Safety I and Safety II for Suicide Prevention – Lessons from How Things Go Wrong and How Things Go Right in Community-Based Mental Health Services

Jun, Gyuchan Thomas; Canham, Aneurin; Noushad, Fabida; Gangadharan, Satheesh

doi:10.1007/978-3-319-96098-2_56

Cited by 6 publications

(16 citation statements)

References 3 publications

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“…Such adaptive capacities also apply to suicide risk detection and response in clinical care practices. A study among community-based mental health workers in the UK revealed a complex decision-making process involving uncertainty and trade-offs regarding patient clinical needs, patient desires, legal and procedural obligations, and resource considerations [28].…”

Section: Introductionmentioning

confidence: 99%

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

et al. 2020

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Background: Safe clinical practice for patients hospitalised in mental health care during a suicidal crisis is situated within a dynamic, non-linear and uncertain context. Under such complex conditions, the adaptive capacity is considered vital to handling challenges and changes in clinical care. This study aimed to explore safe clinical practice for suicidal patients hospitalised in mental health wards through understanding healthcare professionals' (HCPs') capacities to adapt to challenges and changes in clinical care. Methods: This study applied a qualitative design with focus group and individual interviews. Twenty-five HCPs participated in the focus groups, and 18 participated in individual interviews. The study was conducted in open and locked wards in a university hospital in Norway providing specialised mental health services for patients with mental illness. Results: HCPs described their adaptive capacities for clinical practice relative to three themes. 1) HCPs used expertise to make sense of suicidal behaviour to support complex decision making. Their strategies included setting aside forms and checklists to prioritise trust and making judgements based on more than just patients' spoken words. They improved their understanding by seeking others' perspectives through collaborative sense-making processes involving the healthcare team and patient. 2) HCPs individualised the therapeutic milieu to address the diversity of patients with suicidal behaviour by creating individual clinical pathways, making trade-offs between under-and over-protection and adjusting observations. 3) HCPs described managing uncertainty as necessary for providing safe clinical practice. They managed uncertainty as a team by developing mutual collegial trust and support and creating a shared understanding. Conclusion: HCPs' adaptive capacities are vital to the complex set of practices involved in safe clinical practice for patients hospitalised during a suicidal crisis. By using expertise, individualising the therapeutic milieu, and managing uncertainty, HCPs individually and collectively develop their capacities to adapt to challenges and changes in clinical care. HCPs cannot easily ensure safe clinical practice by following standards; safe clinical practice depends on HCPs' adaptations. Ward systems that ensure collegial trust and support, as well as arenas that foster shared understanding and situational awareness, are needed.

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Section: Introductionmentioning

confidence: 99%

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

et al. 2020

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“…På klinisk nivå har selvmordsforebygging i perspektiver fra resiliens blitt omtalt i en systematisk litteraturstudie (Berg et al, 2017a), fire kvalitative studier (Littlewood et al, 2019;Jun et al, 2019;Berg et al, 2020a;Berg et al, 2020b), en editorial (Quinlivan et al, 2020), og en studieprotokoll (Berg et al, 2017b), samt en doktorgradsavhandling (Berg, 2020). Litteraturen antyder at på klinisk nivå innebaerer et Safety-II -perspektiv å innlemme betydningen av ekspertise, det individtilpassede, og systemer og kultur som støtter helsepersonellet i det daglige arbeidet.…”

Section: Klinisk Nivåunclassified

Fra Safety-I til Safety-II: Mot nye perspektiver på pasientsikkerhet i selvmordsforebygging

Berg¹

2021

Suicid.

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Sentralt for resiliens i helsetjenesten er Safety-II-perspektivet. I et Safety-II-perspektiv anses tilpasninger som sentralt for å skape trygge pasientforløp for den enkelte pasient. Forfatteren argumenterer for at resiliens i helsetjenesten gir nyttige perspektiver til suicidfeltet. I et Safety-I-perspektiv forebygges selvmord ved å sikre at alle ansatte følger prosedyrer ogkorrigerer svikt. Mens Safety-I-tilnærmingen kan gi gode resultater i en klinisk praksis hvor det er kunnskapsgrunnlag for at den enkelte prosedyren gir gode utfall for pasienten, vil ikke denne tilnærmingen være tilstrekkelig i en praksis kjennetegnet av usikkerhet relatert til hva som virker, og hvor prosedyren ofte tilpasses for å imøtekomme varierende krav i pasientbehandlingen. I et Safety-II-perspektiv forstås sikkerhet som systemets evne til å oppnå suksess under varierende omstendigheter. Forskning på resiliens i helsetjenesten og Safety-II-perspektivet innen selvmordsforebygging er i startfasen. Studiene gir innsikt i at et Safety-II-perspektiv på sikkerhet i selvmordsforebygging innebærer å innlemme det individtilpassede og relasjonelle i pasientsikkerhetsarbeidet. Et Safety-II-perspektiv innebærer også en endring påregulerings- og tilsynsnivå fra å plassere skylden for pasientselvmordet på det enkelte helsepersonell og manglende selvmordsrisikovurderinger, til å forstå og anerkjenne kompleksiteten helsepersonell til dagligstår overfor.

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“…However, patients have not been used extensively as sources of knowledge in RHC [35,36]. Furthermore, few empirical studies have adopted RHC perspectives to suicide prevention [37][38][39], and none have incorporated patients' perspectives. This synthesis of an in-depth qualitative case study applying RHC to suicide prevention can fill this gap.…”

Section: Introductionmentioning

confidence: 99%

Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis

Berg

Rørtveit

Walby

et al. 2022

BMC Health Serv Res

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Background The prevailing patient safety strategies in suicide prevention are suicide risk assessments and retrospective reviews, with emphasis on minimising risk and preventing adverse events. Resilient healthcare focuses on how everyday clinical practice succeeds and emphasises learning from practice, not from adverse events. Yet, little is known about resilient practices for suicidal inpatients. The aim of the study is to draw upon the perspectives of patients and healthcare professionals to inform the conceptual development of resilient practices in inpatient suicide prevention. Methods A narrative synthesis was conducted of findings across patients and healthcare professionals derived from a qualitative case study based on interviews with patients and healthcare professionals in addition to a systematic literature review. Results Three sub-themes categorise resilient practices for healthcare professionals and for patients hospitalised with suicidal behaviour: 1) interactions capturing non-verbal cues; 2) protection through dignity and watchfulness; and 3) personalised approaches to alleviate emotional pressure. The main theme, the establishment of relationships of trust in resilient practices for patients in suicidal crisis, is the foundation of their communication and caring. Conclusion Clinical practice for patients hospitalised with suicidal behaviour has characteristics of complex adaptive systems in terms of dynamic interactions, decision-making under uncertainty, tensions between goals solved through trade-offs, and adaptations to patient variability and interpersonal needs. To improve the safety of patients hospitalised with suicidal behaviour, variability in clinical practice should be embraced. Trial registration https://doi.org/10.1136/bmjopen-2016-012874

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Safety I and Safety II for Suicide Prevention – Lessons from How Things Go Wrong and How Things Go Right in Community-Based Mental Health Services

Cited by 6 publications

References 3 publications

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

Adaptive capacities for safe clinical practice for patients hospitalised during a suicidal crisis: a qualitative study

Fra Safety-I til Safety-II: Mot nye perspektiver på pasientsikkerhet i selvmordsforebygging

Shared understanding of resilient practices in the context of inpatient suicide prevention: a narrative synthesis

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