Downloaded 10 times
Editor's Notes
- #2 These are notes from the teaching presentation on Risk Management at Management STEM, Thursday 13th November 2014
- #3 Objectives for the session: to understand - what is Risk? Why does it matter to us as ED clinicians? How can we manage it?
- #4 Risk Management means having in place a corporate and systematic process for evaluating and addressing the impact of risks in a cost effective way and having staff with the appropriate skills to identify and assess the potential for risks to arise. To start off we need some definitions; in pairs we tried to define “risk” and “hazard”.
- #5 This is the definition of hazard taken from the CMFT Risk Management Strategy document which outlines how the trust measures and acts upon risks. Each trust will have one, many are in the public domain and they are relatively easy reading.
- #6 The definition CMFT uses for Risk references specifically impact upon the trust’s objectives. Do you know what your trust’s objectives are? How can you find them out? Most trusts have a vision/mission/objectives document which is also in the public domain.
- #7 This is one of the stated objectives of CMFT. So now it’s easy to understand what would constitute a risk; the objective is very generic and effectively everything and anything we do has the potential to impact it in a negative way. Hazards are slightly easier for us to understand as clinicians as we are used to thinking of harm in a healthcare delivery context; but risk management extends beyond clinical care into all aspects of the trust’s functioning.
- #8 Why does Risk Management matter? There are a variety of pressures on the trust to deliver on its objectives in addition to the pressures on senior management to identify and act upon risks.
- #9 We do not have infinite resources in the NHS and we cannot afford to waste. Some risks occur around needless wastage and by addressing those we can afford better care for all our patients The NHS is an extremely complex organisation and the trust needs to be accountable for everything that happens within it For better or worse, the public expects that we will work towards reducing risks
- #10 The risk management we see comes in two complementary strands; we try to minimise risks before they occur and identify the risks which have lead to harm which has already occurred.
- #11 This is a primary and secondary approach towards risk and involves not only risk assessments but in the “recognise” phase we undertake incident reporting and investigations when things have already gone wrong. The two complement each other and are equally important; we are not going to go into incident reporting too much although that is the half we are usually more familiar with.
- #12 Root cause analysis of events which have occurred should identify relevant risks which can be modified or mitigated to prevent further occurrences. If these root causes are still in existence after the incident the risk persists. Most incidents occur not in isolation but as a combination of human factors and system failures.
- #13 Risk management in the primary sense aims to permit objective assessment, removing emotional elements and blame. Processes are formalised so that a common language is used even if that feels counterintuitive to us.
- #14 Risk assessments: identify, assess and evaluate anything that can interfere with the delivery of the highest standard of service and working environment within the trust. The trust has legal responsibilities towards its staff as well as towards patients and these fall on all levels of management; chief executive has overall responsibility but: Medical Director = Caldicott guardian Finance Director = overall fiscal responsibility, trust’s senior information risk owner Board of Directors = responsible for overseeing process of identifying and prioritising risks Clinical Directors = responsible for ensuring changes are implemented in their directorate ALL STAFF = responsible care for health, safety and welfare of themselves and others, co-operation on matters of risk management and health and safety, hazard reporting with reasonable action to reduce or eliminate associated risks (hence trust induction/mandatory training)
- #15 Risk assessments include an analysis of severity and likelihood. It should also identify any existing standards and controls in place to manage the risk. Controls include any action, procedure or process undertaken to either contain the impact of a risk to an acceptable level, decrease the likelihood or increase the probability of a desired outcome. Not all risk can be eliminated. Residual risk is the grade of the risk quantification once controls have been put in place. All risk that can be minimised and managed locally must be.
- #16 Risks are dynamic; they are constantly changing so for effective risk control up-to-date information is needed on the risks themselves, the controls in place and whether they are managing the risk as designed. Therefore risk assessments have a review date.
- #17 Likelihood of a risk becoming reality is scored on the following table.
- #18 Obviously these definitions can be hard to determine, particularly around the 2-4 sections. Research and audit can help provide data.
- #19 In addition, the severity of the risk is important. What impact would it have if it was realised?
- #20 Risk Management exercise: add category descriptors for the following classes of risk Patient Experience Quality, Complaints & Audit Physical or non-physical assault Service/Business Interruption Fire Incidents Litigation Claim Target/Standard Impact Financial Impact Falls Pressure Ulcers
- #21 These assessments of likelihood and severity are then added into the risk matrix. The scores are multiplied to give an overall risk score which determines the escalation of the risk itself.
- #23 Individual risk assessments are held within a departmental risk register. Those risks which are particularly high scoring or difficult to mitigate might also be entered into the directorate risk register; those particularly high scoring are on the corporate risk register for the whole of the trust.
- #24 The Risk Register is a tool to collate and record risks, enabling measurement and prioritisation. These are held at different levels.
- #25 The cutoff point for entry onto the corporate risk register at CMFT is 15. Risks scoring more than 15 are referred to the executive director (if a divisional risk) for a decision on onward referral or the chief exec if a corporate risk. If the risk score is agreed, the revised risk register is reviewed and agreed at an executive directors’ team meeting. Supporting reports are made to the trust risk management committee and a report on the Trust Risk Register is made to the board of directors. The Trust Risk Register contains all the trust-wide risks with risk scores of 15 or greater.
- #26 And what does this mean for us? Well, the trust will have to make resources available - financial and otherwise - for mitigating risk, particularly in the context of high scoring and corporate or strategic level risks. For example, failing to meet the Four Hour Target for two consecutive quarters has implications for a foundation trust; SRFT was able to look at and act upon their ED layout as a factor in overcrowding in a relatively short space of time.
- #27 Score the likelihood and severity for each of the following Ebola patient attending your current ED Incorrect diagnosis made by ED US Observation ward closes for D&V Nurse punched by intoxicated patient; fractured jaw requiring surgery
- #29 These are notes from the teaching presentation on Risk Management at Management STEM, Thursday 13th November 2014