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Dear Colleagues,I would like to share this Topic (RISK MANAGEMENT) with you..I have presented in one of the Khartoum congresses few years ago. It may be of value for some of you mainly those taking their second part exam or those providing save women health services


  • 1. Risk ManagementAwareness Raising Dr.Ahmed Eltigani Elmahdi Hussain Consultant Obstetrician&Gynaecologist Cavan General Hospital, IRELAND

2. Risk Management who does it?

  • Nuclear Industry
  • Aircraft Industry
  • Chemical Industry
  • Oil and Gas Industry
  • Transport Sector
  • Finance Sector

3. Why do these industries prioritise Risk Management?

  • because they are all high risk industries and any breach of safety has far reaching consequences in terms of:
    • Their employees
    • The general public
    • The environment
    • Their reputation
    • Their survival and profits

4. Risk Managent Definitions The culture, processes and structures that aredirected towards the effective management of potential opportunities and adverse eventsSource: AS/NZS 4360 :1999 R M Standard The process wherebye an organisation anticipates the potential for injuries or losses and acts to avoid thoseinjuries before and/or to ameliorate them after they occurSource: R M in Health Care Dr. G. Roberts 5. Risk Management - Process The systemic appllication of management policies,procedures and practices to the task of establishing the context, identifying, analysing, evaluating, treating, monitoring and communicating riskSource: AS/NZS 4360 : 1999 R M tandard 6. Is there any evidence that we should do it in Healthcare?

    • Beverley Allitt
    • Bristol Inquiry
    • Dr.Shipman
    • Blood Transfusion Services Board
    • Organ Retention
    • McColgan Child Abuse Inquiry
    • Dr. Neary


  • In the period from 1991 to 1995 between 30 and 35 children under 1 died after open-heart heart surgery in the Bristol Royal Infirmary


  • Dr Shipman Family GP had become the focus of Europe's biggest ever murder investigation
  • Convicted of 15 murders, suspected of killing more than 297 patients over 24 years.

9. Health Care is a risky business for patients

    • Harvard Medical Practice Study, 1991
      • 3.70% of hospital admissions lead to adverse events
      • 1.85% of hospital admissions lead to avoidable adverse events
      • 0.50% of hospital admissions lead to adverse events resulting in death
      • corresponds to 120,000 avoidable deaths p.a. in USA
      • (correspondsto approx. 170,000 avoidable deaths p.a. in Europe)
    • Quality in Australian Healthcare Study, 1995
      • adverse event rates of 14-16%
      • 98,000 avoidable deaths p.a.
    • University College London, 1999
      • UK8-10%
      • Medical error kills >40,000 p.a. in the UK and is the third most likely cause of death after cancer and heart disease (Vincent et al)


    • Vincent et al, 2001
      • Retrospective review of 1.014 records in London.
      • 10.8% had an adverse effect (half preventable)
    • Building a Safer NHS, 2001
      • Study of 6,500 cases of adverse events
      • 87 deaths
      • 345 serious injuries.
      • Included hospital acquired infections

Health Care is a Risky Business for Patients 11. How often do errors in care occur?

  • United Kingdom: 10-11%
  • New Zealand: 10%
  • Denmark: 11%
  • Australia (latest): 11%

Around one in ten hospitalised patientssuffer an adverse event 12. Prescribing Errors

  • In 2000, an estimated 1,200 people in England & Wales died as a direct result of medication prescribed
  • (Audit Commission 2001 )
  • Out of 193 claims, 19.3% were caused by prescribing errors.
  • (MPS 2000)

13. Why is Risk Management an issue in Healthcare?

  • US - Medication errors cost 5-10% of healthcare budgets to remedy
  • NHS - Excess bed occupancy due to medical error costs 750m pa
  • NHS - Hospital acquired infections costs 1b pa
  • NHS - Excess nursing absenteeism costs 200 - 400m pa
  • NHS - 500k accidents to visitors and staff in hospitals costs 154m pa
  • US - For every $1 cost of iatrogenic disease in the acute sector $1 isincurred in the community
  • 1 acute patient in 1000 will die of a hospital acquired infection ie 15% -30% of which are preventable
  • 1 acute patient in 100 will die of a pulmonary embolusie 50% - 100% of which are preventable

14. Why is Risk Management an issue in Healthcare? cont

  • Health Care is a Risky Business
  • for staff
  • UK Health and Safety Commission, 1999:
    • Average days lost per worker per annum due to work related illness
    • Armed Forces 0.30
    • Construction 2.18
    • Coal Mining 2.35
    • Nursing 2.74
    • Average for all occupations 0.71

15. Why is Risk Management an issue in Healthcare? cont

  • Health Care is a Risky Business -for staff
    • Sickness absence in theUK NHS costs 700m p.a. Sickness absence rates of 5% compare to a national average of 3.7%representing 200m p.a. excess sickness absence for healthcare workers. (Williams, Mitchie, Pattani, 1998)
  • And its costlywherever you work.
    • There are 9000 to 9500 work related compensation claims in the Irish courts each year (Byrne, 2001)

16. Why is Risk Management an issue in Healthcare? cont

  • Healthcare is a stressful business.
    • 46% of nurses feel unsafe at work and 17% perceive excess stress and insufficient support
    • (Zurich Municipal/Glasgow Caledonian University, 1999)
    • 30% of medical students suffer stress related disorders and 10% suffer mental illness (Wrate, 1999)
    • 66% of doctors use alcohol to relieve stress, 40% feel negative affect toward patients (Firth-Cozens, 1999)
    • public scrutiny and expectations of healthcare workers increases vulnerability to stress (James, 1999)

17. Clinical care The environment of care Financial resources CLINICALGOVERNANCE ORGANISATIONAL CONTROLS FINANCIAL CONTROLS Health & Safety Human Resources Integrated Care Due Diligence Risk Strategy Quality Reviews Risk Reviews Clinical Audit Practice Developments Claims Management Education & training Performance Management Re-engineering of Systems Service Continuity Planning Healthcare Risk Management 18. The keys to making Risk Management work

  • Context
  • Culture
  • Risk Management Systems

19. Establish Context Identify Risks Analyse Risks Treat Risks MON I TOREvaluate Risks The Context The Risk Management Process AS/NZS 4360:1999 Risk Management Standard COMMUNI CATE 20. Stop it Accident Incident Investigation Task Person Discipline them Past Approach:Person centred investigations Situation ?????? 21. Why a systems approach?

  • Person approach
  • Who can we blame?
  • Doesnt get to the bottom of the problem
  • Discourages reporting
  • System Approach
  • What can we learn?
  • Looks at individuals as just one component of event
  • Analyses all factors & how they interact
  • Individuals are fallable
  • Errors are inevitable
  • Not who made the error but why did the defense systems fail?

22. DefenceBarriers J. Reason 1994 Case Analysis Using Reasons Statistical failures in defences Organisational Accident Causation Model 23. J. Reason 1994 Case Analysis Using Reasons Organisational Accident Causation Model Statistical failures in defences Situation Task Errors Violations CorporateCulture Managementdecisionsandorganisationalprocesses Local climate Error- producingconditions Violation- producing conditions DefenceBarriers Latent failures in defences 24. Focus on process not individual People and perfect processes make a q

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