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  1. By Ryhan Ebad
  2. Introduction Hospitals treat thousands of people every day. There are risks involved in the treatment of patients, the management of staff and the running of hospitals and clinics. Human error, poor organisation and lack of clarity on management arrangements are all risks. Errors and accidents can cause discomfort, cost money, jobs and in the most extreme cases, lives.
  3.  Is a systematic identification and treatment of risk.  Is a logical and systematic method of identifying, analyzing, treating and monitoring the risks involved in any activity or process.  Is a continuous process of reducing risk to organisations and individuals alike.  Assures statutory responsibility to manage and monitor health & safety, corporate and clinical risk.  Is a standardised process used in business and industry to reduce injuries, errors, faults and accidents and at the same time improve quality. Risk Management
  4. Who Uses Risk Management? Risk Management practices are widely used in public and the private sectors, covering a wide range of activities or operations. These include: • Finance and Investment • Insurance • Health Care • Public Institutions • Governments
  5. How is Risk Management Used? The Risk Management process steps are a generic guide for any organization, regardless of the type of business, activity or function. There are 7 steps in Risk Management Approaches.
  6. 1. Establish the context 2. Identify the risks 3. Analyze the risks 4. Evaluate the risks 5. Treat the risks Risk is dynamic and subject to constant change, so the process includes continuing: 6. Monitoring and review 7. Communication and consultation Risk Management Approaches
  7. Step 1: Establish the Context The strategic and organizational context in which risk management will take place. How will you assess and analyse the risk? What are the criteria you will use to judge the likelihood and consequences of risk? For example, the nature of your business, the risks inherent in your business and your priorities.
  8. Step 2: Identify The Risks Defining types of risk, for instance, ‘Strategic’ risks to the goals and objectives of the organization. What could stop you achieving your objectives and outcomes? • Identifying the stakeholders, (i.e., who is involved or affected). • Past events, future developments.
  9. Step 3: Analyze The Risks How likely is the risk event to happen? (Probability and frequency?) What would be the impact, cost or consequences of that event occurring? (Economic, political, social?) Are our existing risk controls working and what are the potential consequences of risks happening?
  10. Step 4: Evaluate The Risks Rank the risks according to management priorities, by risk category and rated by likelihood and possible cost or consequence. Determine inherent levels of risk. What is the balance between potential benefits and adverse outcomes of managing these risks?
  11. Step 5: Treat the Risks Develop and implement a plan with specific counter-measures to address the identified risks. How can we develop and implement specific cost-effective strategies to increase benefits and reduce potential costs? Consider: • Priorities (Strategic and operational). • Resources (human, financial and technical). • Risk acceptance, (i.e., low risks).  Document your risk management plan and describe the reasons behind selecting the risk and for the treatment chosen.  Record allocated responsibilities, monitoring or evaluation processes, and assumptions on residual risk.
  12. Step 6: Communicate and Consult Who will need to know about and be involved at each stage of the risk management process?
  13. Step 7: Monitor and Review  In identifying, prioritizing and treating risks, organizations make assumptions and decisions based on situations that are subject to change, (e.g., the business environment, trading patterns, or government policies).  Are we achieving the right outcomes and how do we know?  Risk Management policies and decisions must be regularly reviewed.  Risk Managers must monitor activities and processes to determine the accuracy of planning assumptions and the effectiveness of the measures taken to treat the risk.  Methods can include data evaluation, audit, compliance measurement.
  14. How Do I Identify Risk ? Some hazards and risks are easy to identify; faulty electrical sockets, unsafe flooring or in-patients not having name bracelets. Others risks are more difficult to recognise; contaminated surfaces, a mistake during a rushed staff handover, medication allergies, or common practice to make something quicker or easier that raises the risk of something going wrong. You want it to be routine for staff to know how to identify and report clinical risk, poor practice or faulty machinery.
  15. Risk Identification If you are trying to identify risks it is important to think about how things happen in your work area. You need to use up-to-date, accurate information about how your service works, if possible from both staff and patients. This could be recent incidents, audits, questionnaires, complaints or the views of those who visit your work area.
