Governance systems

Governance systems, accountability and processes sustain and improve high-quality care.

In practice

Having structured internal audit and reporting systems (see Leadership).
Recording and reviewing all instances of restraint and seclusion as soon as possible, to prevent or minimise future restraint.
Informing executive level staff about incidents immediately as they arise.
Establishing and adhering to clear debriefing processes for staff (three-tier: immediate, delayed and senior review; post hoc debrief and incident debrief following restrictive intervention) and considering collaborative debriefs with the person with lived experience.
Practising debriefing through simulation training.
Ensuring there is cultural awareness and recognition of the effects of previous trauma on the experience of restrictive practices.
Reporting on restraint and seclusion rates and improvement activities in public spaces.
Modelling excellent behaviours when services and staff adopt guidelines and to share what worked well or didn’t across services.

Examples

Consumer peer worker post seclusion collaborative review

Implementation of a post incident review in collaboration with consumer, peer workers and clinicians. Post seclusion event briefing - to understand what took place proceeding, during and following the intervention.

Accountability

Establishment of the mental health co-design committee

A committee was established to improve the therapeutic environment using a co-design approach with consumers and carers to reduce and where possible eliminate seclusion and restraint.

Accountability

Post hot debrief and incident review

A hot debrief is a lessons learned review carried out immediately after the event to ensure all feedback, outcomes and actions required are obtained before anyone leaves.

Accountability