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Risk Management

Health care risk management:
Maternity wing risk analysis
Ensuring safety and trust in healthcare
Risk Management
 The method of detecting, analyzing and managing risks to the resources and profits of a
company is called risk management. Such risks or challenges may come from a wide
range of sources, including financial instability, legal obligations, failures in strategic
management, incidents and natural disasters.
 The prospect of unforeseen, disruptive incidents that may cost the company money or
force it to close indefinitely is faced by any company and organization. Risk assessment
helps businesses to try to compensate for the unexpected by minimizing risks and
additional expenses before they emerge.
Risk Management
Key Elements
 Identification of assets which are to be protected. What are you safeguarding, and why
(privacy, defense, etc.)
 Identify the risks of the assets. What could happen to the properties described in step 1?
Order the hazards by both effects and chance.
 Apply controls until the dangers are reduced to an acceptable degree in a layered
and overlapping way.
 Check the adequacy and efficiency of the controls and how they perform.
 Track the software and periodically repeat the same process.
Risk management as a
Risk management can be said to be a
process as illustrated in the diagram.
Risk Management
Healthcare: Maternity Wing
The Childbirth Risk Management Structure should consist of mechanisms that define and ensure:
 There is an Accountability Board that is aware of potential risks in maternity care and will assign
capital accordingly, in a prioritized manner, to mitigate risk and ensure that it achieves its
 The risk of harm, disruption or failure to patients , employees, guests or the organization shall be
removed and where this can not be handled in a manner that minimizes the risk.
 Workers identify and use the risk recognition, evaluation, monitoring and management process.
 Maternity Service satisfies its constitutional criteria in order to conform with the safety laws
requiring risk assessment.
 The Childbirth Service shows compliance with the critical health and safety criteria monitored
by the Care Quality Commission and the CQC Registration specifications.
Risk factors to be addressed
 Acts, rules , guidelines, corporate enforcement
 Conditions of participation for Medicare
 Privacy, secrecy (infringement of data)
 Health records and observations
 Human capital, credentialing, personnel
 Rights of patients
 Control of prescription
 Prevention and management of infection
 Reporting of violence
 Safety of the setting
Stakeholders viewed in the risk
management analysis of the maternity
The Divisional Director of Women's, Children's & Mental health interface
lead Clinician
Head of midwifery
All staff (collective and individual responsibilities)
Roles and responsibilities
The Divisional Director of Women's, Children's & Mental Health Interface, Lead Clinician and Head of Midwifery are professional leaders and
share overall responsibility for clinical risk control in the Maternity Service assisted by:
Consultant Obstetrician Gynecologist (Lead for Delivery Suite)
Consultant Anesthetist for Obstetrics
Lead Midwife for Public Health and Maternity Outpatients
Lead Midwife for Normal Birth and Maternity In-patients
Maternity Services Clinical Risk Midwife
They have collective roles which are:
Act as role models to help further a positive culture toward patient safety and risk management in general.
Implement the Risk Management Strategy in areas of direct responsibility and provision of advice to the rest of specialty on its use.
Co-ordinate clinical risk activities within Maternity Services
Ensuring risk management education/ training needs are identified
On-going development and review of the Risk Management Strategy
Roles and Responsibilities:
Divisional Director of Women’s, Children’s & Mental Health Interface
 The Director of Midwifery and the Lead Specialist Obstetrician collectively share the
responsibility for professional risk assessment for the maternity service.
 Ensures that the workers working within the maternity service understand and carry out
their individual risk management obligations.
 Ensure that risk concerns within the maternity service are considered at the executive level
of the Trust by the risk control arrangements of the Northern Devon Healthcare NHS .
 Accountability to the Head of Operations
Roles and responsibilities:
lead Clinician for women services
 Responsible for the delivery and provision of stable maternity care.
 Contributes directly and by sufficient delegation to successful risk control within Maternity
 Ensure that risk problems within maternity care are taken into account within the Trust at
the executive level
 Contributes to the local development and execution of company policy and practices
and assures that adequate preparation and information is given to workers to perform
their obligations.
 Advising advisory colleagues on their duty to supervise junior medical professionals and
maintaining consistency with the standards of risk control policy
 Hold informal / formal meetings with workers where problems of risk have been found.
Roles and responsibilities
Head of midwifery
Manage concerns relating to clinical and environmental risk resulting from risk control processes of Confidence such as accidents,
grievances, accusations, risk evaluations, audits, and other agencies' details.
