Data-driven quality improvement is essential to ensure improved patient outcomes and better care for those at risk of suicide. Specifying all aspects of suicide care in the clinical workflow and monitored in a health record will provide necessary data to identify successes and failures in care.

However, continuous quality improvement can only be effectively implemented in a safety-oriented, “just” culture free of blame for individual clinicians when a patient attempts or dies by suicide.

In a Zero Suicide approach:

A data-driven quality improvement approach involves assessing two main categories:
  • Fidelity to the essential systems, policy, and patient care components of the Zero Suicide model
  • Patient care outcomes that should come about when the organisation implements those essential components

To Implement Zero Suicide

Assess Fidelity to the Zero Suicide Model

  • Create a plan to assess the organisation’s fidelity to the Zero Suicide model. Completing a fidelity assessment will allow you to:
    • Determine how closely the elements of the Zero Suicide model are being followed
    • Check on quality
    • Help identify opportunities for improvement

You will find more information about assessing fidelity to the Zero Suicide model at the Assessing Fidelity section below.

Measure Patient-Care Outcomes

Create a plan to set patient-care goals and to evaluate the outcomes that systems, policy, and patient-care changes are designed to produce, using the Zero Suicide Data Elements Worksheet.

  • Create a plan to collect and review patient-care data every six to twelve months.
  • Provide feedback regularly to senior leadership and staff on progress toward patient-care goals in conjunction with the systems, policy, and patient care practice changes being made in the organisation’s Zero Suicide approach.

You will find more information about measuring outcomes at the Patient Care Measures section below

Assessing Fidelity

Return to the Organisational Self-Study

If you began your review of this toolkit with the Lead section, you will remember that the first step an organisation should take is to complete the Zero Suicide Organisational Self-Study. The self-study is a tool that is designed to allow you to assess what core elements of suicide safer care your organisation currently has in place.

Used alone, the results of the self-study will show where an organisation’s suicide care practices are already effective and where they can be strengthened, which will inform the overall work plan.

A year or so after your organisation has launched a comprehensive suicide care approach, you should also use the self-study to measure your organisation’s progress, as an assessment of fidelity to the Zero Suicide approach. Completing the self-study every year will tell you and your organisation how well you are adhering to the Zero Suicide model and point out the next areas that need strengthening.

Measuring Patient Care Outcomes

Work Plan

In creating an evaluation plan for a Zero Suicide initiative, the implementation team should:

  • Identify patient-care outcomes that indicate that systems and policy changes may be having the desired effect on actual practice.
  • Assess care outcomes for all patients who have a suicide care management plan.
  • Develop, review, and improve efforts for collecting data on suicide attempts and deaths for those in care.
  • Assess the experience and satisfaction of patients who are or have been engaged in a suicide care management plan.

Data Elements Worksheet

To assist in this process, the Zero Suicide Data Elements Worksheet provides suggestions for what data elements to measure in an evaluation plan. These include:

  • Screening
  • Assessment
  • Safety plan development
  • Lethal means counselling
  • Missed appointment follow-up
  • Acute care transition

The Data Elements Worksheet suggests additional rates that are useful for health and behavioural health care organisations to examine, if possible:

  • ED usage
  • Inpatient admissions
  • Number of suicide attempts among all patients
  • Number of suicide attempts among patients with identified risk
  • Suicide among all patients
  • Suicide among patients with identified suicide risk

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