Alliance national human factors review in high secure care
The East Midlands Alliance and Health Innovation East Midlands recently led a human factors learning review to support continuous improvement in working practices in high secure units across England and Scotland in relation to the use of mechanical restraint.
A human factors approach puts people at the centre of the review - both service users and staff. This allows an in-depth look at working practices and encourages questioning around how people think, where people do things, what they can do, what they use and how the things they do affect others.
This supports a better understanding of the complexity and variation of working practices in a way that data alone cannot achieve. The human factors approach minimises the limitations of a review and ensures improvement decisions can be based on the wide knowledge of a whole system, targeting the areas with the most influence.
The Alliance and Health Innovation East Midlands review adopted a human factors approach to better understand when and how mechanical restraint is currently used at Ashworth High Secure Hospital in Merseyside, Broadmoor Hospital in Berkshire, Rampton High Secure Hospital in Nottinghamshire and The State Hospital in South Lanarkshire. Recognising that the use of this practice is highly nuanced and complex, the review aimed to support the co-production of best practice guidance for high secure settings.
The review included an analysis of patient experience (from clinical notes and surveys), ward visits, focus groups with staff and interviews with ward leads. Hierarchical task analysis was used and each process was mapped against its goals, plans and operations.
Kay Khan, Head of Improvement Programme Delivery at Health Innovation East Midlands, said: "The outcomes of the review helped create themes to drive improvement by obtaining a greater understanding of mechanical restraint use in high secure environments. A set of principles for mechanical restraint use was recommended and good practice guidance. The review showcases a collaborative way of working together on a challenging problem and advocates the benefits of sharing and learning."