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Section 136: Examine phase

 

Section 136: Examine phase

Section 136: Examine phase

The Examine phase of the Section 136 case study involved defining key aspects of the assessment, identifying the stakeholders, and describing the system. These involved several smaller steps, as follows:

Record background:

Outline goals:

Set risk criteria:

Identify stakeholders:

Describe system:

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

 

Diagram showing the Examine phase as part of the overall SSA process. This phase involves Record background, Outline goals, Set risk criteria, Identify stakeholders and Describe system.

The Examine phase of the Section 136 case study

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Recording the background

Key background details for the Section 136 SSA were recorded in the SSA Assessment Form, as shown opposite. For reasons of confidentiality, the actual title of the SSA has been anonymised to ‘Section 136 new build’ and the roles of the team members are given instead of their actual names.

The group conducting this SSA also briefly described the background to the project. In particular, the SSA was triggered by the building of a new secure mental health unit for young people. This provided an opportunity to improve the service, as well as address some concerns with their existing Section 136 arrangements. Further background is provided in the Introduction to this case study.

Information about how to record the background in an SSA is provided in the Guide section: Record background.

Screenshot of the Record background page from the Section 136 case study. A project title, team name and date are given, as well as the descriptions of the five team members, e.g Project manager and nurse. Some description of the background to the project is also provided. The full form in pdf is available from the Resources page.

Background details were recorded on the ‘Record background’ page.
(Click image to enlarge)

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Describing the system (in words)

In the Section 136 SSA, the system was described as ‘the process for admitting a young person to the proposed secure mental health unit in accordance with Section 136’. This was recorded in the SSA Assessment Form, as shown opposite.

This brief description was adequate to set the scene for the rest of the SSA. A longer description in the form of a process map was produced later in this case study, but this was not necessary at the start of the SSA.

Information about how to write a system description is provided in the Guide section: Outline goals.

Screenshot of the Outline goals page from the Section 136 case study. The system is described as the process for admitting a young person to the proposed secure mental health unit in accordance with Section 136. The full form in pdf is available from the Resources page.

A description of the system was recorded on the ‘Outline goals’ page.
(Click image to enlarge)

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Setting the scope

The scope of the Section 136 SSA was recorded in the SSA Assessment Form, as shown opposite. The scope covered those steps in admitting a young person to the mental health unit that take place at the unit itself. This was because these are the aspects affected by the new build and over which the Trust has control.

An SSA with a broader scope could have included an assessment of the operations and the decision making processes by the local police force who may bring patients to the unit, or the referral processes used by colleagues in the primary or acute care sectors. On the other hand, a more focused SSA could have looked at the risks in just one step in the process.

The group conducting this SSA also specified the types of risks that the SSA would examine. They decided to focus on safety risks to service users and staff, but included a catch-all statement that they would ‘consider other types of risk where appropriate’. This allowed other salient types of risks to be included as well when appropriate.

Information about how to set the scope of an SSA is provided in the Guide section: Outline goals.

Screenshot of the Outline goals page from the Section 136 case study. The section on Scope is circled. It says that the assessment focuses on the process of admitting a young person to the unit. It focuses on the parts of this process that take place at the unit itself. It does not examine the processes once the patient has been admitted. It will concentrate on safety risks to service users and staff, including violence and agression and the risks of delayed care, and will confiser other types of risk where appropriate. The full form in pdf is available from the Resources page.

The scope of the SSA was recorded on the ‘Outline goals’ page.
(Click image to enlarge)

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Establishing the goals

The goals of the Section 136 SSA were recorded in the SSA Assessment Form, as shown opposite. The goals were closely related to the things that had triggered the SSA in the first place, in particular the disquiet over existing arrangements, and the increasing number of incidents at the old unit, with the increased age of patients being admitted.

As a result, the goals were to determine how to improve the service and address capacity issues, while also examining the risks involved in opening a new unit.

Information about how to establish the goals in an SSA is provided in the Guide section: Outline goals.

Screenshot of the Outline goals page from the Section 136 case study. The goals are circled. They are to examine the risks involved in the opening of a new unit and address them as far as is practical, to determine how to improve the service, and to address the unit's capacity issues, with the increase in number of patients, now that patients aged 17 are included. The full form in pdf is available from the Resources page.

The goals of the SSA were recorded on the ‘Outline goals’ page.
(Click image to enlarge)

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Setting impact and likelihood definitions

The impact and likelihood definitions used in the Section 136 SSA were set by the NHS Trust, as laid out in the Trust's Risk Assessment Procedure document. The criteria provided definitions for different levels of impact and likelihood between 1 (low) and 5 (high). This document was listed on the ‘Set risk criteria’ page of the SSA Assessment Form.

Other documents that might be useful to refer to during the SSA were also listed on this page. These included the architectural plan of the unit and the Section 136 Procedure.

Information about how to set the impact and likelihood definitions is provided in the Guide section: Set risk criteria.

Screenshot of the Set risk criteria page from the Section 136 case study. The section on documents is circled. The documents listed are the Trust Risk Assessment Procedure, the architectural plan of the unit, including the 136 Suite, and the Trust Section 136 policy and procedure. The full form in pdf is available from the Resources page.

Risk criteria documents used during the SSA were listed on the ‘Set risk criteria’ page.
(Click image to enlarge)

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Setting risk bands

The Trust's Risk Assessment Procedure also specified colour-coded risk bands for categorising risks, as follows:

  • 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.

These risk bands were recorded in the SSA Assessment Form by deleting the risk scores associated with the blue and yellow bands, and changing the risk scores for the remaining bands (red, orange and green) to match the bands specified in the Trust's documents.

