 PM Eastern Time
Session 6 – Being Proactive and Avoiding CrisesDate: 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 PreparednessCharles Saldanha and Amar Shah
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Faculty14
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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Faculty15
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 organization 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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Mental health servicesNewham, Tower Hamlets, City & Hackney
Forensic servicesAll 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
IAPTNewham, Richmond and Luton
Speech & LanguageBarnet
Challenges and
opportunities in East London
Cultural diversity
Social deprivation
Geographical diversity
Commissioningarrangements
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 our staff to innovate and drive change
• Engaged and motivated staff leads to improved patient outcomes
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 organisation
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 & roadshows2. Microsite3. Using the power of narrative4. Celebrate successes5. Network of champions / ambassadors6. Learning events
1. Initial assessment of alignment & capability2. Recruiting central QI team3. Online training4. Face-to-face training5. Follow-up coaching on projects6. Develop in-house training for 2016 onwards
1. Align all projects with improvement aims2. Align team / service goals with improvement aims3. Align all corporate and support systems4. Patient and carer involvement in all improvement
work5. Embed improvement within management structures
Reducing Harm by 30% every year1. Reduce harm from inpatient violence2. Reduce harm from falls3. Reduce harm from pressure ulcers4. Reduce harm from medication errors5. Reduce harm from restraints
Right care, right place, right time1. Improving patient and carer experience2. Reliable delivery of evidence-based care3. Reducing delays and inefficiencies in the system4. 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 online 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 = 3300Requirement = introduction to quality improvement, identifying problems, change ideas, testing and measuring
changeTime-frame = train 10-20% in 2 years
Estimated number = 250Requirement = deeper understanding
of improvement methodology, measurement and using data, leading
teams in QITime-frame = train 30-50% in 2 years
Estimated number = 25Requirement = deeper understanding
of improvement methodology, understanding variation, coaching
teams and individualsTime-frame = train 100% in 2 years
Estimated number = 10Requirement = setting direction and
big goals, executive leadership, oversight of improvement, being a
champion, understanding variation to lead
Time-frame = train 100% in 2 years
Estimated number = 5Requirement = deep statistical process control, deep improvement methods, effective plans for implementation &
spreadTime-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 yourDriver 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 team will get in contact in a few days
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QI Team
QI Resources
Project Sponsor
QI Forums
PreworkWorkshop
9/29-10/1
Webex 1
10/14
Webex 2
11/2
Supports:
• Listserve
• Assignments
AP-1 AP-2Webex 3
11/30AP-3
Project
PlanningReliability
Sustaining
Gains
Workshop
(3 days)
Webex #2Webex #1
• Faculty consults• Webex calls• Coaching calls
Learning Set
Webex #3 Learning SetAP-5AP-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 month learning 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 forteams to submitproject ideas to the QIteam, who will helpwith planning,structure andmeasurement, andensure projects arealigned 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
20 1 0
2 1 2 2
11
8 6 9
12
94
7
7
8
14
2
3
2
2
5
Children's Services Community HealthNewham and MHCOP
City and HackneyMental Health
Corporate Forensics Newham MentalHealth
Other SpecialistServices
Tower HamletsMental 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 CollMULTIPLE I/P WARDS
MHCOPMULTIPLE I/P WARDS
CHNEPCS
MULTIPLE I/P WARDS
C&HREHAB AOSCONNOLLY
NewhamMULTIPLE I/P WARDS
NewhamPSYCHOLOGY
MHCOP TRAINING LODGE
Children’sCDC x2
CAMHS x3
MHCOPMEMORY SERVICE HACKNEY
C&HALL CMHTS
Reducing harm
by 30% every
year
0.1
1
10
100
1000
04/0
1/1
2
18/0
2/1
2
25/0
2/1
2
07/0
3/1
2
23/0
3/1
2
30/0
3/1
2
31/0
3/1
2
17/0
4/1
2
19/0
4/1
2
09/0
5/1
2
04/0
6/1
2
17/0
6/1
2
22/0
6/1
2
17/0
7/1
2
30/0
7/1
2
28/0
8/1
2
11/0
9/1
2
17/0
9/1
2
21/0
9/1
2
10/1
0/1
2
07/1
1/1
2
09/0
1/1
3
20/0
4/1
3
17/0
5/1
3
02/0
7/1
3
08/1
0/1
3
11/1
0/1
3
Days
betw
een i
ncid
ents
of
phys
ical
viole
nce
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
0
10
20
30
40
50
60
70
80
90
100
No.
of
Pro
ne
re
str
ain
ts
Restraint in a prone position
UCL
LCL
52
72
92
112
132
152
172
No.
of
Restr
ain
ts
All reported episodes of restraint
UCL
LCL
50
70
90
110
130
150
170
190
210
230
Jan-1
2F
eb-1
2M
ar-
12
Apr-
12
May-1
2Jun-1
2Jul-12
Aug-1
2S
ep-1
2O
ct-
12
Nov-1
2D
ec-1
2Jan-1
3F
eb-1
3M
ar-
13
Apr-
13
May-1
3Jun-1
3Jul-13
Aug-1
3S
ep-1
3O
ct-
13
Nov-1
3D
ec-1
3Jan-1
4F
eb-1
4M
ar-
14
Apr-
14
May-1
4Jun-1
4Jul-14
Aug-1
4S
ep-1
4
No.
of
Ph
ysic
al V
iole
nce
Incid
en
ts
All incidents of physical violence
UCL
LCL
20
30
40
50
60
70
80
90
No.
of
Incid
en
ts u
sin
g s
eclu
sio
n
All incidents managed through the use of seclusion
UCL
LCL
500
550
600
650
700
750
800
850
900
No.
of
Rep
ort
ed
In
cid
en
ts
Reported Incidents
UCL
LCL
75%
77%
79%
81%
83%
85%
87%
89%
91%
93%
95%
Jan-1
2F
eb-1
2M
ar-
12
Apr-
12
May-1
2Jun-1
2Jul-12
Aug-1
2S
ep-1
2O
ct-
12
Nov-1
2D
ec-1
2Jan-1
3F
eb-1
3M
ar-
13
Apr-
13
May-1
3Jun-1
3Jul-13
Aug-1
3S
ep-1
3O
ct-
13
Nov-1
3D
ec-1
3Jan-1
4F
eb-1
4M
ar-
14
Apr-
14
May-1
4Jun-1
4Jul-14
Aug-1
4S
ep-1
4
Be
d O
ccu
pa
ncy
Bed Occupancy
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web qi.eastlondon.nhs.uk
email [email protected]
@ELFT_QI
Questions/Discussion58
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:
Expedition Communications
Listserv for session communications:
To add colleagues, email us at [email protected]
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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