Through quality improvement to increased effectiveness A journey of reflection Remember users, quality, ROM, accreditation Seeing each other Unifying through learning from each other EXAMPLES from patient perspective simonrwilkinson@gmail.com, Akershus university hospital, Norway

From the art of not-knowing to the «science» of not-knowing!

Course in not-knowing for medical students, University of Utah All you think you know that you actually do not know All you think you do not know that you actually know Solution: Meeting with others who do not know

QNIC audit circle

Reflective function Tour of the unit: opportunity to validate the Environment and Facilities standards Working through the self review workbook: focusing particularly on unmet standards to encourage action planning Open discussion: an opportunity to look in depth at a specific issue (e.g. development of therapies, use of video conferencing for therapeutic work)

Standard levels Type 1: Failure to meet these standards would result in a significant threat to patient safety, rights or dignity and/or would breach the law AND the fundamentals of care, including the provision of evidence based care and treatment Type 2: Standards that an accredited ward would be expected to meet Type 3: Standards that an excellent ward should meet or standards that are not the direct responsibility of the ward

Environment and facilities Buildings Rights: Rooms for parents, telephone access, interpreters Safety Food Involvement in developing unit

Staffing and training Staffing norms Multidisciplinary working Systematic teaching in essential areas – patient rights, structured methods, treatment plans, HLR Introduction for new employees Supervision Recruitment

Admission and discharge Admission – exclusion crittieria, speed, info to parents and patients Contact with others involved in treatment/care – incl. Family Discharge

Treatment and care NB this is vegetarian Investigations Breadth of treatment options Structure to unit routines Treatment plans Schooling

Information, Consent and Confidentiality Info available to the public, carers, patients How to complain Identification of staff Consent and ability to give informed consent

Rights and Legal aspects Mental health legislation Respekt for patient rights – incl. Being involved, complaints, Use of force Cooperation with child care

Clinical governance Evaluation of treatment – experience of admission, of those who refer, results, place in total service provision Use of error reports Routines for cooperation with other professionals Procedures and protocolls – house rules, emergency sedation, limit setting Health and Safety

Strengths, Challenges and Others’ solutions