1. SAFE Care - ‘Safety Express’ – Mental Health & Learning Disabilities
In Mental Health & Learning Disabilities the QIPP workstream is focused onto 4 main harms : Self harm, Violence & Aggression, Slips, Trips & Falls and Medication errors
Aim
Primary Drivers
Secondary Drivers
To deliver a reduction of harm within mental health and learning disability services from incidents involving :
Self harm
Violence & aggression
Slip, Trips, Falls
Medications errors
by Dec 2012
Leadership and
Safety Culture
Clinical Care 95% reliable
Supportive infrastructure
Service user and
family-centred care
Effective risk assessment
Robust care planning
Promoting choice, dignity & respect
Information giving
Effective working between teams
Sound evidence based practice
Clear clinical leadership
Education and Training
Active patient/carer involvement
Clinical supervision / Mentoring/Preceptorship
Access to therapeutic interventions
Safe clinical environments
Effective learning safety culture
Access to equipment
Operational systems/ policies
Meaningful activities and engagement
Learning from patient/carer feedback
Visible/ ongoing Executive support
Promoting physical health including nutrition and hydration

2. QIPP Safe Care – Acute Settings
The QIPP Safe Care workstream is an improvement programme designed to help organisations reduce harm. In Acute Services Safe Care tackles 4 major harms in the NHS; Falls, VTE, Pressure Ulcers, Catheter Acquired UTI by 50%,

3. 50% reduction in in-patient physical assaults each year until 2012
Measurement
Leadership
Communication (SBARD)
Reliable risk assessment
Collateral information
Aim
Primary drivers
50% reduction in in-patient physical assaults each year until 2012
Secondary drivers
Local feedback
Standardised
care
Training
Supportive eRecord

4. Driver Diagram - STAR Unit
Secondary Drivers
Primary Drivers
A. Raise awareness
B. Introduce a SU advanced
statement re management of
V&A.
Care Planning
Aim
A reduction in incidents of violence& aggression by 20% in the STAR Unit during 2012/13
A. Post all records (agreed actions)
of the community meetings in a
central area.
B. Post a weekly activity programme
at a central point on the ward.
Environment
A. Develop a formal process
regarding the planning of social &
therapeutic activities.
B. Introduce a community meeting.
C. Redesign role of staff member –
activity co-ordinator.
Therapeutic
Interventions
A. Review and compare data – make
data easily available to staff..
B. Identify specific times/places/
personnel involved in V&A.
C. Provide poster for staff comments
re new PDSAs.
D. Provide staff with written updates
re V&A to inform staff on return
from days off.
E. Recruit permanent staff to vacant
posts.
A driver diagram is used to conceptualise an issue and determine its system components which will then create a pathway to get to a goal.
Use driver diagrams to build a theory about the system that underlies your improvement project topic
Workforce
© 2010 AQuA
Secondary drivers are interventions associated with primary drivers. They can be used to create projects or change packages that will affect the primary driver.
Primary drivers are the systems changes which will contribute to achieving the Aim outcome measure. 4 4

5. Trust Harm Reduction Strategy Driver diagram
PRIMARY
OUTCOME
(Measure)
Sustained reduction I the frequency of the three most common types of incident each year (20% annually for each year over five years from April 2011)
Incidents are:
-Falls,
-Violence and Aggression -Self Harm
Balancing Measure
Ensure other types of incidents are not neglected and increase as a result of targeted intervention.
Governance Structure
Report to H&S bi-monthly actions and incident data
Executive lead Kim Crowe to report to board
Tony Crumpton to report to H&S
Leadership
Identify and inform Stakeholders
Engage early implementers
Identify strategic and clinical leads
Monitoring
Policy compliance
Incident data
Implementation strategies
Secondary Drivers
- Identify reporting lines
- Strategy Lead and clinical leads (x1 for each harm)
-Identify external groups Safety Express to develop comparison data B C
- Engage AQuA in supporting the process-
-Identify with CBU’s wards / units for implementation
- Support unit managers in adopting change process
-identify change champions
B C
- Implement measures based on PDSA cycles
- Share good practice / share successes - Share / report findings
-Develop sensitive measures / baseline data
-Identify and support clinical champions C
Primary drivers are system components which will contribute to moving the primary outcome
Secondary drivers are elements of the associated primary driver. They can be used to create projects of change packages that will affect the primary driver
Trust Harm Reduction Strategy Driver diagram
Definition: A driver diagram is used to conceptualise an issue and determine its system components which will then create a pathway to get to the goal

6. Aim
To reduce physical assaults to staff by 20% in one year on the Trust baseline
Safe Environment
Staff Experience
Communication 
 Handovers
Patient Experience
Primary drivers describe the systems / larger components which will contribute to achieving the overall aim. Each usually has an associated measure
Secondary drivers are elements of the associated primary driver. They are interventions which can be used to create projects or change packages that will affect the primary driver.

7. Aim
50% reduction on numbers of detained patients absconding from acute Inpatient wards by Dec 2012
Evidence based policy and guidance that is implemented
Therapeutic milieu
Person Centred approach
Audit of baseline
Develop understanding of existing literatiure
RA to include risk of AWOL, staff trained
Identifying and dealing with patients concerns
Risk assessment, profiling and management
Patient activities
 Safe and appropriate environment
Primary drivers are systems components which will contribute to moving the primary outcome.
Secondary drivers are elements of the associated primary driver. They can be used to create projects or change packages that will affect the primary driver.
Driver diagram
Driver diagrams are a type of structured logic chart with three or more levels (see example below). These would include:
1. a goal or vision 2. the high-level factors that you need to influence in order to achieve this goal (called ‘primary drivers’) 3. specific projects and activities that would act upon these factors We decided upon 2 projects initially – Audit of baseline Develop semi structured audit tool – in red This information lead us to complete a PDSA ..