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)

Answer

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]

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References12Show ledger

[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

Opening definition (30–45 seconds)

Answer

Psychiatry Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Psychiatry Fellowship fellowship atlas.

References12Show ledger

[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

Quality improvement and patient safety in psychiatry — structured clinical viva

Opening definition (30–45 seconds)

Quality improvement and patient safety in psychiatry — structured clinical viva

Opening definition (30–45 seconds)