Developing a Quality Control Strategy for Violence Reduction

Jen Taylor-Watt & Andy Cruickshank

by Jen Taylor-Watt, QI Lead for City & Hackney and IAPT and Lead Improvement Advisor for Violence Reduction &

Andy Cruickshank, Associate Director of Nursing for QI and Senior Improvement Advisor for Violence Reduction

In order to hold the gains we’ve achieved through the Violence Reduction Collaboratives, it’s key that we develop strong structures and processes for understanding the health of our inpatient systems, enabling teams to identify quickly when there are risks of things going out of control. A key step we have used to do this to date has been the unitwide safety huddles, and we are now taking this a step further with the introduction of visual management strategies within unitwide huddles.

A key structure; the unitwide huddle

Like on a ward level, unitwide huddles help the whole unit to come together to understand what the concerns and issues are and to agree actions to be taken as a team. It enables managers and staff from across the unit to be conscious of problems and to support each other to address these; thereby functioning more as a whole system, rather than isolated wards.

For example, at a unit-wide huddle in City & Hackney last week, the representative from Bevan PICU (Psychiatric Intensive Care Unit) raised the fact that a service users’ glasses had been broken on the ward and this was understandably leading to unhappiness and agitation, because they couldn’t see properly. Bevan was low on staff that day though, so couldn’t safely release anyone to escort the service user to replace his glasses. The unitwide huddle quickly agreed it was a priority for the unit to sort this as quickly as possible and another Ward Manager immediately agreed to release a member of their staff to support the PICU address the person’s needs.

Quality Control through visual management; the Quality Control Board

The QI team is working with the units in Tower Hamlets and City & Hackney to look at how we can strengthen our Quality Control strategy further, through using the ideas of visual management by developing Quality Control Boards, as shown in figure 1, Tower Hamlets, and figure 2, City & Hackney.

Figure 1 – Tower Hamlets Quality Control Board, June 2017

Figure 2 – City & Hackney Quality Control Board, August 2017

As you can see from these images, Quality Control Boards attempt to bring together all the key data, which gives a sense of how a system is functioning. Rather than just relying on the information that individuals decide to bring to the huddle, teams go through a process of reflecting on the data they need every time to understand how their system is functioning. This therefore mitigates against the risk of important information and connections being missed. It provides a more objective framework that the whole team can work with to see what is important and what needs discussion. It therefore helps to more systematically manage the control of the hospital as a system and focuses staff on what they need to pay attention to.

Staff from Tower Hamlets, who are the furthest ahead with developing their approach to using Quality Control Boards, have reflected that the Quality Control Board also really helps the unit learn, and that use of the board is a step up from previous huddles, making them better aware of unit wide issues. They have fed back that it is also improving their problem solving and critical thinking, and helping them to more fully consider and keep track of follow-up plans.

Tower Hamlets staff are keen to emphasise that they’re nowhere near finished with refining their Quality Control Board. It is very much a process of getting started, seeing what is useful and reflecting on ways in which it could be strengthened even further. Becks Lingard, Matron for Rosebank PICU and Brick Lane Ward in Tower Hamlets, kindly supported City & Hackney leadership to get going with their Quality Control Board, so we now have the opportunity to share the learning across the two units as they both take this forwards. Newham also plans to start soon.