While we are very proud of the quality improvement we have achieved to date, in the spirit of continuous improvement and striving for perfect care, we recognise there is always room for more.
Our understanding of what it means to ‘strive for perfect care’ is changing. It no longer means just striving for perfection in an episode of care, but also means becoming more preventative and integrated in our approach, seeing people in the context of their families, their communities and their neighbourhoods, not as problems to be solved, but as assets to be invested in.
We characterise the next phase of our improvement journey as being about embedding quality improvement techniques and results, including in our newly acquired services, so that we move from having some great examples of outstanding care to more systematic quality improvement that is everywhere in our organisation.
To reflect this quality improvement in the mainstream of our services, we continue to aim to have an overall CQC ‘Outstanding’ rating for our services by 2024.
We use a zero-based approach to deliver significant safety improvements in places that have historically been in the ‘too difficult box’. By framing our ambitions in this way, we can unlock the talent we have. This culture of continuous improvement will be critical in ensuring recovery from the COVID-19 pandemic for service users, staff and our services.
We strive for a Restorative Just Culture. This is an environment where we put an equal emphasis on accountability and learning. It’s a culture that instinctively asks, in the case of an adverse event “what was responsible, not who is responsible”.
Of course, it’s not the same as an uncritically tolerant culture in which anything goes – that would be as inexcusable as a blame culture.
We’ve learnt from established academic works and studied other industries and systems where there's always an element of risk.
Zero tolerance of disrespectful behaviours and racism are now set out in our Trust’s goals.
We’ve created special tools for staff to support civility and manage inappropriate behaviours. This approach has seen a significant reduction in disciplinary cases.
No Force First
No Force First is our initiative aiming to reduce restrictive practice in our care. All the work we’re doing is part of our long-term goal to achieve Perfect Care. At the heart of that is trying to reach the highest possible standards in everything we do, not just in clinical care but also how we deliver our messages to the outside world.
External organisations have taken such an interest in our journey to No Force First, but there are senior figures in other organisations (and still a few in our own) who still believe suicide is inevitable and No Force First is unachievable. It’s when we are confronted with attitudes like those that we need to show our courage on a number of levels:
- Organisational – the Board must have the serious ambition to make change and turn ideas into reality despite opposition or conflicting views from peers.
- Professional – clinicians and GPs must confront their own practices and practices of others, a difficult challenge to change day-to-day methods and gently change the system without confrontation.
- Experts by experience – they have given so much to help coproduce practice, having the courage to tell their stories and, in some cases, having the courage to stand up and address and influence large groups of people.
- Staff and patients – have shown great courage in accepting No Force First and making Mersey Care a better caring environment. Our belief that people who use our services are at the centre of everything we do and are, to use our own Perfect Care terminology, ‘the people we serve’ helps to strengthen our incredible emotional commitment to positive change – whatever the obstacles we may encounter.
If you would like any more information about the No Force First initiative, contact the project lead for No Force First on 0151 472 4550.
We were the first NHS mental health trust to commit to achieving zero suicides among our service users in 2015.
Mersey Care is a founder member of the Zero Suicide Alliance (ZSA), a collaboration of organisations committed to preventing suicide, and has developed training to give people the skills and confidence to identify, support and signpost someone presenting with suicidal thoughts or behaviour.
You can access the ZSA training here.
Find out more about our Trust’s suicide prevention work.
Mersey Care believes strongly in setting the highest of healthcare standards across everything we do. This includes zero tolerance of harm from medication, which we aim to achieve through the following steps:
- Zero moderate / severe harm incidents relating to medicines
- Zero preventable harm from clozapine
- 100% of inpatient acute antibiotic prescribing reviewed within 72 hours
- 100% of medication administered as injectable rapid tranquilisation with a risk of psychological harm will be subject to a multidisciplinary review within 48 hours.
Mersey Care is committed to reducing the number of falls and has introduced new practices to ensure that. These include:
- 100 per cent of inpatients have a falls screening within 24 hours of admission and those at risk of falls have a multifactorial risk assessment and management plan in place
- 20 per cent reduction in harm related to falls in inpatient areas, taking account of the previous 24 month rolling baseline
- Standardised falls risk assessment process across community settings to be introduced, by September 2021
- Develop a clear pathway for access to support services for those identified as at risk of falling in the community, supported by our integrated care teams.
Find out more about our falls prevention work.
Mersey Care has a history of setting ambitious goals for the type of organisation we want to be and services we want to provide. Mersey Care is on a journey to become an anti-racist organisation.
This is a significant and large scale goal and each year we will set objectives to support us in striving forwards.
Our Operational Plan recently described how we would establish a goal for zero acceptance of racism, discrimination, and unacceptable behaviours, taking these actions to make progress:
- Create a workforce that is representative of the communities that we serve through positive action in recruitment
- Improve understanding of “What is racism and allyship” and create tools to make this happen
- Improve black, Asian and minority ethnic (BAME) colleagues’ experience of working within the Trust in line with Restorative Just and Learning Culture approaches
- Reduce the gap between black, Asian and minority ethnic staff and white staff in their experience of bullying, harassment and abuse, using staff survey results (such as our Culture of Care Barometer) to inform action required.