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How data is essential in improving patient safety in mental health settings

Why data is essential in improving patient safety in mental health settings

April 2024

In March, the government published an important independent ‘Rapid Review’ report prepared by a team lead by Dr Geraldine Strathdee exploring the use of data in inpatient mental health settings and its links to patient safety.. It talks about the importance of ‘measuring what matters,’ and of ensuring that all staff have access to the information they need to keep people safe. It also talks about the importance of ensuring that lots of different types of data are used to check on the quality and safety of services.

 

Data as a strategic component of governance

Iris Care Group was formed in 2023 bringing together complex mental health provider, Ludlow Street Healthcare, and Supported Living provider, Holmleigh Care Homes. Using data to drive improvements in safety was a central strategic component of governance processes at Ludlow Street Healthcare for nearly 10 years and is now being rolled out across the new wider group.

We would like to share our own data experiences to support the call to ensure that the Strathdee recommendations are implemented by all care providers in inpatient mental health and learning disability services.

  • Iris Care Group has its own system called ‘Livedata’ that provides a live ‘dashboard’ overview of incidents in all of the previous Ludlow Street Healthcare hospital and community services. These dashboards are updated in real time so that all staff can see the pattern of safety related incidents in their services – the time they happened, their location, their severity and who was involved.

As many of our services need input from peripatetic staff, there is a built-in function that ensures that anyone involved in a person’s care gets an immediate email notification of an incident as soon as it is entered onto the system, meaning that our teams know about the safety of the people they support even if they don’t always work where that person lives.

This system allows us to respond quickly to safety incidents and it has helped us to  reduce the use of physical restraint by 90% since we built it in 2016. The system was designed specifically for use in mental health and learning disability services by clinicians and social care staff, rather than being a software product designed by software engineers who may have never worked in roles directly delivering health and social care.

  • All of our data is brought together in single site and whole organisation governance dashboards. As well as incident reporting, these systems give staff, leaders and commissioners information on key safety information such as safeguarding data, staff training records, complaints and compliments, specialist reviews of restrictive practice and restraint, health and safety information and clinical outcomes such as measures of the experienced safety of service users, and the experience and feedback of staff.

This data is used to populate both local and organizational risk registers, where the risk status of every part of the organisation is overseen by leadership at all levels.

  • Every service user in all our services is asked to complete both Patient Reported Experience Measures and Patient reported outcome measures, to make sure that we collect important safety and satisfaction data from everyone we support.. Every service also reports its Service Reported Experience Measures and Service Reported Outcome measures (such as staff culture, the use of restraint and other key safety information)

Together with the use of patient stories – because it is not just about numbers –  these measures give an overview of the safety and quality of all our services. This data is available to anyone who both wants to see it and  who is legally allowed to  – such as service users, commissioners, and regulators.

Whilst we always offer this data to our commissioners and regulators, we hope now that the Strathdee review has been published that those overseeing services will be automatically asking for this data in support of  a whole system approach to safety improvement.

  • We have policies and processes that direct the right responses to safety data. This is one of the biggest issues in mental health care – safety data is collected but not used. It’s the ‘so what; question – data is not just an inert set of numbers – it should guide safety actions and good organizational functioning in health and care.

As an example, we ask people in all our services to give information on how safe they feel both by using standardised measures and also by asking them after any incidents and in monthly care plan co-production sessions. MDTs and governance teams have to respond to this data – if the person says they don’t feel safe, there has to be a response to that. Similarly, our policies say that if a person has been involved in any incident involving restraint  there has to be a review and that has to part of a thematic review of restrictive intervention. Each service writes one of these 4 times a year. They are circulated to all our services for shared learning purposes.

  • We don’t use simple trend analysis to tell if some aspect of the care we provide is getting better or worse; just looking at a trend doesn’t tell you much because in health and social care it’s normal for most issues to vary over time.

This is why the government report has directed that all boards and services must understand and  use something called ‘statistical process control or ‘SPC.’ We use SPC for all our safety data – both to make sure that services are measuring themselves accurately against their own aims to minimise safety incidents but also because those accountable for our services need to know when something ‘out of the ordinary’ is happening in any area of the care we provide.

  • We are developing more advanced analytic tools involving the use of new technologies such as AI. Iris Care Group’s clinical and operational teams have spent years designing information systems purely designed to ensure that we have a robust and consistent approach  to safety and quality across our diverse care settings – comprising differently sized services across over 50 sites providing both health and social care to people with complex but varied health and care needs.

Now that technology has advanced, we are using all the data we have collected on safety issues over a lengthy period of time to develop, in house,  new tools that will help our teams be even more informed about quality and safety issues and to further improve our responsivity to safety signals. It’s important to say these developments also need to be considered with safety in mind, so we are using the developing governance frameworks for the use of AI in healthcare in all our forward planning.

 

Iris Care Group supports Geraldine Strathdee’s report and the government’s recommendations.

 

At Iris Care Group we have been actively and passionately committed to the utilisation of data for  many years within our own services, and we believe the report’s recommended data-driven approach is essential to driving future improvements in safety and quality and the experiences of all those who use mental health services.

 

Dr. Andrew Hider explains how we use restraint data to drive improvements in safety

Dr Andrew Hider is Iris Care Group’s Clinical Director as well as a Consultant Clinical and Forensic Psychologist.

He studied Experimental Psychology and Philosophy (PPP) at Corpus Christi College, University of Oxford, graduating in 1996.  After a period of two years working for a specialist challenging behaviour service based at the Welsh Centre for Learning Disability he completed his clinical training at the University of Plymouth and received his Doctorate in Clinical Psychology in 2001.

Since then he has worked exclusively with people with severe and complex problems and offending behaviour and has worked with forensic populations in low and medium secure and community settings in the United Kingdom. Clinically he is interested in providing psychological support to people whose needs may cross over multiple clinical areas including mental illness, personality and complex trauma, and learning disability.

His research interests include evaluating inpatient group therapies and interventions for men with offending behaviours and mental health problems, evidence-based triage in the psychological therapies, the relationship between neurodevelopmental disorders and offending behaviour, violence risk, and mental health staff cultures.  He is currently an external examiner on the Doctorate in Forensic Psychology at the School of Medicine, University of Nottingham.

Andrew is a member of Iris Care Group’s  Board of Directors with specific accountability for supporting reductions in restrictive practice and the promotion of person-centred principles throughout the organisation.

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