MP 91-2000 Dynamic approaches to healthcare risk management

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                                                                                           Dynamic approaches to
                                                                                           Healthcare risk management
This is a free 7 page sample. Access the full version at

                                                                                                        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

                                                                                                        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
                                                                                           Dynamic approaches
                                                                                           to healthcare
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                                                                                           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
                                                                                                                                             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
                                                                                                        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
                                                                                                                           Promoting accountability for quality
                                                                                                                           Dr Chris Brook

                                                                                                                     79 The responsibility of hospital boards for clinical
                                                                                                                           Michael George, Tom Brennan and Dr Heather Wellington
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                                                                                                                     83 Linking claims management with clinical risk
                                                                                                                           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

                                                                                           147 Integrated risk management within the health
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                                                                                                Sue Williams

                                                                                           Dr Maree Bellamy1

                                                                                                              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
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                                                                                                              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
                                                                                                              As an overarching principle, accountability has taken on a greater significance—
                                                                                                              accountability for multiple dimensions of performance—financial, 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
                                                                                                              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
This is a free 7 page sample. Access the full version at

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