1. 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
Akershus university hospital, Norway

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

3. 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

5. QNIC audit circle

6. 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)

7. 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

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

9. 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

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

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

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

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

14. 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

15. Strengths, Challenges and Others’ solutions