  16.  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. Identifying Risks Is About Asking:
  17. Approaches to Identify Risk Can Include:  Brainstorming on possible risks in a facilitated session.  Mapping out the processes and procedures of the ward or the patient journey on a wall chart and ask staff to identify risks at each stage.  Drawing up a checklist of risks and asking for feedback. If you are looking for help or training on how to identify risks in your work area you should discuss this with your manager, risk management staff and/or clinical governance staff in your organisation.
  18.  Step 1 Build a safety culture.  Step 2 Lead and support your staff.  Step 3 Integrate your risk management activity.  Step 4 Promote reporting.  Step 5 Involve and communicate with patients and the public.  Step 6 Learn and share safety lessons .  Step 7 Implement solutions to prevent harm. Seven Steps to Patient Safety
  19. Managing Risk Risk can be managed at two overlapping levels: 1. Strategic/management level. 2. Day-to-day staff/patient operational level.
  20. Potential Causes of Risk 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.  Clinical incidents that have a direct effect on the outcome of patient care.
  21. Risk Management and Patient Safety  Risk management has been influenced by the growing awareness of the number of errors, incidents and near- misses that happen in healthcare and the effect on the safety of patients. Traditionally, risk management has been about professional and organisational performance and systems - the financial or corporate cost of making mistakes.  Patient Safety aims to improve the safety and quality of care through reporting, analysing and learning from patient safety incidents and 'near misses' involving hospital patients.
  22. Risk Management and Patient Safety Correlation Past Present Clinical risk management Patient safety Competence Performance Individual oriented Team and systems oriented Voluntary code Regulatory framework Clinician centred Patient centred
  23. 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.
  24. How do I Assess or 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;  it can be about a particular clinical process such as minor surgery.  the storage of hazardous materials in a health centre or the financial status of an organisation. Risks can also be analysed at different stages in a process, such as before and during treatment.
  25. Risk Assessment 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.
  26. 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?
  27. Five Steps to Risk Assessment Risks at your workplace can be assessed by the follow the five steps: Step 1 Identify the hazards. Step 2 Decide who might be harmed and how. Step 3 Evaluate the risks and decide on precautions . Step 4 Record your findings and implement them. Step 5 Review your assessment and update if necessary .
  28. Tips…..  Don’t overcomplicate the process.  In many organisations, the risks are well known and the necessary control measures are easy to apply.  You probably already know whether, for example, you have employees who move heavy loads and so could harm their backs, or where people are most likely to slip or trip.  If so, check that you have taken reasonable precautions to avoid injury.
  29. Remember…… When thinking about your risk assessment:  A hazard is anything that may cause harm, such as chemicals, electricity, working from ladders, an open drawer etc.  The risk is the chance, high or low, that somebody could be harmed by these and other hazards, together with an indication of how serious the harm could be.
  30. Step 1: Identify The Hazards First you need to work out how people could be harmed. When you work in a place every day it is easy to overlook some hazards, so here are some tips to help you identify the ones that matter:  Walk around your workplace and look at what could reasonably be expected to cause harm.  Ask your employees or their representatives what they think. They may have noticed things that are not immediately obvious to you.  Refer to the manuals and other materials to practical guidance on where hazards occur and how to control them .
  31. Identify Hazards  Check manufacturers’ instructions or data sheets for chemicals and equipment as they can be very helpful in spelling out the hazards and them in their true perspective.  Have a look back at your accident and ill-health records – these often identify the less obvious hazards.  Remember to think about long-term hazards to health (eg high levels noise or exposure to harmful substances) as well as safety hazards.
  32. Step 2: Decide Who Might Be Harmed and How For each hazard you need to be clear about who might be harmed; it will help you identify the best way of managing the risk. That doesn’t mean listing everyone by name, but rather identifying groups of people (eg ‘people working in the storeroom’ or ‘passers-by’). In each case, identify how they might be harmed, i.e. what type of injury or ill health might occur. For example, ‘shelf stackers may suffer back injury from repeated lifting of boxes’.
  33. Who Might Be Harmed Remember:  Some workers have particular requirements, e.g., new and young workers, or expectant mothers and people with disabilities may be at particular extra thought will be needed for some hazards.  Cleaners, visitors, contractors, maintenance workers etc, who may workplace all the time.  Members of the public, if they could be hurt by your activities; if you share your workplace, you will need to think about how your others present, as well as how their work affects your staff – talk.  Ask your staff if they can think of anyone you may have missed.
