Risk Management in the NHS

1
Risk Management in the NHS

• ALARM Scotland Conference
• 20th September 2004
• Pat OConnor
• Head of Risk Management
• NHS Tayside

2
Overview

• Background
• Risk Management Activities within NHS Tayside
• Explain structure and process
• Explain Risk Assessment Methodology
• Open discussion

3
Definition

• Risk-
• threat that an event or action will affect
  an organisations ability to maximise value and
  to achieve its business objectives.
• Risk Management
• an infastructure that enables an organisation
  to identify, analyse , assess, treat, monitor and
  communicate risks in a way that will enable
  organisations to minimise losses and maximise
  opportunities

4
Why Manage Risk?

• Corporate Governance
• Clinical Governance
• NHS Quality Improvement Scotland
• External Reviews
• Performance Assessment Framework
• Continuous Improvement

5
Corporate Governance Framework (Vowel Test)
Patient Focus
Service Delivery Arrangements
Standards of Conduct
Accountability Effectiveness Integrity Openness
Inclusively Up to date/Evidence Based
Structures and Processes
Risk Management and Internal Control
6
Structure and Process

• Strategy
• Risk Management Group
• Links to Clinical Governance
• Integrated Risk Management
• Everybodys business

7
Risk Management System System

• Whole systems approach
• The Risk Control Plan (Register)
• Reporting and Managing Incidents
• Complaints
• Claims
• Risk Surveillance

8
Structure
9
RISK MANAGEMENT PROCESS Adapted from AS/NZS
436099 Risk Management in Clinical
Practice Eunice Muir 2001amended P.OConnor2003
NHS ACTIVITY

• INTERNAL SOURCES
• Clinical governance
• Risk management systems
• Incident monitoring
• GP adverse event reporting
• Variance analysis
• Trends/Clusters
• Complaints
• Claims

RISK IDENTIFICATION
M O N I T O R R E V I E W
C O M M U N I C A T I O N
C O N S U L T A T I O N
REACTIVE
PROACTIVE
Incident Reporting
Risk Assessment
Adverse Event
Risk/Incident Review RCA
RISK ANALYSIS Impact Likelihood x Consequences
Root Cause Analysis
RISK EVALUATION Risk Control Plan, Cost Benefit
Analysis Performance Management Standards

• EXTERNAL SOURCES
• Advisory Committees
• NHSQIS
• National Guidance
• Academic Papers
• Professional Journals
• Patient Experience Surveys
• Confidential Enquiries
• Ombudsman
• Fatal Accident Enquiries
• National Patient Safety Agency

ACCEPT / TREAT RISK Minimise or Transfer
10
Risk Radar

• Recognise the risks
• Analyse the risks
• Determine the current controls
• Action plan for improvement
• Review

11
Recognise the Risk - Identification

• Strategic Leadership
• Examine Objectives
• Group Activity
• Consider Positives and Negatives

12
Analyse the Risk - Likelihood
Recognise the Risk - Identification
Likelihood Score

• Likelihood X Consequence matrix
• Strategic Leadership
• Examine Objectives
• Group Activity
• Consider Positives and Negatives

13
Determine the Current Controls

• 5 Categories of Control
• Management
• Policies and Procedures
• Contingency
• Timetable
• External Controls/Guidance

14
Action Plan - Including Resources

• Target
• Timescale
• Tolerance
• Additional Information
• Review

15
Benefits

• Does not remove individual professional judgement
• Provides consistent framework
• All inclusive clinical/non-clinical risk
• Informative - raises concern gives reassurance
  that risk are managed

16
Critical Success Factors

• Integrated Approach
• Regional Co-ordination
• Executive leadership/direction
• Reporting to Governance Structure