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

Zero suicide Mersey Care – mental health trust programme 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 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) 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) 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’

25 Solutions: Traditional CRM, ERM, VDERM 25

26 Process of figuring out what kinds of future events might prevent or slow the achievement of objectives or enhance the prospects of success. Assess Identify Evaluate Mitigate Monitor Process of figuring out what kinds of future events might prevent or slow the achievement of objectives or enhance the prospects of success. Determine which risks are most critical and how individual risks are related to each other. Evaluate outcomes and decide which risks need to be addressed. 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. 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. ERM ISO Process 26

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