1. 4 Steps to Safety Violence Reduction Programme. Implementation
Andrea Langley
RMN and Quality Improvement Manager

2. Intervention tracker

5. What has gone well? Engagement in the project and with facilitators
Collaborative events and core training
Co-production
Teams designing interventions and processes –testing
Champions have been key
Wards with higher levels of V&A welcome a structured framework
Interventions that focus on behaviour and risk

6. What have been the biggest challenges?
Frontline resistance
Implementation as a priority
Staffing impact
Is this relevant to our clinical area?
Intentional rounding and Compact - ?culture change
PDSA cycles and learning logs
Process monitoring – seen as another audit
Facilitator role is time intensive

7. Unexpected benefits
Teams welcoming learning from our lived experience representatives
Reduced restrictive practice
Reduced agency spend
Reduced severity of harm
Improved conversations about quality and safety
Shift, for some, away from ‘just observations’ to engagement
Consultants leading operationally
Difficult data conversations leading to teams moving towards triangulation of own data for improvement

8. Recommendations:
Resistance is engagement
Prevention rather than reduction
Include frontline staff early
Talk about data early
Co-produce and collaborate
Persevere 

9. Feedback
“I don’t like it when staff increase my DASA score and zone without talking to me
“ I get the time of day for someone to listen to me”
“It’s good, we don’t have to bother them. It’s good to chat about anything. They will help you with anything”
“ I like knowing I get to see the same person and they will understand me each time”
“I like my 1:1 time I can get my feelings out”
“smooth transition from something which was currently taking place on the ward to now being done in a more structured way”
“Self-isolating patients now get staff time each shift”
“Continuity of day-to-day care is more effective due to improved quality of patient handover”
“Due to IR I am able to recognise when my patients are having a bad day”
“Better nursing care”