Establishing the relationship between staff and ward characteristics and patient safety incidents on adult mental health wards - #StaffedWards.

BACKGROUND Around one in ten acute mental health hospital admissions involves a medical error, one in six an adverse event. We refer to these as ‘safety incidents’. The deaths of UK mental health patients has prompted a Government rapid review and a national inquiry. The factors which contribute to patient safety in mental health settings vary from the factors which contribute to patient safety in physical healthcare settings, but this is poorly understood. An especially neglected area is how mental health staff and team characteristics may influence safety. ‘Toxic leaders’, for instance, may role-model unhelpful behaviours or suppress staff instincts to speak out. This research will address the evidence gap and create new translatable knowledge to support urgently needed safety improvements across the mental health sector. AIM To explore individual and collective staff factors that increase/reduce the risk of safety incidents on adult acute mental health wards, to inform evidence-based recommendations for mental health organisations, regulatory bodies and national training organisations. Objectives: 1. Develop an evidence-informed staff risk and protective factors theoretical model; 2. Understand the extent to which variation in incident data on wards is driven by staff and team characteristics; 3. Explore underlying mechanisms of relationships between incidents, and staff and team characteristics. METHODS Design: Mixed methods with three phases informed by a Lived Experience Advisory Group (LEAG). Phase 1: Systematic integrative literature review to develop a theoretical staff risk and protective factors model (Obj 1). Phase 2: Hierarchical modelling of longitudinal quantitative routine data to measure and record the extent of differences across wards; understand the extent to which variation is driven by ward, patient and staff considerations; and identify outlier wards for further investigation (Obj 2). Phase 3: Case studies in 5 outlier wards to explore mechanisms underlying the staff risk and protective factors model (Obj 3). Timeline: 30 months ANTICIPATED IMPACT AND DISSEMINATION Our study will provide the first evidence about the relationship between staff and ward characteristics and incidents on mental health wards. This information will be of interest to academics and clinicians internationally. It will inform future interventions to promote safety in mental health and other services. The dissemination strategy is based on proven effective mechanisms and will be informed by the LEAG and a stakeholder event. Outputs will include written reports, oral presentations, regular blog posts on a project website, an infographic and lay summary, a stakeholder event and a brief training resource for ward staff. Our dissemination approach aligns with NIHR guidance. We will target key stakeholders including NHS service providers and staff, service commissioners and regulators, policy makers and academic researchers. Written, verbal, electronic and face to face methods will be employed to target patient/service user, carer, public, practitioner and academic audiences. Guided by the Study Steering Committee, LOMANI and the LEAG we will co-design the strategy, which will be refined towards the end of the project at our stakeholder event. We have established links with relevant community, professional and NIHR networks, which will enable us to spread our findings across multiple regions, and support wider knowledge mobilisation.