Speaker 1: Hi everybody, welcome to my talk today Risk Management in Healthcare and this is the final video in my playlist series linked to quality improvement and change management so do check out my other videos, helpful for any healthcare students on change management modules or quality improvement modules and any healthcare professionals who are preparing for interviews because you might have questions on risk management. So I'm going to give a simple overview of risk management, what it is, how we predict, evaluate and prevent risk, look at some risk assessments and calculating risk, never events in healthcare and clinical incidents. So I hope you find it helpful, if you do don't forget to give me a thumbs up on YouTube and I hope you enjoy the talk. So if we look at risk management in healthcare, firstly what is risk? Risk is the likelihood of something happening that has consequences. So if you're asked at an interview what risk management is, it's about teams working together to prevent risks happening, it's about implementing actions to reduce the likelihood and impact of risk and we reduce the likelihood of risk by systematically identifying, assessing and evaluating risk through risk assessments and calculations that inform strategies to avoid and minimise future risk or harm, that will be to patients, staff or the organisation. And it's important to remember that risk management is not just about the risk to patients, you identify risks and threats that could harm staff as well or anyone else within an organisation such as visitors. And I noticed recently a UK NHS trust had a significant increase in violence and aggressive behaviour aimed at A&E staff and the staff were given body cameras as part of the trial to tackle abusive behaviour and there would have been instant reports filled and risk assessments completed to evaluate and predict the future risk to staff in that area that would have enabled these preventative measures to be put in place. So hopefully that gives sort of an example of identifying, assessing, evaluating and then risk and then strategies to avoid risk in the future. Risk management in healthcare also links to other key areas and concepts. For example, the Department of Health definition of quality describes three criteria that link to safety, experience of care and effectiveness of care. So if you don't manage risk, then quality of care is going to be impacted, it's going to be less safe, so the user experience will be affected and care will be less effective. If we look at the concept of clinical governance, that's an umbrella term and clinical governance is simply a framework or system of accountability to improve the quality of a service or your aim could be to sustain a service that already provides quality care and safeguarding standards as well. So risk management is considered to be part of clinical governance and you'll see risk management is one of the seven pillars of clinical governance. If we look at quality assurance, that's the process for checking that quality standards have been met and that includes various methods such as audits where we have ongoing monitoring of quality of care against agreed standards for quality to be measured and assured. If you have any assignments or interviews coming up, you might find some of these additional videos helpful that are on my YouTube channel where some key terms are explained and there's some practical example. So service evaluations in healthcare are explained using examples, clinical audit and quality improvement and quality assurance terms in healthcare and then a video on what the difference is between research, quality improvement, service evaluation and audit and there's some good key references in those videos too. In healthcare, we've got a range of risks that include operational, strategic and performance risk. So for example, a hospital or community trust objectives might not be met which will make services unsustainable potentially if they can't stay financially afloat and these are risks that affect the delivery or national local priorities that are set by NHS improvement. We also have got financial risk, organisations must keep within budget and generate income to survive and there's financial risks also linked to operational performance. So if you don't meet your national targets, your finances might be at risk but also links to litigation when things might go wrong and organisations might be sued which is very costly. Being sued might cause a reputational risk and an organisation may have some bad publicity when things go catastrophically wrong. For example, a hospital could be highlighted on BBC News and we all remember the Mid Staffordshire Hospital Inquiry and the Francis Report. At a more local level, we've got clinical risks. These are risks related to health and well-being of service users and patients and staff and the provision of care and I'll talk a little bit more about clinical incidents later. And then we've got health and safety risk. We need to protect all people in the building, for example, and there's a focus on environmental factors and risks. And then another one is information and security risk which we here talked about a lot more. Breach and confidentiality or disclosure of sensitive information. It includes loss of data, cyber attacks that are happening more frequently nowadays in the UK. In the United Kingdom, we've got local and national risk management systems. So local risk management systems aim to collect and manage data on adverse events, complaints, claims and risk. And the purpose is to integrate data to identify learning and implement improvement. So risk management information systems are about integrating all our governance processes. They're not just about incident reporting. And performance data from NHS providers is available through these national IT systems and they monitor trends monthly, quarterly and annually. And in England, we've got a new learn from patient safety event service being rolled out to replace the existing national reporting and learning systems. And these systems are going to evolve in the future. So it's really important when you're working in healthcare to find out about these systems. Also, members of the public can record patient safety incidents directly on a national reporting and learning system. So identifying risk using risk assessments. Most healthcare professionals will be familiar with a risk assessment, which is a qualitative or quantitative evaluation of the nature and extent of a risk. Risk assessments are completed by scoring the likelihood of the risk occurring and the impact should it occur. So, for example, we have a false risk assessment to check how likely it is that the patient may fall. And risk assessments, we've got a variety for pregnant workers, for example, and new mothers. We've got COVID risk assessments to estimate the risk of a person catching coronavirus and becoming seriously unwell. And then that allows healthcare workers to determine what PPE, personal protective equipment they should select and where, depending on the level of risk from their COVID risk assessment. And