Sarah is Together’s Head of Quality Improvement and has overseen the implementation of several new systems for assessing and dealing with risk in our services.

“Two new systems established this year are transforming the way the organisation responds to and handles risk. Firstly, our new Risk Panel meets monthly to assess and feedback on the risk management plans of individuals who we have identified as having behaviours or vulnerabilities that present a higher level of risk. Secondly, a weekly review of incidents in services examines trends and responses to understand where improvements can be made or processes strengthened. Along with our Risk Register and Quality and Safety Committee, these form a framework for supporting staff to manage risk in a way that achieves the best outcomes for service users.

We are supporting more and more people with multiple complex needs, and this means we need robust responses to challenges that may be new to us. We need to support staff to do their jobs well even when the environment is challenging, but most importantly we need to understand the people we support, particularly those who are most marginalised and disadvantaged.

We need to understand the people we support

The aim of the two systems my team has put in place this year is to really get to the bottom of what factors come into play when someone becomes really unwell. Both systems are led by our most senior managers, who can quickly put in place new ways of working, extra resource or training, for example, in response to either an individual risk or an identified trend in risks or incidents.

It’s partly about minimising risk and avoiding crises, but it’s also about acknowledging that people’s wellbeing does sometimes deteriorate, and we need to be ready to respond when this happens. Integral to this is asking the individual what helps when they become unwell, and what can lead to crisis in the first place. Their preferences, knowledge and previous experience are key to responding in the best way – only with this information can we make sure the right things are in place for them and that these are put into practice at the right moment. This could be crisis plans and advance directives, but it could also be all sorts of other things that we won’t know unless we have that crucial conversation with them.

This mirrors our approach to supporting people in a person-centred way: just as a person is in control of their support when working towards achieving goals, the same is true in a crisis, only the planning and information gathering may have happened in advance.

For example, someone using one of our services was repeatedly self-harming and hiding medication, with the incidents becoming increasingly severe. The case was discussed at the weekly incident review meeting and the risk management plan created by the service was referred to the Risk Panel. As a result, the Area Manager now facilitates a learning session with managers and senior support staff to discuss what can be done to prevent similar incidents in future, and what additional support can be offered. The team now holds weekly Reflective Practice sessions and works closely with the service’s Psychologist to look at the context and root causes of incidents, which are now becoming less frequent.

Nuances in the handling of a crisis can make a huge difference to the time it takes someone to recover from it, the likelihood of it happening again, the impact on other service users, and the person’s continued experience of using the service.

The quality of attitudes is just as important as the quality of processes

Getting it right means looking at root causes and what is happening in the person’s life at a given moment, from their perspective. It means avoiding the temptation to impose our own idea of what is the best course of action.

Staff need to not be afraid of risk, nor ignore it. They need to feel comfortable and supported to report openly when something goes wrong, not just so things can be assessed and improved, but so that knowledge can be shared, rather than sitting with just one person. All the right systems can be in place but ultimately it’s about how people use them: the quality of attitudes is just as important as the quality of processes.

Our new approach has significantly increased the volume and quality of reporting by staff about incidents and risk. It means those directly supporting service users know that senior managers are in touch with the practical challenges they face. Transparency and honesty are key – there are always new and different ways of responding to the challenge of risk. In this sense, it is a learning process that is never finished.