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Section 4 Techniques and Tools
4.15 Significant event analysis (SEA)
SEA is an audit tool used primarily in health services. Its origins lie within Critical Incident Methodology developed in the USA for use with occupational groups(1). This is one approach that could be used to encourage feedback from staff and it could also be used with groups of service users.
SEA is a way of sharing stories in a systematic way for service improvement. The technique works by bringing people together in a regular team meeting or occasional workshop to focus on particular incidents they consider significant, in order to learn and improve. These might be about successes and particularly satisfying experiences as well as problems. SEA is used mainly as an approach to self-evaluation with staff and can be adapted for work with service users or existing tenants groups.
Participants, with the help of a facilitator, decide how to analyse the individual episodes, incidents or stories. The facilitator ensures that the analysis is undertaken in a systematic and detailed way. It is important to analyse both the particular detail of the event and also to draw out more general insights or lessons to discover what can be learnt about the overall quality of services and to identify what changes might lead to future improvements.
Evidence suggests that this more systematic approach can be easily built into the routines of an organisation, can lead to rapid change and can encourage a service user focus amongst staff. It can help to make hidden things explicit and so improve understanding. If used with a mixed group of staff and service users, it could highlight discrepancies within the wider system about what is supposed to happen and what actually happens in practice in service delivery.
Examples of significant events might include successful management of a crisis, violence to staff, inappropriate referrals, repeat homelessness and compliments and complaints. Although not focused solely on adverse events, it does acknowledge that even in such situations there is usually some part which is well managed and should be acknowledged.
Guidelines for undertaking SEA with professional teams based on work done within the NHS are detailed in Figure 4.4.
Figure 4.4 A step to step guide to significant event analysisPRINCIPLES • Involve the whole team • Hold regular meetings to discuss events (both good and not so good) • Focus on system improvement rather than the individual (develop a ‘no blame’ culture) STEP 1 • Discuss types of event to record • Develop team ‘ground rules’ for meetings and decide how best to facilitate the meeting as a team. • Make date for first SEA meeting • Collect events as they occur using a record book STEP 2 • Collate events a week prior to the meeting • Create an agenda recognising the priority of topics, availability of personnel, involvement of team members, sensitivity of topics and be flexible to add ‘hot topics’. STEP 3 • Circulate agenda 48 hours prior to meeting • At the meeting run through the recording sheet of the last meeting, in particular the action points. • Each new event is presented by the person(s) involved in the event and followed by a discussion. Discussion should focus on: o Positive aspects of service o Aspects needing improvement o Interface issues o Team issues o Summary o Recommendations and action STEP 4 • As a team decide the possible outcome for events o Congratulations o Change recommended o No action required o Further evaluation/audit required o Further work required • Record key points (event, discussion and decision, actions to be carried out and by whom). • Set date and time of next meeting Source (adapted from) |
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Significant Event Analysis: checklist
√ Choose appropriate events, both everyday and exceptional cases; contrasting what happens is a way of bringing out key learning points.
√ Do not determine in advance or to others what should be seen as significant – let participants decide.
√ Provide facilitation of meetings; make sure people stay focused on the task and do not get distracted.
√ Develop ground rules for the session; it should not be about apportioning blame.
√ Consider how this approach might be used with groups of service users and with mixed groups of service users and staff.
Alternative and related approaches
• Using comments, compliments and complaints as feedback
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