risks are assessed on the basis of impact, consequence and the severity and the likelihood of the risk occurring with that's within the current situation and controls being in place. So risk scoring and calculating risk is a consistent way to assess the level of risk. And if you're students, you're going to see lots of different types of risk assessments according to the specialities and the fields that you work in. So talk to practice supervisors about them, observe them in use and try and use them with supervision at first when you become registered. So what is a never event in healthcare? Never events are serious incidents that are wholly preventable and have the potential to cause serious harm or death. So never events are so serious that they should not occur if healthcare providers follow national guidance and safety recommendations. So you've always got those national guidance and policies that link to never events. And it's important to remember that serious harm or death does not have to happen for an incident to be categorised as a never event. So never events include incidents such as wrong surgery site, retained foreign objects, post procedure, misplaced nasal or orogastric tubes and full details of never events can be found on the NHS department website. So for example, I work in England, so there is a page for never events on the NHS England website. Moving on to clinical incident reporting. Most healthcare professionals have to report clinical incidents during their career and you record events on a clinical incident form. Some examples of incidents that are recorded include patient and staff injuries like slips, trips, falls, newly acquired pressure ulcers, needle stick injuries, medication administration errors, equipment failures, a patient who cannot be found or a patient complaint and there's lots more. When you complete a clinical incident report, there will be an overall risk rating and clinical incident forms use risk matrices to calculate an overall risk rating as follows. So it will be consequence rating times likelihood rating, which will equal the overall risk rating. Consequence ratings may be insignificant, minor, moderate, major or catastrophic. Likelihood ratings may be classed as rare and likely, possible, likely or almost certain. And the overall risk rating is graded to provide an impression of where, whether there is a low or extreme risk of reoccurrence, for example, of harm. It's often linked when you look at rating on clinical instance forms, you'll see often red, amber, green and colour, different colour codes used. And it's important to check the systems that your employer uses and become familiar with them. And if you're a student or a newly registered practitioner, look out for staff completing an incident form. And when you complete one for your first time, try and get somebody to supervise you if you're unsure, but never be afraid to ask. Looking at responding to an incident and risk, following escalation and the recording of an incident and data from the report, the data is going to be investigated and analysed by a line manager to learn from the feedback and to plan for improvement in the service. And this follow up investigation may involve staff writing more detailed statements about what happened at the time. One person should always lead an investigation initially and collect the data and statements from everybody involved. And if you are involved in an incident where you may have to go to court or even just writing a statement, always take legal advice from your union representative. And also, if your manager states any of your performance is being investigated as part of the incident report, we have a professional duty of candor in the UK and the NMC, the Nursing and Midwifery Council and the General Medical Council advocate that openness and honesty is which is paramount when things go wrong. Healthcare professionals have got this duty of professional candor, professional duty of candor, sorry, where positive open communication should be promoted and there should be no blaming or accusations. And it's really dangerous for staff and patients to work in a toxic blame culture where staff are afraid, too afraid to speak out. Failure to report an untoward incident is unacceptable and indicates cultural safety failings in an organisation. And that was shown in the Mid Staffordshire NHS Foundation Trust Public Inquiry and the Francis Report. After an incident, you evaluate the potential risk level that includes not doing anything as well. And there's four ways you can respond to an incident and a risk. Take out the risk, stop the risk, you stop what you're doing, whatever's causing the risk. Secondly, control the risk. So you might do that through implementing more policies, procedures or training and educating staff. Thirdly, transfer the risk. So there could be this sharing of risk with others in other teams. You might be bringing in specialist experts and then fourthly, accepting the risk. But it needs to be, it depends on what type of risk it is, but it needs to be monitored for future issues and changes in a situation. Moving on to risk register. The risk register provides a framework where risks are recorded with objectives and future actions. So it's essential for successful risk management because it allows for this follow up. And also it provides an audit trail to show what you're doing about the incidents. And it provides, it's helpful if you're questioned professionally by the Care Quality Commission, for example, or if there was future litigation, you've got that audit trail of documentation. All risks that are a future threat must be allocated a risk owner who's the lead personal and responsible for ensuring that the risk is adequately controlled and monitored. And higher, the highest priority risks are always focused upon first. So in summary, risk registers are a tool for documenting risks, the controls, documenting actions to manage each risk. And employer operational and strategic risk registers are an integral part of the system of internal control. So you might see in placements that there's corporate risk committees and audit committees where a lead for governance will oversee risk management processes. So do try and shadow and observe these meetings and risks that are recorded on the risk register will inform local planning, management decisions and future priorities. So finally, if you are a student out there, early career nurse, make sure you network locally and nationally. Look at the NHS and employer websites for resources. NHS trust departments will have leads for risk management, clinical governance and audit activity. You might have directorate governance groups, quality and incident reporting groups and committees and just try and network with all the leads in those areas. We also have a local and national quality improvement hubs if you're interested in quality improvement. Some helpful references there. If you have any questions at all, put them in the YouTube comments or if you prefer to ask them privately, you can DM me on Twitter or on my website and I hope you found it helpful today.