Ensures that all accidents and near misses inside maternity facilities are reviewed in compliance with the Trust Policy and that an inquiry
in compliance with the Incident Response and Inquiry Policy of the Trust is conducted for serious incidents
Review grievances, charges, summaries of events and pattern analyses to ensure that challenges are identified, action plans created,
enforced and tracked.
In compliance with the Training Needs Analysis (TNA), track personnel attendance at required risk training.
Provide recommendations on broad policies and procedures for trust.
Ensure that the Business Risk Registry is checked and revised and associated resource challenges are established.
Ensure direct touch links within Maternity Facilities and feedback on risk-related concerns to the Risk Team. Ensure efficient coordination
links within Maternity Care on risk-related concerns and feedback to the Risk Team.
Hold informal / formal meetings with workers where concerns with risk have been found
Responsible to the Executive Officer and responsible to the Director of Nursing professionally.
Roles and Responsibilities:
All Staff
It is inclusive of Medical staff, Midwives, Maternity Care Assistants, Ward Clerks and any other
member of staff working within the Maternity Services. Risk management is everyone’s
responsibility and as such, is a fundamental requirement of all staff to carry out their duties
All staff have a responsibility to:
Identify and assess risk, taking appropriate action to reduce risks to an acceptable level
Inform managers or a member of the risk management team of any unacceptable levels of risk outside their sphere
of responsibility or authority.
Report clinical and non-clinical risks and to complete incident reporting forms in accordance with the Trust Incident
Management and Investigation Policy.
Short term Strategic plan
 Education & Training Risk control programs need to outline workforce training criteria, which
may include new employee registration, continuing and in-service training, regular evaluation
and confirmation of competencies, and event-specific training.
 Healthcare risk response & reduction strategies may also provide collaborative processes to
respond to identified threats and incidents, including acute response, follow-up, monitoring,
and avoidance of repeat failure.
 Reporting Procedures Each healthcare institution would have a framework for recording ,
classifying, and monitoring potential hazards and adverse effects, which is simple and
convenient to use. Protocols for required documentation must be used in all schemes.
 Communication plan As it is important for the health risk management team to encourage
open and spontaneous discussion, guidance about how to interact about risks and with whom
to interact in the health risk management plan should be included. The subsequent measures
and follow-up events should be reported. It is also important that the strategy outlines the
monitoring standards for divisions and C-Suite employees. In addition, the strategy should foster
a healthy , non-blame atmosphere and incorporate anonymous reporting capability.
Long term Strategic plan
 Patient & Family Grievances In order to improve patient loyalty and minimize the possibility of
lawsuits, protocols for tracking and responding to patient and family concerns should be
outlined in the Risk Management Strategy. Answer times, personnel roles and recommended
actions must be expressed and shared.
 Purpose, Goals, & Metrics Risk management plans should specifically identify the intent and
benefits of the health risk management strategy. Clear objectives for the avoidance of
insurance lawsuits, sentinel accidents, close misses and the potential risk expense of the
company should also be well expressed. In addition, the proposal should be comprehensive
and required to report on quantifiable and actionable data.
 Contingency Plans Risk assessment plans will need to provide a contingency strategy for
undesirable system-wide disruptions and catastrophic events such as EHR malfunctioning,
security breaches, and cyber assaults. The strategy has to provide disaster preparedness for
such topics as epidemic outbreaks, long-term lack of control, and terror threats or mass
 Both the short term and long term strategies can be compared to the ASHRM's strategic
plan in that both are mainly focused to improve risk management.
 This is achieved by a summary of both short-term and long-term plans which is to provide
health care risk managers with the resources, knowledge and support to strategically and
broadly manage risk, reduce uncertainty, add value, and advance health and safety.
 Agency for Healthcare Research and Quality [Internet]. National healthcare disparities report
2013. [cited 2016 Jan 15]. Available
from: http://www.ahrq.gov/research/findings/nhqrdr/nhdr13/chap4.html.
 Institute for healthcare improvement [Internet]. Patient safety. [cited 2016 Jan 16]. Available
from: http://www.ihi.org/PatientSafety.
 Risk Management Handbook for Health Care Organizations, accessed on 28th March 2016
from; http://sites.tums.ac.ir/superusers/111/Gallery/20120206075323Rick%20Management.pdf.
 Risk Assessment Tool and Guidance - Health Service Executive. [cited 2016 Mar 28]. Available
from: https://www.hse.ie/eng/about/Who/qualityandpatientsafety/resourcesintelligence/Qualit
 World Health Organization [Internet]. 10 facts on patient safety, 2014. [updated 2014 Jun; cited
2016 Jan 15]. Available from: http://www.who.int/features/factfiles/patient_safety/en/.