Question

How do you approach risk assessment in a hospital?

Answer 1

Risk management (RM) generally encompasses risks in the political, legal and business environment. Clinical risk management (CRM) is a specific form of RM focusing on clinical processes directly and indirectly related to the patient.

RM is an integral component of a healthcare firm's standard business practice. Healthcare Providers Service Organization (HPSO) and Nurses Service Organization (NSO). Risk assessment is a process or application of a methodology for evaluating risk as defined by probability and frequency of occurrence of a hazard event, exposure of people and property to the hazard, and consequences of that exposure. The purpose of the RM program is to protect patients, staff members and visitors from inadvertent injury. Different methodologies exist for assessing the risk of natural hazard events, ranging from qualitative to quantitative.

RM is a structured approach to managing uncertainty related to a threat, through a sequence of human activities including risk assessment, strategy development to manage risk and mitigation of risk using managerial resources.

Using a RM approach will provide health service organisations with a framework to assess and address risks identified in the organisation.

To determine if a standardised risk management approach has been set for your HPSO, it is recommend you contact your state or territory health department or health service ownership group, for information on the recommended risk framework.

HPSO will need to assess the risks associated with an action and develop a plan of action that is prioritised in accordance with the findings of the risk assessment. Health services may also need to complete a sample audit to establish baseline data for the identified risks.

Who is at risk?

• Patients - some patients more than others. For example the elderly; ‘surgical patients’; neonates; or patients with indwelling devices
• Health care workforce - the workforce are also health consumers and may have extensive exposure to the risk
• The organisation - this could be corporate or clinical risk.

Who has to address the risk management issues?

• The health system - the risk may be outside the control of an organisation
• The organisation - the risk may be corporate or clinical in nature
• The team who are delivering the care - the risk may come from the pattern of work or team dynamics
• The individual - the risk may be skills, knowledge or situationally based

Principles of Risk Management

Avoid risk - Identify appropriate strategies that can be used to avoid the risk whenever possible, if a risk cannot be eliminated then it must be managed
Identify risk - Assess the risk, identify the nature of the risk and who is involved
Analyse risk - By examining how a risk can occur; what the likelihood; and what are the consequences of this risk occurring
Evaluate risk - Determine how the risk can be reduced or eliminated. Document the process, response and outcomes.
Treat risks - Manage the risk by determining who is responsible for taking actions, when and how this will be monitored.

Steps to minimise risks
To minimise risks, you will need to identify:

1. Who is at risk?
2. What is involved?
3. Why can it happen?
4. How likely is it?
5. What are the consequences?
6. What can be done?
7. Is the solution applied to the situation/risk identified?

How will we know how often the risk is likely to happen and what is the impact of the risk?
The risk assessment requires you to assess whether the risk is likely to be common or rare, or severe or mild. The sources of data that may help you understand how likely the risk will occur in the clinical or corporate environment include:

• Monitoring and audit results to identify frequency or scope of risk
• Surveillance data
• Complaints
• Observations
• Literature
• Benchmarking