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Section 136: Assess phase

 

Section 136: Assess phase

Section 136: Assess phase

The Assess phase of the Section 136 case study involved identifying, assessing and evaluating the risks in the system, as follows:

Identify risk:

Assess risk:

Guidance on how to do the Assess phase can be found in the Guide part of this website.

Diagram showing the Assess phase as part of the overall SSA process. This phase involves Identify risk, Assess risk and Evaluate risk.

The Assess phase of the Section 136 case study


Identifying risks

The Assess phase of the Section 136 SSA started by identifying risks, i.e. things that could go wrong with the system. The group conducting the SSA examined the process map created in the Examine phase of the SSA. They listed the main steps in this map in the second column of the risk table in the SSA Assessment Form, as shown opposite.

For each of these steps, the group then considered ways in which it could go wrong, and recorded these in the next column of the table headed ‘What could go wrong?’. For example, the step ‘Unit gets staff in place’ could go wrong in two main ways: there may be insufficient staff available to accept the patient, or there may be delay in getting the staff in place.

When considering what could go wrong, the group spent considerable time examining the architectural plans of the proposed unit and the Section 136 procedure. It would also have been useful to consult other sources of data such as previous risk assessments or incident reports from the existing mental health unit. However, these were not available during the meeting.

Completing the risk table took some time, and the group ran out of time during the first two-hour session. As a result, a second session was arranged for a couple of weeks later.

Information about how to identify problems in the system is provided in the Guide section: Identify risk.

Screenshot of part of the risk table from the Section 136 case study. The following columns are circled: What is going on, and What could go wrong. For each item listed in the first, there is one or more thing that could go wrong listed in the second. For example, one item reads: Police and YP arrive at unit. Things that could go wrong with this are: Delay in getting staff in place to receive and assess the patient, and No space in unit due to another patient already being present. The full form in pdf is available from the Resources page.

The main things that could go wrong were recorded on the
‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge).


What problems might it cause?

The group conducting the Section 136 SSA examined what problems each of the risks might cause. They particularly considered the impact of the risks on the service provided by the unit, and on the young person being assessed. These were recorded in the fourth column of the risk table in the SSA Assessment Form, as shown opposite. Some of the issues could cause multiple problems, which were listed on separate rows in the table.

For example, there may be insufficient staff available to accept a patient. The group conducting the SSA identified two main ways that the unit would probably address this. One is to refuse to accept the patient. Another is to pull staff from other parts of the unit in order to accept the patient. Both of these could be problematic. For example, pulling staff from elsewhere in the unit could reduce staffing levels in those other parts of the unit, which may cause knock-on problems. Both of these responses where therefore listed in the risk table next to ‘Insufficient staff available to accept patient’. An extra row was added so that each response could be considered separately.

Information about how to consider what problems the risks might cause is provided in the Guide section: Analyse risk.

Screenshot of part of the risk table from the Section 136 case study, highlighting column 4: What problems might it cause?. Each thing that could go wrong in column 3 results in one or more problems in column 4.  For example, one issue is Insufficient staff available to accept patient. This could result in the unit being unable to accept the patient, or in reduced staffing in other areas of unit at times of high activity.  The full form in pdf is available from the Resources page.

Possible problems were recorded on the ‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge)


What are we already doing to prevent it?

It is important to examine what measures are already in place to reduce each of the risks. However, in the Section 136 SSA, the mental health unit had not yet been built, and therefore there were no measures in place. The group conducting the SSA instead examined the measures that were in place in the previous unit, and measures that were already planned for the new unit.

These measures included early notification that a patient was going to arrive, adequate staff capacity and clear procedures. These were recorded in the fifth column (headed ‘What are we already doing to prevent it?’) in the risk table in the SSA Assessment Form, as shown opposite.

Information about how to identify existing measures to prevent the risks is provided in the Guide section: Analyse risk.

Screenshot of part of the risk table from the Section 136 case study. Column 5 is highlighted. It is entitled: What are we already doing to prevent it?. This column lists measures taken to prevent the issues in earlier columns in the table. For example, measures taken to prevent Insufficient staff being able to accept the patient include Staff capacity and Early notice of arrival. The full form in pdf is available from the Resources page.

Measures already in place to prevent problems were recorded on the ‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge)


Retrieving risk criteria

The Section 136 SSA used the risk criteria identified in the Examine phase of the SSA. These had been recorded on the ‘Set risk criteria’ page of the SSA Assessment Form. This page referred to the definitions and criteria set out in the local Trust's ‘Risk Assessment Procedure’. This document was brought out so that it could be referred to during the next few steps of the SSA. The description on the ‘Set risk criteria’ page of the Assessment Form also provided a useful summary of the risk bands used.

Information about how to retrieve the risk criteria in an SSA is provided in the Guide section: Analyse risk.