  34. Step 3: Evaluate The Risks and Decide On Precautions Having spotted the hazards, you then have to decide what to do about them. It is required of you to do everything ‘reasonably practicable’ to protect people from harm. You can work this out for yourself, but the easiest way is to compare what you are doing with good practice. So first, look at what you’re already doing, think about what controls you have in place and how the work is organized. Then compare this with the good practice and see if there’s more you should be doing to bring yourself up to standard.
  35. A Table Like This To Set A Level of Risk. You must define what these risk levels mean to you. Extreme Very High Moderate Low Negligible Almost certain Severe Severe High Major Moderate Likely Severe High Major Significant Moderate Moderate High Major Significant Moderate Low Unlikely Major Significant Moderate Low Very low Rare Significant Moderate Low Very low Very Low
  36. Decide on Precautions In asking yourself this, consider:  Can I get rid of the hazard altogether?  If not, how can I control the risks so that harm is unlikely? When controlling risks, apply the principles below, if possible in the following order:  Try a less risky option (e.g. switch to using a less hazardous chemical).  Prevent access to the hazard (e.g. by guarding).  Organize work to reduce exposure to the hazard (e.g. put barriers between pedestrians and traffic).  Issue personal protective equipment (e.g. clothing, footwear, goggles etc).  Provide welfare facilities (e.g. first aid and washing facilities for removal of contamination).
  37. It Is Good to Know  Improving health and safety need not cost a lot. For instance, placing a mirror on a dangerous blind corner to help prevent vehicle accidents is a low-cost precaution considering the risks.  Failure to take simple precautions can cost you a lot more if an accident does happen.  Involve staff, so that you can be sure that what you propose to do will work in practice and won’t introduce any new hazards.
  38. Step 4: Record Your Findings and Implement Them  Putting the results of your risk assessment into practice will make a difference when looking after people and your business.  Writing down the results of your risk assessment, and sharing them with your staff, encourages you to do this.  When writing down your results, keep it simple, for example ‘Tripping over rubbish: bins provided, staff instructed, weekly housekeeping checks’, or ‘Fume from welding: local exhaust ventilation used and regularly checked’.
  39. Record Your Findings We do not expect a risk assessment to be perfect, but it must be suitable and sufficient. You need to be able to show that:  A proper check was made.  You asked who might be affected .  You dealt with all the significant hazards, taking into account the number of people who could be involved.  The precautions are reasonable, and the remaining risk is low.  You involved your staff or their representatives in the process.
  40. A Good Action Plan A good plan of action often includes a mixture of different things such as:  A few cheap or easy improvements that can be done quickly, perhaps as a temporary solution until more reliable controls are in place.  Long-term solutions to those risks most likely to cause accidents or ill health.  Long-term solutions to those risks with the worst potential consequences  Arrangements for training employees on the main risks that remain and how they are to be controlled.  Regular checks to make sure that the control measures stay in place.  Clear responsibilities – who will lead on what action, and by when. Remember, prioritize and tackle the most important things first. As you complete each action, tick it off your plan.
  41. Step 5: Review Your Risk Assessment and Update If Necessary Few workplaces stay the same. Sooner or later, you will bring in new equipment, substances and procedures that could lead to new hazards. It makes sense, therefore, to review what you are doing on an ongoing basis. Every year or so formally review where you are, to make sure you are still improving, or at least not sliding back. Look at your risk assessment again. Have there been any changes? Are there improvements you still need to make? Have you or your coworkers spotted a problem? Have you learnt anything from accidents or near misses? Make sure your risk assessment stays up to date.
  42. Update Risk Assessments When you are running a business it’s all too easy to forget about reviewing your risk assessment – until something has gone wrong and it’s too late. Why not set a review date for this risk assessment now? Write it down and note it in your diary as an annual event. During the year, if there is a significant change, don’t wait. Check your risk assessment and, where necessary, amend it. If possible, it is best to think about the risk assessment when you’re planning your change – that way you leave yourself more flexibility.
  43. Thank You