Transcript A four pronged approach to mental health care

Working together to transform
quality and safety:
risk and person centred care
Dr David Fearnley
Consultant Forensic Psychiatrist
Medical Director
Mersey Care NHS Trust
3 February 2015
Overview
• Engaging finance and clinicians
• Moving from policy to practice
• Centre for Perfect Care
• Quality improvement
• No Force First
• Zero suicide
• Value Driven Enterprise Risk Management
Engaging finance and clinicians
• Working with an outstanding finance team!
• Clinical leadership for
• CIP
• PbR (mental health clustering)
• Care and quality strategy
• and which is supported by finance
• Culture of mutual coaching
Centre for Perfect Care
• Health care can be unsafe
• Medical errors third leading cause of death in USA
• NHS clinical negligence claims liabilities £26.1 billion
• Our Centre for Perfect Care integrates
• quality improvement
• innovation
• R&D
• Stimulated learning from new partners
No Force First
• Arose from recovery programme
• US approach in response to deaths during restraint
• Quality improvement training (AQuA)
• Service users fully involved (coproduction)
• Piloted on 4 wards (rolled out to 4 more wards Sept 14)
No Force First
• Unexpected benefits
• Sickness absence
• 21 months before project = 588 days
• 21 months after project began= 18 days
• Evaluating the cost/benefit of the programme (Lockton)
Zero suicides
• Deputy Prime Minister Nick Clegg said:
‘Suicide is, and always has been, a massive taboo in our society. People are
genuinely scared to talk about it, never mind intervene when they believe a
loved one is at risk. That’s why I’m issuing a call to every part of the NHS to
commit to a new ambition for zero suicides. We already know that this kind of
approach can work in dramatically reducing suicides.’ (19/1/15)
Zero suicide
• Henry Ford Hospital System
• Culture and clear success outcome
• Training
• Measurement
• Person centred
120
Suicide Death Rates – Henry Ford Hospital System, Detroit
100
Rate per 100,000 Persons
Internal
State of Michigan
80
Combined Suicide Deaths
60
40
20
0
1999
2000
2001
2002
2003
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2005
2006
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2008
2009
2010
Zero suicide
• Mersey Care – mental health trust programme
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•
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Zero suicide policy (key interventions and robust audit)
Safety plan and training
Post suicide reviews
Safe from Suicide team
Zero suicide
• Strategic Clinical Networks
• Cheshire and Merseyside (e.g. perfect depression care)
• South West (e.g. high risk, hot zones)
• East of England (e.g. community awareness, GP training)
Risk management of the future
• Working with partners:
• Lockton, the largest privately owned, independent insurance brokerage firm
• Mills-Reeve, law firm
• Stanford University Hospital Network, California
• Lockton and Mills-Reeve analysis/workshop (December 2014)
• Insights relate to traditional risk management vs. enterprise risk
management
Lockton analysis
• Key areas
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Identifying incident cost (patient and employee claims)
Incident claims management process weaknesses
Evaluating mitigation impact
Calculating total cost of risk
Claims Severity (sample 8538 NHS claims)
• Of the “Psychiatry/Mental Health and Psychology” claims (107)
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41.5% cost more than £100k
29.2% cost more than £250k
21.5% cost more than £500K
Average cost is £632k (present day values)
• For Mersey Care (84 claims)
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•
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19% cost more than £100k
6% cost more than £250k
3.6% cost more than £500K
Average cost: £95k (present day values)
Claims life cycle (incident to settlement)
• Average sample NHS is 6.3 years
• 33% of claims cost paid in legal fees
• Mersey Care is 4.8 years
• 36.4% of claims cost paid in legal fees
• Can take years to resolve claims even when liability accepted
• Cost implications of incidents/claims not always fully appreciated
Risk management in the future
• Traditional risk management
• Reactive
• ‘Defend and deny’
• ‘File and forget’
Solutions:
Traditional CRM, ERM, VDERM
25
25
ERM ISO 31000 Process
Determine if your risk management process has been effective. Monitor the timeliness and
effectiveness of the various outlined steps to reduce risks and boost gains.
This is where the action is. Develop and follow steps to reduce risks at
the top of your list as well as steps to increase potential benefits.
Mitigate
Evaluate
Assess
Identify
Monitor
Evaluate outcomes and decide which
risks need to be addressed.
Determine which risks are most critical and how individual risks are
related to each other.
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www.theriskauthority.com
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Lockton, Stanford and UK provider study
• Study to measure effectiveness of evidence-based clinical risk
management systems
• Stanford will run the pilots with 5 UK providers
• Mersey Care is the only mental health trust involved
• Study will identify contributory factors
Lockton, Stanford and UK provider study
• Deep analysis of most recent two years incident data
• Detailed report identifying specific risks and opportunities for safety
improvements
• Track additional two years data
• Real time analysis
Working together to transform quality and
safety: risk and person centred care?
• Engaging finance and clinicians
• Moving from policy to practice
• Quality improvement science
• Coproduced (person centred)
• Evidence based risk management
Thank you