Screenshot of the Set risk criteria page from the Section 136 case study. This page lists risk criteria documents: the Trust Risk Assessment Procedure, the architectural plan of the unit, and the Trust Section 136 policy and procedure. It also describes the risk bands used in this SSA: Green (risks scores 1 to 7), Orange (8 to 15) and Red (16 to 25). The full form in pdf is available from the Resources page.

The risk criteria were retrieved from the
‘Set risk criteria’ page.
(Click image to enlarge)


Estimating impact

The group conducting the Section 136 SSA estimated the impact of each of the potential problems. To do this, they compared each problem with the definitions of impact in the Trust's ‘Risk Assessment Procedure’. This document included detailed definitions of various levels of impact (also called consequences) from 1 (Negligible) to 5 (Extreme). The resulting impact scores for each problem in the SSA were recorded in the sixth column in the risk table in the SSA Assessment Form, as shown opposite.

In the Section 136 SSA, there was only a small degree of disagreement over the impact scores assigned to each problem. With a wider range of opinions, it might have been helpful to include views from additional colleagues or to search more widely for additional evidence, such as consulting with staff from other units, or reviewing academic literature.

Information about how to estimate impact is provided in the Guide section: Analyse risk.

Screenshot of part of the risk table from the Section 136 case study. The column for Impact scores is highlighted. For example, the problem of being unable to accept a patient due to insufficient staff being available has been given an impact score of 3. The problem of reduced staffing in other areas of the unit has an impact score of 4. The full form in pdf is available from the Resources page.

Impacts were recorded on the ‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge)


Estimating likelihood

The group conducting the Section 136 SSA also estimated the likelihood of each of the potential problems. To do this, they referred to the definitions of five different levels of likelihood in the Trust's ‘Risk Assessment Procedure’. These ranged from 1 (Rare) to 5 (Certain). The resultant likelihood scores were recorded in the seventh column in the risk table in the SSA Assessment Form, as shown opposite.

The architectural plans helped to rate some of the risks. For example, one of the risks was ‘Patient goes for smoking break in courtyard outside and absconds over the wall’. The likelihood of this happening was influenced by the height of the wall, which was described on one of the views in the architectural plan.

Information about how to estimate likelihood is provided in the Guide section: Analyse risk.

Screenshot of part of the risk table from the Section 136 case study. The column for Likelihood scores is highlighted. For example, the issue of being unable to accept a patient due to insufficient staff being available has been given a likelihood score of 1. The issue of reduced staffing in other areas of the unit as staff are reallocated to accept a new patient has a likelihood of 4. The full form in pdf is available from the Resources page.

Likelihoods were recorded on the ‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge)


Calculating risk

The risk scores in the Section 136 SSA were calculated and recorded in the final column in the risk table in the SSA Assessment Form, as shown opposite. The group conducting the SSA calculated the risk score for each problem by multiplying the impact and likelihood scores for that problem together.

Information about how to calculate risk is provided in the Guide section: Analyse risk.

Screenshot of part of the risk table from the Section 136 case study. The column for the risk scores is circled. These scores are obtained by multiplying the likelihood and impact scores together. For example, the problem of being unable to accept a patient due to insufficient staff being available has an impact of 3 and a likelihood of 1, and thus a risk score of 3. The problem of reduced staffing in other areas of the unit as staff are reallocated to accept a new patient has an impact of 4 and a likelihood of 4, and thus a risk score of 16. The full form in pdf is available from the Resources page.

The risk scores were recorded on the ‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge)


Evaluating risk

The risk scores in the Section 136 SSA were colour-coded according to the risk bands in the Trust's ‘Risk Assessment Procedure’. These bands had also been summarised on the ‘Set risk criteria’ page of the SSA Assessment Form. In summary, the criteria were:

  • 16-25: Red. High Risk. Needs to be addressed.
  • 8-15: Orange. Medium Risk. Should be reduced to as low as is reasonably practical.
  • 1-7: Green. Low Risk.

The colour-codings were applied to the risk scores in the final column of the risk table in the SSA Assessment Form, as shown opposite.

One of the risks was rated Red, indicating that it really needed to be addressed, while another five were rated Orange, indicating that action should be taken to reduce them if reasonably practical. Note that the image above only shows one page of the risk table - other risks are on a subsequent page. All of the pages can be found in the Section 136 download.

The next phase of the SSA (the Improve phase) then focused on proposing and implementing actions to reduce these risks.

Information about how to evaluate risks is provided in the Guide section: Evaluate risk.

Screenshot of part of the risk table from the Section 136 case study. The column for risk scores is circled. The scores are colour coded, depending on the risk score. Scores between 1 and 7 are coloured Green, those between 8 and 15 are Orange, and those between 16 and 25 are Red. The full form in pdf is available on the Resources page.

Colour-codings applied to the risk scores on the ‘Identify/Assess/Evaluate risks’ pages.
(Click image to enlarge)