PRODUCT TESTING
The New York State Office of Mental Health’s product testing guide, Patient Safety Standards, Materials and Systems Guidelines, was created with leading US architectural practice, Architecture+.
Ligature Hardware, we felt it was too simplistic; it didn’t really consider the determination or planning, or indeed the time, some service-users have to create ligatures. We felt something more representative of the challenges in mental health environments was needed. Secondly,” he continued, “we looked at robustness testing. Here the Department of Health’s 2011 publication, Environmental Design guide: Adult Medium Secure services, includes a number of test procedures for windows and doors, but tends to set out quite crude testing mechanisms, for instance using a big paving maul, with little detail on how it was swung at the door, in which direction, and which part of the door was targeted. In real life, somebody attacking a door will be using a heavy body impact, but one can only successfully bring this impact to bear from shoulder to waist height. When you apply ergonomics and anthropometric data, there are practical limits on how body impact can be applied.”
Not making the optimal decisions Philip Ross had seen, ‘first-hand’, people testing heavy body impact at the very top of a door, 2.1 m high, despite there being no way that somebody could use their body weight to attack a door thus. He said: “There were thus instances where people were making decisions – having carried out their own testing – but drawing the wrong conclusions. The biggest challenge with the existing robustness testing, however, was that it wasn’t independently undertaken, and there was no repeatability.” Existing guidance on robustness was, the
project participants felt, ‘generally pretty high-level’, meaning it could be interpreted in many ways. In the same way that the DiMHN and BRE working group had considered some of the key ways service- users attempt to find ligature points as they developed ligature risk tests, the group approached robustness.
“This,” Philip Ross explained, “is where the design workshops held at the BRE during 2018, typically attended by 50-70 people, came in. While lots of manufacturers, architects, and a few estates teams attended, we recognised we didn’t have much of a clinical audience. We were advised that with clinical staff, we would be better holding such events closer to them, and making their events ‘clinical only’. Thus, in holding a second tranche of workshops for clinical staff, we went armed with notes on all the feedback already received, and asked the attendees to add to the notes based on their experience and observations.” The clinical workshops were hosted later in 2018, in London, Manchester, and Scotland, and provided feedback ‘hugely valuable’ in the new guidance’s development. Philip Ross said: “It was really helpful to hear clinical personnel discuss real-life incidents, understanding how they had happened, and why. After all, there was no point in creating testing guidance simply for its own sake. We needed to understand what the modes of failure were, and, almost think in reverse engineering terms, i.e. if these were the types of incidents, and this is how they occurred, what testing would have identified this, and how can we ensure that we do it?”
Anti-barricade devices
Philip Ross explained that, as an example, it was highlighted during the workshops that in 2017 an NHS Safety Alert had been issued about anti-barricade devices, as a result of a staff member being taken hostage by a service-user, and excess force being put on the door, to the extent that other staff couldn’t get in. The Safety Alert highlighted that anti-barricade devices need to be utilised and designed to be able to cope with aggression and violence, and that mental healthcare providers with such devices installed should regularly test them. Philip Ross said: “We subsequently received numerous calls from Trusts asking which test guidance or standards they should follow here, but of course there weren’t any. In that scenario, we were looking at the problem, and understanding the key criteria. Among the key learnings was that service-users will actually co- ordinate barricade scenarios to learn how the anti-barricade system operates. They might, for example, get someone to raise an alarm of a barricade happening, and then watch the staff member enact anti- barricade, so they can identify potential ways to tamper with the door. With our testing system, the test engineers get to observe the anti-barricade being enacted 10 times, before then trying to manipulate it themselves. That’s a good example of trying to see things from the patient perspective, and being a bit more ‘real- world’ in the testing.”
Evidence-led approach
This, Philip Ross explained, also applied to other areas. He said: “With ligature, for
There are a number of potential ligature points to consider on an item such as a door. Right: There are many points at which a determined attacker might physically attack a door, with differing body force and impact, including via a punch, and a full ‘body ram’.
THE NETWORK | JULY 2020 13
New York State Office of Mental Health/Architecture+
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