Having enjoyed a relatively warm and sunny summer for a change, there will inevitably be the usual speculation regarding possible climate change and the effect of human activity in warming the planet. Whether or not that is accepted depends on the individual’s point of view and most people are of the view that human activity can have some overall effect on the climate.
The difference between ‘climate’ and ‘weather’ of course is that ‘climate’ is the weather that you expect depending on long term averages, whereas ‘weather’ is what you actually get. What has this got to do with patient safety and patient safety in mental health specifically?
In the same way that the weather changes from day to day but follows an overall pattern consistent with the climate, how “safe” a ward or facility is can alter from hour to hour depending on the level of activity, the number of staff and the challenges that are being dealt with. The overall ‘safety climate’ ( on average how safe a ward or unit is in terms of the number of adverse events or the quality of care) is something which can be measured, and there is increasing evidence that it can be altered by interventions to change the safety culture, and therefore climate.
MEASURING THE SAFETY CLIMATE
Tools have existed for some time which gauge a staff group in an organisation’s assessment of how safe the facility feels. The sort of questions that staff are asked include whether or not they know who to report adverse events to, whether they would feel able to report such events, and how supported they feel by managers and others. Such tools have proven useful in identifying well functioning facilities across all industries including health, versus those where the climate does not support safe practices or encourage reporting of problems.
A search of the literature however revealed to us in the Scottish patient Safety Programme for mental Health (SPSP-MH) that no-one had previously developed a specific safety climate tool aimed at the users of services, specifically mental health services.
The SPSP –MH programme has over the last eighteen months supported a group led by VOX (Voice of Experience) to develop and amend a patient safety climate tool for use by patients in mental health facilities. All Health Boards in Scotland have now used this tool to produce baseline information regarding how safe the participating wards feel to the patients within them. Again it asks similar questions to the staff climate tool about what they would do in the event of feeling unsafe, who they would report things to, whether they feel safe at different times of day or night, or in different locations, and how they feel when things are going wrong and if they are supported after upsetting events, such as witnessing an episode of restraint.
Already this has produced exciting insights into how variable this might be and the kind of things which seem to be important to patients using our services. For instance, a very small pilot here in Dumfries identified early on that patients did feel safe during the day when they had a named nurse who they could speak to but at night they didn’t have a specific named nurse and therefore this left them feeling more vulnerable in some instances. This led to a quick and simple change to address this.
CAN WE CHANGE THE SAFETY CLIMATE?
Having identified that a climate of safety in a ward or unit can be measured usefully using such tools, including tools used by patients or service users themselves, the key question is can the climate or culture of a facility change and can that change result in improvement?. The answer seems to be a very definite yes.
One example is where colleagues in Greater Glasgow have been developing an amended patient safety walkround to include a more mental health specific slant and a specific’ safety conversation’ which aims to gauge the safety climate, and the level of any activity around the patient safety programme within that facility. Similar to feedback from the patient safety climate tool, early use of this approach has identified variation between units, with an apparent link to the units relative engagement in SPSP-MH work to address patient safety issues.
Essentially the more teams are committed to looking at their practice and processes and to making changes to try and improve safety, the safer the ward feels, both to staff and patients.
CLIMATE CHANGE – FOR THE GOOD?
There is no doubt that the weather in Dumfries, as elsewhere, will continue to vary, and whether the climate alters such that we will have more of the pleasant summer weather that we enjoyed remains unclear. In terms of work around patient safety changing the safety climate and culture within our services, the Scottish Patient Safety Programme is producing increasing evidence that this is the case and that hopefully the climate change that we see will be one which we don’t need to worry about and which will be to the benefit of staff and patients.
DR DAVID J HALL is Clinical Director & Consultant Psychiatrist at NHS D&G and National Clinical Lead for the Scottish Patient Safety Programme Mental Health