Quality Management in Mental Health. II. Managing Risk of Dangerousness

Abstract

In 1995 R. L. Coleman and D. E. K. Hunter described a quality management approach that produced measur able improvements in quality of care in a state-operated psychiatric hospital. Continued evolution of this ap proach has subsequently enabled the development and implementation of effective processes for managing risk of dangerousness among patients throughout the hospi tal. Supported by management principles that promote hospital-wide quality improvement, clinicians and man agers produced an environment that was conducive to promoting quality. The hospital-wide quality improve ment context involved integrating multiple activities designed to promote quality of care, including signifi cant collaborations with other health care organiza tions. The hospital's mission as an acute care psychiat ric facility has required that it focus on assessing and managing risk of dangerousness in a systematic manner. This was done through developing and utilizing a pre dictive risk assessment instrument and indicators for managerial oversight. This was accomplished in these steps. First, clinical leaders rated potential criteria ac cording to estimates of their ability to predict danger ousness behavior and reviewed their estimates in rela tion to clinical findings. Second (and concurrently), clinicians and managers implemented procedures to monitor clinical risk and performance. Finally, outcome data were reviewed. They suggested that this approach was effective in reducing risk of dangerous behavior among patients on all psychiatric wards.