I lead a team of multidisciplinary researchers who explore the power of routinely collected data for improving our understanding of patient safety. Our hope is that this insight will be translated into improvements in patient care.
On this World Mental Health Day, there is an opportunity to reflect on the implications of harm to staff who deliver care to some of the most vulnerable patients in any healthcare system and what we might do to better protect them from harm.
We recently published a study that focussed on staff safety in the mental healthcare setting and I'd like to discuss some of the findings in this blog.
Our recent observational study, published in the Health Informatics Journal, focussed on staff safety in the mental healthcare setting. We worked with a mental healthcare provider to extract and analyse incidents of adverse events.
In one aspect of the work, we looked specifically at the incidents that were reported that had recorded a member of staff as a ‘victim’ of the adverse event. From the 1 September 2014 to the 31 March 2017, 19,693 members of staff were reported as victims across 10,119 adverse events. For context, this was the equivalent of around 25 incidents per week, but it is important to keep in mind that this was for both harmful and non-harmful incidents and near misses. The most common incident was ‘aggression by patient on staff or other’.
We were interested in exploring whether nurse staffing levels affected adverse events on staff. To investigate this we made use of nurse staffing data for each inpatient area. We were able to obtain data that quantified the planned, the clinically required and the actual, staffing level of nurses.
We found that, in many cases, registered nurse staffing affected staff safety. Where there were more registered nurses, there tended to be less adverse events on staff.
We also found that, although there was also a relationship with unregistered nurses, staff harm was more resilient to understaffing of unregistered nurses. This leads us to hypothesise that the role of the registered nurse provides additional benefits to risk mitigation and that it’s not simply about head count but rather the type of skills and care provision that the healthcare team provides.
However, it is important to note that these relationships were not consistent across all locations and all shifts.
On the night shift, for example, we found that as the clinically required level of unregistered nurses decreased, the number of adverse events to staff increased. This suggested that where the perceived clinical demand was low, the risk to staff was highest.
This has important implications. This implies that the perceived clinical demand for nursing staff doesn’t appropriately consider the risk of harm to staff, particularly during the night shift when the clinically required levels of unregistered nurses is insufficient to project staff from harm.
The use of these data in this way is novel and as researchers, we are very excited about the promise of utilising routinely collected data to predict both patient harm and staff harm. We hope that this will provide significant opportunities to improve healthcare safety.
In order to provide effective and sustained high levels of mental health care, we need to understand the challenges presented by the mental healthcare environment, and the need to staff these environments in such a way that keeps the workforce safe. We are doing a long term study to explore the environment and workforce retention in secondary and mental healthcare. You can find out more here.
About the Author
Dr Sarahjane Jones is a senior research fellow at Birmingham City University. She is a health services researchers with a particular interest in the application of routine data to healthcare safety improvements.