Aim of programme
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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.

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Aim of programme

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 study new england journal of medicine 1991

Harvard Medical Practice StudyNew England Journal of Medicine 1991

  • 3.7% patients suffered an adverse event

  • Of these 13% died

  • 58% events related to system errors


Summary of new complaints procedure 1998 9 12 period mdu experience

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

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

  • 24% of complaints made after bereavement

  • Non-clinical issues accounted for 34% of complaints

  • 10% of complaints related to attitude

  • 93% settled at L.R.


Mdu settled claims against uk gps

MDU Settled Claims Against UK GPs

  • Failure to diagnose - 51%

  • Medication error - 26%

  • Pregnancy including labour - 13%

  • Minor surgical procedure - 7%

  • Other - 3%


Mdu claims settled

MDU Claims Settled

  • Quality of medical care - 7%

  • Medical record issues -60%

  • System failures-33%


Mdu complaints study 1999

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 Governance

  • Clinical risk management

  • Complaints procedures

  • Adverse incident reporting

  • Clinical audit

  • Evidence- based practice

  • Whistle blowing

  • Performance review


Risk management

RISK MANAGEMENT

  • A careful examination of what

  • could cause harm

  • its significance and

  • what precautions are needed to eliminate the risk or reduce it to an acceptable level


Risk management benefits

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

    The four principles of risk management

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

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

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

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


    Risk management techniques

    Risk Management Techniques

    • Complaint handling

    • Risk assessment

    • Staff awareness/training

    • Protocol and guidelines monitoring

    • Good medical records

    • Adverse incident reporting


    Risk areas

    Risk Areas

    • Staff - especially locums

    • Organisation

      • adequate staffing

      • regular guideline review

    • Communication

    • Consent

    • Record keeping


    Clip 2 morning surgery

    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

    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

    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)?


    Aim of programme

    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

    The MDU’s risk management pack

    Part one - Communication

    How to use it


    Each part contains

    Each part contains:

    • Case history examples

    • Checklist

    • Reference sections

    • Action plan

    • Score/evaluation sheet


    How to complete

    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

    Scoring system

    • Yes - undertaking the activity

    • No - area needs review

    • Score 3 = essential

    • Score 2 = important

    • Score 1 = good practice


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