HEALTH FOUNDATION: CLOSING THE GAP IN PATIENT SAFETY PROGRAMME
SAFER CARE PATHWAYS IN MENTAL HEALTH PROJECT
Frequently Asked Questions (FAQ) on System Safety Assessment (SSA)1
What is SSA?
SSA stands for System Safety Assessment. It is a method to help think about “what could go
wrong” in a system. A system could be anything from a care pathway to a project plan for a
service improvement, to a new ward or even the movement of a service from acute care to
the community. Rather than waiting for things to go wrong and suffering the consequences,
SSA is a process for proactively thinking about and addressing risks, so problems can be
prevented up front. It is a structured process for identifying and addressing risk in healthcare
– but usually at a “system” level rather than patient by patient.
How does it work?
Before we can work out “what could go wrong” we need to describe the system. This might
be in the form of a set of procedures, known risks or incidents, but often involves some
process mapping, typically using flow charts or other types of diagram. Once the system is
described, this forms the basis for thinking about what could go wrong. Using this
description, SSA tries to do this carefully and systematically. It also requires the knowledge
of system experts – usually anyone who has had experience of the system or a similar one.
For example, SSAs have taken place with junior nurses, senior sisters and specialist nurses,
managers, board members, ward clerks, pharmacists, health commissioners, doctors and
occupational therapists. Once we know what could go wrong, we need to think about how
likely this is, and how bad it would be if it did go wrong – the risks. If any of these risks are
too big, we can then consider how to reduce them. All of this is done in a proactive and
systematic way, across the system that is being looked at.
Why are we doing SSA?
This forms part of a project sponsored by the Health Foundation, a charity that supports
research and implementation projects to improve the quality of healthcare. This project aims
to test SSA across the five mental health trusts in the Eastern region, on a range of relevant
projects. Each trust will select one or two pathways to do a SSA. The project will last
between 2014 and early 2016. More information can be found here:
http://www.health.org.uk/areas-of-work/programmes/closing-the-gap-in-patientsafety/related-projects/safer-care-pathways-in-mental-health-services/
Is SSA new?
At the core of SSA is a standard process for managing risks. The principles will be familiar to
many NHS staff, but the systematic and proactive way in which it is done may be less so.
The types of risk being assessed may also be different. Current risk assessments in the
NHS often focus only on “health and safety” risks, such as the risk of tripping over or risks
from exposure to heat sources such as hot water. SSA, however, can focus on any type of
1
Also called Prospective Hazard Analysis (PHA)
risk, such as risks to patient or staff safety, risks to meeting a target or risks to an
organisation.
SSA can – but does not have to – also involve a range of methods that are used routinely in
areas outside of healthcare, such as the nuclear, offshore, aviation and aerospace
industries. One common method is Failure Mode and Effects Analysis (FMEA), which has
been used to a considerable extent in healthcare, but mostly in the USA rather than the
NHS. There are many other methods. We only tend to use these more “formal” methods
when there is enough time, and when they would be helpful.
SSAs have taken place across many different sectors of the NHS, from acute to mental
health, the community and commissioning services. SSAs have investigated risks across
many areas of healthcare such as: crisis resolution home treatment teams, the process of
sectioning a patient under the Mental Health Act, smoking cessation on a secure mental
health unit, a new Trauma Network, documentation in an acute trust and emergency
preparedness planning in a US hospital.
Is it difficult to do?
The principles of risk assessment will be familiar to many healthcare staff, but doing a “good”
SSA requires time and experience. Bringing together a strong team of “system experts” is
crucial. To help run the SSA sessions, a project manager and a facilitator will support each
team throughout the process. With facilitation, staff typically find the SSA process to be fairly
straightforward.
Does it require any training?
With facilitation, SSA can be done without any training, but it can help to have one or two
knowledgeable members in each NHS SSA team. We will train a small number of staff at
your organisation in how to do SSA.
What are the benefits?
SSA is ultimately a way to help create better healthcare systems, which benefit patients,
staff and organisations. Identifying and managing risks up-front before they have caused
harm can improve the quality of a service, reduce costs and reduce frustration for staff and
patients, who so often have to battle with systems that are not designed as well as they
could be. By getting people together and giving them the “head-space” to think through the
issues in a system, risks can be reduced and quality improved.
Are there any risks?
The main risk is the time commitment to do a SSA. We will work with each team to ensure
this is kept to a minimum. Risks that are too high will need to be reduced. Whilst these often
require an up-front financial investment, the long-term savings tend to outstrip the
investment, if the SSA has been done accurately.
How much time does it involve?
This depends very much on the size of the system to be looked at, the level of detail you
would like to go into and how comprehensive you would like the SSA to be. SSAs can be as
little as two hours’ team work. More comprehensive SSAs may take several sessions of half
a day or so. The facilitators try to be flexible and sensitive to the needs of the team members
and the trust, so that we can strike a good balance between pragmatism and rigour.
Who will be involved?
Each NHS Trust involved in this project will pick a SSA team of local staff to help provide this
“expert system knowledge”. Typically, SSA teams consist of 2-8 people, with a range of
professional backgrounds.
When will it start?
We expect to start the SSA process in late summer / autumn of 2014, and anticipate
finishing by spring 2015.
What if I have more questions?
We understand this may be new to people and you are most welcome to ask questions. Tim
Bryson and James Ward are the main contacts.
Tim Bryson is an independent healthcare consultant and the Project Manager for the Health
Foundation: Safer Care Pathways in Mental Health project. Tim is an experienced mental
health nurse and was previously an executive director of a mental health trust for ten years.
Dr James Ward is an engineer, and works part time for the NHS and part time for the
Engineering Department at the University of Cambridge, where he is employed as a
Principal Research Associate. James is the SSA Lead, and is the best contact for technical
enquiries on the SSA process. Contact James on 01223 765107 / jrw38@cam.ac.uk (email
is preferable). James works with Dr Terry Dickerson (Assistant Director of Healthcare
Design) and Professor John Clarkson (Professor of Engineering Design), who are also
members of the project team.
October 2014
Safer Care Pathways in Mental Health – Project Team