Data
Zero Suicide is a data-driven continuous quality improvement framework.
Data-driven refers to the use of quantitative and qualitative information to measure progress and success of the implemented policies, processes, and workflows of the organization’s suicide care improvements.
These can be divided into two types of outcomes: individual level and process level outcomes. Individual level outcomes include the rate of suicide deaths and suicide attempts. Process level data include things that can provide insight into the progress of implementation and whether the policies, processes, and workflows are being sustained to fidelity.
Information can be gathered in a multitude of ways include reports from the electronic health record (EHR), chart reviews, observation of staff, fidelity audits, data collected from external sources (e.g., public health department, coroner or medical examiner’s offices).
After collecting the information, it should be analyzed within a Just Culture. Organizations want to look for the gaps in care provision to understand what areas need to be addressed. An organization with a Just Culture doesn’t ignore blatant disregard of fraud, gross misconduct, etc. but recognizes that humans make mistakes, and that the system should seek better ways to support staff to reduce errors and increase the safety of those in care. Often staff need additional training, reminders, or other supports to address barriers like discomfort working with people who have suicidal thoughts that are causing the gaps in care.
Zero Suicide Data Dashboard
One way to collect, analyze, and report Zero Suicide data is to use the Zero Suicide Data Dashboard. This is an online data reporting system to assist health and behavioral health care organizations to monitor their data that is specific to the implementation and sustainment of the Zero Suicide framework. Data Dashboard users can tailor how they set up their Dashboard to ensure the data reflects how their organization’s suicide care improvements impact outcomes over time.
• Organizations input data on a quarterly time-frame to track the progress of implementation and sustainment of Zero Suicide policies and processes.
• The Dashboard includes key metrics that systems should use to monitor fidelity to the Zero Suicide framework.
• The Dashboard displays and summarizes data for multiple groups (i.e., different departments in the same organization or multiple clinics or hospitals within a healthcare system) over time.
For organizations that do not want to use the Zero Suicide Data Dashboard, the Zero Suicide Data Elements Worksheet provides guidance on appropriate data to collect.
Outcome Data
The main metric that is used to measure individual outcomes is suicide deaths. If an organization’s Zero Suicide efforts are creating change, the number of individuals dying by suicide should reduce. This is an important data point but also one that can take years to show a difference. In the beginning it is possible that there could be an increase in suicide deaths. The organization may be gathering more death data overall and therefore more aware of suicide deaths than before which can be the cause of an increase.
Obtaining Suicide Death Data
Many organizations rely on informal sources of death data like information from support people or published obituaries to collect suicide death data. An important step for a Zero Suicide organization is to develop formal relationships with their local vital statistics office, public health department, medical examiner or coroner’s office, and any applicable Tribal Government to obtain official death data.
Organizations would then cross-reference this data with individuals who have been in their care within a certain timeframe. For example, an organization’s policy might be to review any individual who has died by suicide within one year of separation from care. The organization should determine what the post-discharge time frame is appropriate for them, based on factors like accreditation and organizational policies.
A formalized relationship with a county, state or Tribal government ensures the most available death data. The State Suicide Prevention Coordinator often has access to information and agencies that can assist an organization collect appropriate suicide death data for review.
Beyond initial data collection
Data can be used to tell the story of how the organization is progressing in its Zero Suicide efforts and whether it is faithful to the model. One way to start that story is to ask questions. Once the questions are identified then the data points can be ascertained. Below are some sample evaluation questions.
Individual outcome questions:
- Are individuals who screen positive for suicide risk receiving a thorough risk assessment within the determined timeframe?
- Do individuals who are on the pathway or engaged in suicide specific treatment have lower no-show rates?
- Are we seeing progress for individuals who are in treatment? Reduction in ER visits, lower CSSRS or PhQ-9 scores?
Process measure questions:
- What is the comfort and confidence level of staff who are screening individuals?
- How often are standardized protocols overruled by clinical judgment?
- Is safety planning done collaboratively and is it seen as an intervention and not as a check-box thing?
These are just examples of potential evaluation questions that organizations can use to guide their data collection and analysis.