Risk management within the Health and Social care NHS Hospital

1. MANAGEMENT OF HEALTH AND SAFETY
IN
ROYAL UNITED HOSPITAL BATH NHS TRUST
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2. INTRODUCTION
How risk should be managed in the NHS?
In the NHS risk is managed at two overlapping levels:
1. Strategic/management level
2. Day-to-day staff/patient operational level
Risk management in healthcare includes the whole spectrum of things that could and can go wrong. It includes
slips, trips and falls involving staff, patients and the public, administrative errors that impact on patient care and
clinical incidents that have a direct effect on the outcome of patient care.
communicate and consult: Who will need to know about and be involved at each stage of the risk management
process?
establish the context: How will you assess and analyse the risk? What are the criteria you will use to judge the
likelihood and consequences of risk?
identify risks: What could stop you achieving your objectives and outcomes?
analyse risks: Are our existing risk controls working and what are the potential consequences of risks
happening
evaluate risks: What is the balance between potential benefits and adverse outcomes of managing these risks?
treat risks: How can we develop and implement specific cost-effective strategies to increase benefits and
reduce potential costs?
monitor and review: Are we achieving the right outcomes and how do we know?
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3. HEALTH AND SAFETY
Health and safety is part of risk management and is a statutory requirement on all employers, employees and self
employed contractors. It involves preventing people from being harmed or becoming ill as a result of work activities
by:
minimising risks to health
taking the right precautions
providing a satisfactory working environment.
The Health and Safety at Work Act (1974) placed general duties on all employers to protect the health and safety of
their employees and those affected by their work activities.
Health and safety training to be included in the NHS staff induction and aims to minimise incidents and injuries to staff,
patients and the public. If you are injured at work, information on what happened to you will need to be collected by
your manager and employer, particularly if you are unable to work as a result. You will be asked to complete an
Incident Record form detailing what happened.
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) require employers and
others to report injuries, incidents and some diseases that arise out of or in connection with work. This can include
some incidents involving patients. These reports enable the enforcing authorities to identify where and how risks arise
and to investigate serious incidents.
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4. RISK MANAGEMENT AND CLINICAL GOVERNANCE
Risk management should be seen as an essential component in the delivery of safe and effective care included
in the national Clinical Governance and Risk Management Standards (NHS QIS 2005).
How risk is managed has an impact on the operation of an NHS Board. Good governance in healthcare covers
corporate, staff and clinical governance, all areas of potential risk. Clinical risks can have financial implications
such as an increase in readmissions after surgery and financial decisions such as a freeze on staff recruitment
can have a clinical impact as patients wait longer for treatment. Managing risk effectively also involves
identifying and minimising the opportunity for risks to occur.
Reporting of incidents also provides an opportunity for other teams and departments to learn and make
changes to their practice. The reporting system in your NHS Board may be paper based or may be an
electronic web-based system such as DATIX or Safecode.
Risks that impact on patient care can be monitored, managed and reported via the risk management process
and linked to professional and organisation learning through the NHS Board clinical governance structure.
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5. RISK MANAGEMENT AND PATIENT SAFETY
Clinical risk management Patient Safety
Competence Performance
Individual oriented Team and systems oriented
Voluntary code Regulatory framework
Clinician centred Patient centred
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6. IDENTIFY RISK
This could be recent incidents, audits, questionnaires, complaints or the views of those who visit your work
area.
Identifying risks is about asking:
• what could happen?
• when and where could it happen?
• how and why could it happen?
how can we prevent or minimise risk of this happening?
How you identify risks and who you involve will depend on whether you are looking at a specific ward/team
area or at a more strategic, organisational level. Its useful to involve others in identifying risk as this gives you
different perspectives on the same situation.
Approaches to identify risk can include:
Brainstorming on possible risks in a facilitated session
mapping out the processes and procedures of the patient journey on a wall chart and ask staff to identify risks
at each stage and drawing up a checklist of risks and asking for feedback.
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7. ASSESS AND ANALYSE RISK
Looking closely at what causes risks to happen helps us understand and manage why they occur. Analysis of risks can
take place at a number of levels
Risk assessment involves understanding and knowing what to do if the risk occurs by:
Identifying in advance potential hazards and risks
Deciding who or what might be harmed and how
Evaluating the risks and deciding whether the existing precautions are adequate or whether more should be done
Recording your findings and implementing them
Reviewing your assessment and revising it if necessary.
Five Steps to Risk Assessment (HSE 2006) describes risk assessment as:
simply a careful examination of what, in your work, could cause harm to people, so that you can weigh up whether you
have taken enough precautions or should do more to prevent harm
Analysing risks will involve looking at:
what controls do we have in place to prevent a risk occurring?
what is the consequence of a risk occurring?
what is the likelihood of a risk occurring?
what is the level of risk in light of these considerations?
Weighing up the likelihood and consequences of a risk happening involves categorising risks into a scale or matrix that
gives you a guide to assess what should be dealt with immediately and what can be tackled later.
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8. EVALUATE RISKS
Evaluating risks helps you identify what risks need treatment as a matter of priority. If you have identified a number of
risks then you need to evaluate priorities dependent on your initial criteria for judging the likelihood and consequences
of risk.
‘As Low As Reasonably Practicable’ or ALARP diagram where the width of the triangle tells you about the size of the risk and the chances of it occurring.
This diagram can be helpful when evaluating what risks are acceptable to an organisation or work area.
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9. TAKE ACTION ON RISKS
Once you have analysed and evaluated the risks in your workplace, you then need to draw up an action plan
that details how to treat, get rid of or manage the risk.
When treating identified risks consider:
what are the existing controls? Are there gaps?
what are your objectives for treating the risk?
what controls are practical and sustainable? Check with staff who work in the area.
is the design of the control right? Is it helping you achieve your objectives?
are you involving staff who will need to implement changes?
The action plan will detail what work is done to manage and control risks and allow you to monitor changes
over time. It will also identify the priorities for risk treatment and record which risks are to be tolerated. If
you identify a major risk that cannot be managed or tolerated in your work area this needs to be discussed
and dealt with by management.
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10. CONCLUSION
Effective risk management requires strong leadership from:
NHS Board
Senior management
Clinical leaders
Effective risk management requires openness and transparency:
Among risk managers
With healthcare professionals
With patients and the public
Risk and the Learning Organisation
Six Million dollar question:
Does your NHS Board have a learning strategy? It may be part of the Organisational Development or
Personnel information on training and education available across your NHS Board.
Does this strategy include learning lessons from health and safety and risk management incidents?
How is the learning strategy implemented in your work area?
If not, how is training for risk management, including health and safety accessed in your organisation?
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