Information about how to set the risk bands in an SSA is provided in the Guide section: Set risk criteria.

Screenshot of the Set risk criteria page from the Section 136 case study. The section on risk bands is circled. Risk scores from 1 to 7 are green, 8 to 15 are orange, and 16 to 25 are red. The full form in pdf is available from the Resources page.
The risk bands used during the SSA were specified on the ‘Set risk criteria’ page.
(Click image to enlarge)
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Identifying stakeholders

The group conducting the Section 136 SSA identified stakeholders in the SSA using a brainstorming exercise, recording their ideas on sticky notes. The key stakeholders were then recorded in the SSA Assessment Form, as shown opposite. They were:

  • AMHP (Approved Mental Health Practitioner)
  • Doctor: Psychiatrist
  • Nurse
  • Project manager
  • Ward manager
  • Police
  • Architect
  • Young person (YP)
  • Parents or responsible adult

Information about how to identify stakeholders in an SSA is provided in the Guide section: Identify stakeholders.

Screenshot of the Identify stakeholders page from the Section 136 case study. The stakeholders are divided into three sections. Internal stakeholders are: approved mental health professional, psychiatrist, nurse, project manager and ward manager. External stakeholders are: police and architect. Patients and their representatives are young person (YP) and parents or responsible adult. The full form in pdf is available from the Resources page.

The key stakeholders were listed on the ‘Identify stakeholders’ page.
(Click image to enlarge)

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Selecting stakeholders

Due to careful planning prior to the Section 136 SSA, many of the stakeholders were already present in the room during the first SSA meeting. These included:

  • Doctor: Pyschiatrist
  • Nurse
  • Project manager
  • Ward manager
  • Architect

The SSA might ideally have also included a member of the local Police force and a service user or representative. However, the list of attendees was felt to be adequate to continue the SSA in the current meeting.

Information about how to select stakeholders in an SSA is provided in the Guide section: Identify stakeholders.

Screenshot of the Identify stakeholders page from the Section 136 case study. Some of the stakeholders are highlighted, as follows: psychiatrist, nurse, project manager, ward manager and architect. The full form in pdf is available from the Resources page.

Stakeholders that were directly involved in the SSA were highlighted on the ‘Identify stakeholders’ page.
(Click image to enlarge)

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Mapping the system

The group conducting the Section 136 SSA produced a simple process map of the process of admitting a young person to the mental health unit. To do this, they used sticky notes to represent the main parts of the process. This allowed flexibility in rearranging the parts of the process and adding parts in as members of the workshop suggested them.

Most of the sticky notes were arranged in sequence, representing the main flow of events. Some of the notes were placed alongside, indicating subsidiary activities that the group did not decide to include in the main flow. Key parts of the map were redrawn in diagram form to make it easier to read and follow, as shown on the right.

The process map was kept simple as this was felt to be adequate given the scope of the SSA. In this SSA, there was no need to break down each of the main steps into sub-steps.

Information about how to produce a map of a system is provided in the Guide section: Describe system.

Screenshot from the Describe system page from the Section 136 case study. It shows a photo of a process map created using sticky notes. Some of this has then been tidied up into a flow diagram with arrows and boxes. The diagram starts with the YP (young person) being arrested, and goes through several steps to Assessment being done at the unit. At this point there is a decision, resulting in the YP either being admitted or discharged. The diagram is included in the full form for this case study available from the Resources page.

A map of the system was included on the ‘Describe system’ page.
(Click image to enlarge)

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Setting boundaries

In the Section 136 SSA, the system map described the whole of the process of admitting a young person to the mental health unit. However, in line with its scope, the SSA itself focused only on those parts of the process that take place at the unit itself. This was indicated in the SSA Assessment Form by drawing a red line round the parts of the process map that the SSA would focus on, i.e. around the activities from ‘Unit gets staff in place’ to the young person being admitted or discharged.

It was still helpful to map out the whole process of admitting a young person, as it set the SSA in context, helped to identify stakeholders who might be affected and indicated where other SSAs might need to take place in the future.

Information about setting boundaries is provided in the Guide section: Describe system.

The boundaries of the SSA are marked on the process map on the Describe system page of the Section 136 case study. The SSA includes the steps between the unit getting its staff in place and the young person being either admitted or discharged. The diagram is included in the full form for this case study available from the Resources page.

The SSA boundaries were marked on the process map on the ‘Describe system’ page.
(Click image to enlarge)

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Method 1: Process maps

The group conducting the Section 136 SSA produced a simple process map of the process of admitting a young person to the mental health unit, as described in ‘Mapping the system’ above.

Information about how to map the processes in a system is provided in the Guide section: Describe system.

Screenshot from the Describe system page from the Section 136 case study. It shows a process map. It starts with the YP (young person) being arrested, and goes through several steps to Assessment being done at the unit. At this point there is a decision, resulting in the YP either being admitted YP discharged. The diagram is included in the full form for this case study available from the Resources page.

The process map of the system was included on the ‘Describe system’ page.
(Click image to enlarge)

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Method 2: Communication diagrams

A communication diagram was not produced for the Section 136 SSA. The process map was adequate to capture all the main issues, since the SSA was centred around a process and was relatively simple. It was not felt that a communication map would add anything substantial.

Information about how to map the communication in a system is provided in the Guide section: Describe system.

Screenshot from the Describe system page from the Section 136 case study. It shows a process map. There is no communication diagram for this case study. The full form in pdf is available from the Resources page.

There was no communication map in this SSA. If there had been, it would have been included on the ‘Describe system’ page.
(Click image to enlarge)

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