There are several ways to approach a problem  - a common approach within patient safety is to put in place more restrictions in order to stop harm from occurring.

In this blog, HIEM Senior Improvement Lead and Nurse, Hannah Jackson-Cox describes a recent project, in collaboration with Leicestershire Partnership NHS Trust, that used QI approaches to do the opposite – while reducing incidences of self-harm by 40%. 

The project has been shortlisted for a HSJ Patient Safety Award.

"Self-Harm is a risk to patient safety that impacts patients physically and psychologically. One of the key patient safety priorities in our Mental Health Programme has been to reduce incidences of self-harm.

Alongside this, we have also aimed to reduce practices that restrict the lives of people living in Mental Health inpatient settings.

However, managing self-harm in this environment often results in more restrictions being put in place, for example restricting where patients can go on a ward or at what times they can do different activities.

As one member of staff put it: “Historically, we approached safety by investigating what went wrong and restricting.”

In 2024, we worked in partnership with colleagues at Leicestershire Partnership NHS Trust (LPT) on a project which aimed to reduce incidences of self-harm on an inpatient ward. The project was led by a core team of three Nurses from LPT and HIEM and supported by a multi-disciplinary team of experts in data analysis and improvement.

In a short period of time, the ward saw over a 40% reduction in incidents. Better yet, this was all achieved without increasing restrictions and staff and patients fed back on how this has positively impacted them.

Balancing Safety Priorities: Rethinking Self-Harm Reduction in Patient Care

As a project team, our overarching goal was always clear; we wanted to deliver safer, higher-quality care that truly benefits patients, not just in the short term, but in ways that endure. We were committed to ensuring that any changes we introduced would stand the test of time and reflect genuine improvements in patient experience and outcomes.

One of the key challenges we faced was the tension between reducing self-harm and avoiding an increase in restrictive practices. We felt strongly that while reducing harm is essential, doing so at the cost of patient autonomy and therapeutic engagement would not add long-term value to care.

So, we set out to do things differently.

To achieve our goal, we designed a mixed-methods approach that integrated Appreciative Inquiry (AI) principles, constraints theory, and systematic improvement methods. Our design was intentionally built to reflect the complexity of patient safety challenges—recognising that traditional improvement models often oversimplify these realities.

By embracing this complexity, we aimed to generate improvements that would not only add genuine value to patient care but also be sustainable over time.

Rather than treating self-harm reduction and restrictive practice as separate priorities, we brought them together within a single project. This approach shaped our methodology and encouraged us to explore innovative solutions that might otherwise have been overlooked. We believed that successful therapeutic care is rooted in a holistic, patient-centred approach and we wanted to reflect that philosophy in how we deliver quality improvement too.

To bring this vision to life, we collaborated as a multidisciplinary team, drawing on our diverse expertise. Our group included the Ward Leader, Self-Harm and Suicide Prevention Lead, Quality Improvement (QI) experts, and data analyst.

To begin, we analysed data to identify when and where incidents occurred most frequently, (days of the week, times of day etc). The data revealed a higher prevalence of incidences at particular times of the day and in particular environments.

Unlike conventional improvement, we chose to not set a measurable target to achieve. We determined our aim would be ‘To reduce the number of incidences of self-harm on the ward by December 2024’.

Uncovering examples of good practice

Using Appreciative Inquiry (AI) principles, we approached the data not just to identify challenges, but to uncover good practice. We analysed the same incident data to pinpoint where self-harm was least prevalent. This allowed us to discover examples of good practice already happening which could then be scaled and shared more widely.

We found that incidences of self-harm were fewer on a specific weekday, coinciding with the ward’s all-patient ‘community meeting’.

Conventional improvement practice might have approached the same aim by noting a high prevalence of incidents in patients’ bedrooms during the afternoon and restricting access to that environment at peak times.

However, because the project was committed to not increasing restrictions, we were instead able to think innovatively about other possible change ideas available to them, and target these at peak times instead. 

We looked at why the ward’s ‘all-patients community meetings’ were successful and found it was because patients and staff meet together and patients  contribute to ward decisions, and because the activity is engaging and facilitated.

We then set the challenge to generate innovative ideas for change, enabling holistic improvement, that needed to:

• Not be restrictive.
• Add to patients’ care/experience.
• Be engaging and facilitated activities.

It was important that patients were involved, and the ward used the community meetings to generate more change ideas from patients.

Changes that add value to care rather than restrict

The staff acted quickly on the ideas generated and there is now a greater variety of activities available on the ward - timed particularly to take place at those peak times of day where self-harm incidences were identified as more frequent. For example:

• Patients shared that they wanted to start a ward band. The team allocated funding to purchase instruments.
• Patients asked for a karaoke night. The team found and fixed the karaoke machine, enabling karaoke nights to be reintroduced.
• Patients also suggested that they would like activities that would be self-directed. The team introduced a ‘grab box’ which is full of activities which can be self-directed.
• More community coffee morning meetings were introduced to replicate the ‘Community meetings’.

All the preparation and the hard work paid off and the team achieved over a 40% reduction the in the number of incidences of self-harm within their timescale and without introducing restrictive practices.  

The feedback from people involved speaks for itself:

“We’re able to redirect the time we would have otherwise spent managing incidents into engaging our patients in therapeutic activities.” Charge Nurse

“When I got into nursing, it was focused on being there for patients and supporting them through their journeys. Sadly, some of this has been lost through the administrative side of it all. This feels like a step back in the right direction.” Care team member

“I really like that the ward staff seem to be more present now, it gives me the sense that we are really valued.” Patient / families

“It has been great to be able to work with patients coming up with activities that truly means something to them, something that they properly benefit from.” Activity co-ordinator

Going beyond a project

This approach also encouraged the team to actively seek out and celebrate the best of their existing care. By identifying areas where practice was already having a positive impact, the ward team uncovered valuable insights and examples of excellence. These findings helped to understand what was working well and where there was potential to scale up successful approaches—especially in areas with the greatest opportunity for improvement.

This mindset not only strengthened our methodology but also reinforced a culture of learning where good practice is recognised, shared, and built upon.

The work has been shared widely within the mental health Communities of Practice led by HIEM and at our annual learning event. It has now also been shortlisted for a HSJ award.

As a Nurse, I’m very proud to have worked on this project and to have had the opportunity to work in partnership with colleagues at Leicestershire Partnership NHS Trust. The methods we used can as much be applied to adult physical healthcare inpatient settings as in mental healthcare. We were able to ask questions of practice with a view to continuously improve patient care, experience and outcomes.

This approach reinforces cultures of openness to raise concerns and to raise ideas, whether as a patient or member of staff. It has demonstrated that having an open reporting culture can highlight where there is greatest opportunity to improve and that this will be addressed in a positive way, free from blame and focussed on delivering the best care that we know staff want to give. The ward team can now apply this same methodology to other priorities, building improvement capability and enabling continuous patient safety improvement.

We wish them all the best.

If you would like to speak to us about Quality Improvement approaches that could help benefit your services, please get in touch via This email address is being protected from spambots. You need JavaScript enabled to view it.