Accidents waiting to happen
12 June 1994
NHS risk management is often more concerned with budgets than clinical risks to patients. Arnold Simanowitz reports
When risk management consultants, involved in the NHS, talk about risk management they invariably mean risk to the hospital or trust. The driving force behind the development of the practice, which started many years ago in the US, was the need to reduce the escalating cost of accidents incurred by these institutions.
Although those concerned with medical negligence will always think in terms of clinical risk, the fact is that such risk forms only a small part of the concerns of the industry.
For example the Risk Management manual, published by the National Health Service Medical Executive (now the National Health Service Executive), contains only 18 out of 130 pages on clinical risk. Similarly the main interest of the health sector of the Institute of Risk Management is not the disastrous effects on patients of medical accidents, but the safety at work of employees.
Until recently, the risk manager at many hospitals was the fire officer or similar.
Furthermore, even when the interests of patients are considered, there is much confusion even among experts, between risk management and claims management.
A conference on risk management held recently was introduced with the words: "This seminar focuses on the chief problems that plaintiff patients have encountered in legal actions... and addresses the contribution that risk management and communication strategies can make to help avoid expensive healthcare litigation."
This is clearly a contradiction in terms. As far as clinical risk is concerned, risk management is, or should be, aimed at helping to avoid the incident which leads to litigation, not dealing with the problems that arise in legal actions. The latter is the province of claims management. This blurring of the boundaries has great potential dangers for patients.
While some aspects of claims management could help patients by settling valid claims expeditiously, budget considerations could equally convince a trust that delay in the settlement of a large claim is also efficient claims management.
Accordingly, the ethic of claims management which dictates that such management is essentially devoted to the interests of the trust, will help to reinforce the attitude referred to above, that risk management is similarly oriented.
Unlike risk managers, when patients and their representatives talk about risk management they always mean risk to the patient. However, while the motive for the introduction of risk management may, in most cases, be simply financial, nevertheless the effect can benefit patients. There is a great identity of interest between risk managers on the one hand and those concerned for victims of medical accidents on the other.
It is for this reason that Action for Victims of Medical Accidents (AVMA) is becoming increasingly involved with risk management.
We consider that it is essential in an area as important as this that the patients' perspective is kept continually at the forefront of the issue rather than constituting a spin-off of the procedures.
However, in the light of AVMA's experience of over 17,000 accidents and complaints about clinical treatment, we are in a unique position to help risk managers in hospitals to identify the treatment and behaviour that can be the catalyst of litigation.
There are two areas where this applies. The first is in relation to avoidance of accidents. Risk managers can analyse the accidents which have occurred in their hospitals in the past, as well as monitoring those that are now taking place, and thereby identify the steps which they can take to avoid the same accidents in the future; this is the essence of good risk management.
AVMA can, however, identify from its files the causes of accidents over a much wider spectrum.
The second area is perhaps more important because, while the trusts do have considerable information on accidents, they do not have the information that AVMA has, which can demonstrate innumerable situations in which the poor handling of complaints can lead to unnecessary litigation. AVMA is therefore well-placed to teach those in hospitals responsible for dealing with complaints how to do so properly. This is an essential part of true risk management and can create more patient satisfaction as well as saving considerable sums for the hospitals.
Fortunately this has been recognised by many managers and AVMA is co-operating with the Institute of Health Service Managers in the training of complaints officers.
There is thus a clear role for AVMA, as representatives of victims of medical accidents, to ensure that risk management is conducted for the benefit of patients as well as the trusts. Risk management is too important to be left to risk management consultants, hospital managers and their lawyers.
Arnold Simanowitz is executive director of AVMA.