Reducing seclusion practices – HQSC

Health Quality & Safety Commission

Read how HQSC facilitates and supports DHBs to learn from each other to reduce/eliminate seclusion practices and to make progress on some of their biggest challenges, through the use of data, a unique operating model and online sessions.


DHBs lacked a mechanism to effectively learn from each other about challenges they shared and saw as a priority. The number of seclusion events (isolating mental health patients) were one of these challenges, which had seen an increase during the 2010s.


Zero Seclusion, a project of the Mental Health and Addiction Quality Improvement programme, is working to eliminate the number of seclusion events across all DHBs by learning and sharing from all DHBs and tracking progress towards the clear, agreed vision.

Observations and lessons learnt

Collaboration with other government organisations

Unique operating model for DHBs and central government

The Mental Health and Addiction Quality Improvement programme (QI programme) is a unique programme at HQSC because it is funded by and responsible to DHBs while hosted and embedded in the HQSC team. With DHBs as their customer, HQSC’s role is to run a range of projects across the country for DHBs. Zero Seclusion is one of those projects.

Leverage each organisation's strengths

The QI programme team works with DHB leaders to identify improvement projects through PDSA iteration cycles (plan, do, study, act). The identification process leveraged each other's expertise. DHB leader’s expertise was their frontline insights on the biggest challenges, while the QI programme’s strength was providing the data to support the DHB Leader’s insights.

DHBs given space to share learnings

DHBs know their challenges are often similar across other DHBs. They see the value in sharing and learning from each other, but they lack capacity to drive that kind of collaboration. In this case, with the QI programme leading the projects, teams were given the space to connect and identify what works to share it back to DHBs.

Role of technology


Projects have shifted from large, in person regional meetings, to smaller digital meetings. This means that the DHBs can be better grouped, not geographically but rather by population size or those with similar challenges. This enables better learning and gives people more time to share about topics that are relevant to them.


With their pivot to more online delivery with breakout groups, they made sure to always nominate a Yoda - someone wise (like Star Wars Yoda) to assist with chat moderation, general tech support and to answer ask questions to condense the feedback process.


The team has data that shows the positive impact this work has had on the national seclusion rates and specifically seclusion rates for Māori. The data also shows which DHBs are positively contributing to the statistics and then they can elevate those DHBs’ approach with other DHBs. For example, a DHB with māori leaders, directors and nurses, using a kaupapa Māori approach, were positively contributing to the statistics.

Collaboration with the public and non-government entities


Advisory boards were part of the kaupapa from the beginning to ensure Māori and consumers had strong voices throughout. Advisory Boards were shining a light to help guide the whole conversation.

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