Significant Event Audit in Prison Service Health Care Teams

Mary Fox, Grace Sweeney, Richard Westcott & Jonathan Stead

The objective of this ongoing study is the evaluation of the Significant Event Audit in the Healthcare wings of three remand prisons. The work has been funded by the Home Office.

Study Design and Method

This is a longitudinal study, using qualitative methods of data collection and analysis. Data is collected at each of the three prison sites by (1) observing six consecutive SEA meetings, and (2) interviewing a sample of prison healthcare staff prior to and following the observed SEA meetings. Each of the six meetings are observed by the same researcher, who assumes the role of a non-participant observer, and who keeps a written record of the proceedings. These field notes are supplemented by official agendas and minutes arising from each meeting. Data arising from the observation arm of the study are subjected to a content analysis. Pre-SEA and post-SEA interviews are conducted by the researcher who observed the SEA meetings. These interviews are semi-structured, tape-recorded and subjected to a grounded theory analysis.

At the end of these stages of data collection and data analysis, a 'negotiated feedback session' will be convened at each prison site, so that findings of the study can be shared with study participants.


A total of 14 pre-SEA interviews have been conducted with staff from the three remand prisons. Interview participants include 3 nurses, 3 prison officers, 2 pharmacists, 2 occupational therapists, 2 medical doctors, 1 community psychiatric nurse and 1 psychiatric nurse. These interviews have been transcribed in full and preliminary analysis is in progress.

The observation arm of the study is nearing completion and is due to finish in May 2000. Five SEA meetings have been observed at two prisons and four in the third. Post-SEA interviews will then be conducted with subjects comprising the original sample. All data collection will be completed by August 2000.

Preliminary Findings

Although data collection and data analysis are still ongoing, a number of preliminary points can be made;

a) Leadership is critical - both the leader's style and his/her place in the hierarchy will influence the meeting. Individuals who are at the top of the hierarchal scale need to display even better leadership skills that those at the middle of the hierarchy.

b) There is generally a good understanding of the role and function of SEA meeting,

c) Team members generally express satisfaction with the process, although there is some scepticism as to whether or not it will be effective.

d) Team members are concerned that (i) the meetings will generate more work, and (ii) that they will be potentially divisive.

e) The types of issues brought for discussion at the meetings can be grouped as, (i) policy and procedures, (ii) problems with equipment, (iii) medication, (iv) conflicts with others (disciplinary staff and management), and (v) congratulations.