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Dynamic approaches to Healthcare risk management

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Selected proceedings from

Two International H e a l t h c a re R i s k M a n a g e m e n t Symposia

Apr il 1999 Fe br uar y 2000

S t a n d a r d s

A u s t r a l i a

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Dynamic approaches to healthcare risk management

Selected proceedings from two symposia sponsored by Standards Australia International Sydney, April 1999 and Perth, February 2000 (in conjunction
with the Metropolitan Health Service, Western Australia and the National Health Service, England

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ISBN 0 7337 3352 2 Copyright Standards Australia International All rights are reserved. No part of this work may be reproduced, copied, stored, distributed or transmitted in any form, or by any means, including photocopying, scanning or other mechanical or electronic methods without the prior written permission of the publisher. Published by Standards Australia International, PO Box 1055, Strathfield NSW 2135 Design and typesetting by Write Result, 22 Firwood Trail, Woodvale WA 6026 email:

Dynamic approaches to healthcare risk management


1 Introduction
Dr Maree Bellamy
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3 Governance and risk management in the National Health Service in England

And the application of the Australian Risk Management Standard to risk management in healthcare
Colin Reeves, Neil McKay, Stuart Emslie

17 Personal accountability for clinical care in the British NHS

Geoffrey Haynes

21 Assurance for the Board

Geoffrey Haynes

27 The introduction of clinical risk pooling and clinical risk management standards within the National Health Service
Steve Walker

31 The Bristol Paediatric Cardiac Surgery Inquiry

Dr Isabel Sanderson

35 Controls assurance
Involving the Board
Tim Crowley

43 Risk management
Kevin Knight


Dynamic approaches to healthcare risk management

69 The need for effective dynamic governance in healthcare

Promoting accountability for quality Dr Chris Brook

79 The responsibility of hospital boards for clinical governance

Michael George, Tom Brennan and Dr Heather Wellington
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83 Linking claims management with clinical risk management

The NHS experience
E Jane Chapman

89 Early detection of major risk

Adopting a control self assessment methodology to identify risk and opportunity and enhance learning
G Randolph Just

105 Risk management in the healthcare setting

Judith Napier

109 Role of clinical pathways and variance analysis in risk management and quality improvement
Dr Elizabeth Mullins

113 Credentialling of hospital medical staff

Dr Lionel Wilson

121 A framework for managing the quality of health services in NSW

Maureen Robinson

127 Iatrogenic injury in Australia

Dr Bill Runciman

133 Understanding clinical risk

Stephen McAndrew


Dynamic approaches to healthcare risk management

139 Clinical risk management

Dr Allan Wolff, Jo Bourke, Dr Rob Grenfell

141 Using radar logic to develop standards-based management systems that work
Michael Paskavitz

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147 Integrated risk management within the health industry

Sue Williams

Dr Maree Bellamy1

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Healthcare is undergoing enormous change. On one hand, greater medical knowledge and expertise accompanied by technical improvements are delivering more sophisticated therapies to significant populations. On the other, we see increased media and public attention to quality issues, with an unfortunate focus on adverse events and unsatisfactory outcomes. This juxtaposition highlights the potential problems and pitfalls for all stakeholders. In many countries, a move toward integrated healthcare systems has resulted in a change in emphasis for healthcare managers and providers. There is a greater awareness of the need to provide care, which is acceptable and beneficial to the broader community. Accompanying this is the task of coordinating care across multiple entities and the challenge of developing a culture of system thinking. Integrating medical practitioners within the totality of the scheme requires a change in the approach of clinicians, with new roles for doctors charged with governance responsibilities. As an overarching principle, accountability has taken on a greater significance accountability for multiple dimensions of performancefinancial, clinical, management integration, quality, risk management, community satisfaction and health outcomes. The public demands improved patient safety. There is a concern that the financial pressures and organizational change in healthcare will decrease doctors' expertise, increase workload and reduce safety. The nature of training and certification of practitioners and institutions have also become key issues. According to James Reason2 the more safety researchers have looked at the sharp end, the more they have realized that the real story behind accidents depends on the way that resources, constraints, incentives, and demands produced by the blunt end shape the environment and influence the behaviour of the people at the sharp end. Changes in technology, procedures, and organizations, combine with economic pressures to create new vulnerabilities and forms of failure at the same time that they create new forms of economic and therapeutic success. Managers and clinicians need tools and techniques to improve the quality of services and to reduce risks to patients, staff and organizations. The wisdom of adopting an integrated management approach, at both corporate and clinical levels, to achieve continuous improvement and clinical effectiveness is receiving increasing recognition. In Britain, greater levels of accountability and a push for improved standards of quality are being driven by a change in governance requirements. There is a similar emphasis in the quality management framework released by NSW Health. That document
1. Director of Health, Standards Australia International. 2. James Reason 1997, Managing the risks of organizational accidents.

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MP 91-2000, Dynamic approaches to healthcare risk management

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