Aim of programme to apply the principles of risk management to

practical situations and relate these to personal experiences

to improve the quality of care by implementing initiatives to remedy deficiencies in the service provided.

Harvard Medical Practice StudyHarvard Medical Practice Study New England Journal of Medicine 1991New England Journal of Medicine 1991

3.7% patients suffered an 3.7% patients suffered an adverse eventadverse event

Of these 13% Of these 13% dieddied

58% events related to system 58% events related to system errorserrors

Summary of New Complaints Procedure Summary of New Complaints Procedure ((1998, 9/12 period)1998, 9/12 period) MDU experienceMDU experience

Failure or delay in diagnosis most common Failure or delay in diagnosis most common reason (28%)reason (28%)

24% of complaints made after bereavement24% of complaints made after bereavement

Non-clinical issues accounted for 34% of Non-clinical issues accounted for 34% of complaintscomplaints

10% of complaints related to attitude10% of complaints related to attitude

93% settled at L.R.93% settled at L.R.

MDU Settled Claims Against MDU Settled Claims Against UK GPsUK GPs

Failure to diagnose Failure to diagnose - 51% - 51% Medication error Medication error - 26% - 26% Pregnancy including labour - 13%Pregnancy including labour - 13% Minor surgical procedure - 7%Minor surgical procedure - 7% Other Other - -

3%3%

MDU Claims SettledMDU Claims Settled

Quality of medical care - Quality of medical care - 7%7%

Medical record issues -Medical record issues - 60%60%

System failures-System failures- 33%33%

MDU complaints study 1999 33% complaints were due to failures in

systems, procedures and communication e.g. rudeness/attitude staff or doctor administration problems prescription problems communication

Clinical Governance

Clinical risk management

Complaints procedures

Adverse incident reporting

Clinical audit

Evidence- based practice

Whistle blowing

Performance review

RISK MANAGEMENT

A careful examination of what A careful examination of what

1.1. could cause harmcould cause harm

2.2. its significance and its significance and

3.3. what precautions are needed to eliminate the what precautions are needed to eliminate the

risk or reduce it to an acceptable levelrisk or reduce it to an acceptable level

Risk Management Benefits for patients

– improved quality of care and service– enhanced patient safety– confidence in the service

for health care professionals– protection of confidence and reputation– quality procedures and staff involvement– decreased numbers of complaints and

claims

The four principles of risk management

1. Identify the risks – what’s likely to go wrong?

2. Assess the risk – what are the chances of it going wrong, what could happen, does it matter?

3. Reduce/eliminate the risk – what can you do about it

4. Cost the risk – what are the costs of getting it right v. the cost of getting it wrong?

Risk Management Techniques

Complaint handling

Risk assessment

Staff awareness/training

Protocol and guidelines monitoring

Good medical records

Adverse incident reporting

Risk Areas

Staff - especially locums

Organisation adequate staffing regular guideline review

Communication

Consent

Record keeping

Clip 2 – Morning Surgery

Identified Risks

Breaches of confidentiality – front desk/reception area etc.Health and safety issue.Lack of systems.Phone call interruptions.Verbal requirements regarding nurse visit.Inappropriate roll/responsibilities of receptionist.

What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

Clip 3 – Test Result / Minor Surgery

Identified Risks

Dealing with smear results.Aseptic techniques.Lack of chaperones.Unreasonable patient request.Lack of informed consent.Disposal of clinical waste/needles.

What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

Clip 4 – Home Visit

Identified Risks

Examination.Response to collapsed patient.Communication regarding hospital admission.Communication with mother.Dealing with request for repeat prescription.Dealing with aggressive patient.

What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

Aims of Assessment

Improve patient care

Ensure safe standards of practice

Ensure patient/staff safety and well being

Decrease the number of complaints and claims

Lessen the stress associated with litigation

The MDU’s risk management pack

Part one - Communication

How to use it

Each part contains:

Case history examples Checklist Reference sections Action plan Score/evaluation sheet

How to complete

Team approach set aside protected time read questions and reference section undertake the review (‘yes’ or ‘no’

answers) consider action needed complete action plan complete the anonymised answer sheet return sheet to PCG offices

Scoring system

Yes - undertaking the activity No - area needs review Score 3 = essential Score 2 = important Score 1 = good practice