Psych Vivas · Public-community — quality improvement and patient safety
Quality improvement and patient safety in psychiatry — structured clinical viva
Fellowship viva covering safety science applied to mental health services, measurement, culture, and evidence-linked change packages.
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Target exams
FRANZCPMRCPsychABPNMD-DNB
Prompt
Discuss quality improvement and patient safety in psychiatry for a fellowship viva: define quality vs safety; Donabedian structure–process–outcome with mental health examples; systems thinking and Swiss-cheese (Reason); just culture; Model for Improvement/PDSA with outcome, process, and balancing measures; psychiatry-specific harm domains; Safewards evidence; suicide-prevention service design (Appleby/While); medication and environmental safety (Grasso/Hunt); regional governance frames. Do not invent Never Event lists or local statute section numbers.
Opening definition (30–45 seconds)
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Quality is care that reliably improves outcomes consistent with professional knowledge across domains including safety, effectiveness, person-centredness, timeliness, efficiency, and equity. Patient safety is the systematic reduction of preventable harm. In psychiatry, safety problems are not only "medical complications" — they include self-harm, violence, absconding, medication error, falls, and coercive practice.[1][9]
References12ShowHide
- [1]Donabedian A Evaluating the quality of medical care Milbank Mem Fund Q, 1966.PMID 5338568
- [2]Reason J Human error: models and management BMJ, 2000.PMID 10720363
- [3]Leape LL Error in medicine JAMA, 1994.PMID 7503827
- [4]Berwick DM Continuous improvement as an ideal in health care N Engl J Med, 1989.PMID 2909878
- [5]Bowers L Safewards: a new model of conflict and containment on psychiatric wards J Psychiatr Ment Health Nurs, 2014.PMID 24548312
- [6]Bowers L, James K, Quirk A, et al. Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial Int J Nurs Stud, 2015.PMID 26166187
- [7]While D, Bickley H, Roscoe A, et al. Implementation of mental health service recommendations in England and Wales and suicide rates, 1997-2006: a cross-sectional before-and-after observational study Lancet, 2012.PMID 22305767
- [8]Appleby L, Shaw J, Amos T, et al. Suicide within 12 months of contact with mental health services: national clinical survey BMJ, 1999.PMID 10231250
- [9]Thibaut B, Dewa LH, Ramtale SC, et al. Patient safety in inpatient mental health settings: a systematic review BMJ Open, 2019.PMID 31874869
- [10]Silver SA, Harel Z, McQuillan R, et al. How to Begin a Quality Improvement Project Clin J Am Soc Nephrol, 2016.PMID 27016497
- [11]Hunt IM, Windfuhr K, Shaw J, et al. Ligature points and ligature types used by psychiatric inpatients who die by hanging: a national study J Affect Disord, 2012.PMID 22343063
- [12]Grasso BC, Rothschild JM, Genest R, Bates DW What do we know about medication errors in inpatient psychiatry? Jt Comm J Qual Saf, 2003.PMID 12953603