nan Ward

Trust-level risk identification guidance in the NHS East of England.

BACKGROUND In healthcare, a range of methods are used to improve patient safety through risk identification within the scope of risk management. However, there is no evidence determining what trust-level guidance exists to support risk identification in healthcare organisations. This study therefore aimed to determine such methods through the content analysis of trust-level risk management documents. METHOD Through Freedom of Information Act, risk management documents were requested from each acute, mental health and ambulance trust in the East of England region of NHS for content analysis. Received documents were also compared with guidance from other safety-critical industries to capture differences between the documents from those industries, and learning points to the healthcare field. RESULTS A total of forty-eight documents were received from twenty-one trusts. Incident reporting was found as the main method for risk identification. The documents provided insufficient support for the use of prospective risk identification methods, such as Prospective Hazard Analysis (PHA) methods, while the guidance from other industries extensively promoted such methods. CONCLUSION The documents provided significant insight into prescribed risk identification practice in the chosen region. Based on the content analysis and guidance from other safety-critical industries, a number of recommendations were made; such as introducing the use of PHA methods in the creation and revision of risk management documents, and providing individual guidance on risk identification to promote patient safety further.

A framework to support risk assessment in hospitals.

Abstract Quality problem or issue A number of challenges have been identified with current risk assessment practice in hospitals, including: a lack of consultation with a sufficiently wide group of stakeholders; a lack of consistency and transparency; and insufficient risk assessment guidance. Consequently, risk assessment may not be fully effective as a means to ensure safety. Initial assessment We used a V system developmental model, in conjunction with mixed methods, including interviews and document analysis to identify user needs and requirements. Choice of solution One way to address current challenges is through providing good guidance on the fundamental aspects of risk assessment. We designed a risk assessment framework, comprising: a risk assessment model that depicts the main risk assessment steps; risk assessment explanation cards that provide prompts to help apply each step; and a risk assessment form that helps to systematize the risk assessment and document the findings. Implementation We conducted multiple group discussions to pilot the framework through the use of a representative scenario and used our findings for the user evaluation. Evaluation User evaluation was conducted with 10 participants through interviews and showed promising results. Lessons learned While the framework was recommended for use in practice, it was also proposed that it be adopted as a training tool. With its use in risk assessment, we anticipate that risk assessments would lead to more effective decisions being made and more appropriate actions being taken to minimize risks. Consequently, the quality and safety of care delivered could be improved.

Barriers to design in healthcare

Background Health advisory bodies have suggested that external disciplines such as engineering and design, with their creative, structured approaches to user-focused problem solving, may contribute useful tools and techniques to healthcare service designers. However if external disciplines are to add value to healthcare systems, they need an understanding of current service design practice, and of the environment in which healthcare service designers operate. Method In this ongoing study, using a grounded theory approach, data were collected from 20 anonymous participants connected to a UK NHS hospital. Semi-structured interviews were used to gather information on current design practice within 79 change projects, focusing on requirements elicitation. Open coding produced over 400 codes, organised under four main categories: Projects, Requirements Process, Design Methods (including tools and techniques), and Stakeholders. Via further analysis using theoretical memos and axial coding, the topic of barriers to effective design emerged as a strong theme that is discussed further in this paper. Results Pragmatic barriers to the effective use of design include issues such as high impact of change, difficulties engaging stakeholders in design activities, cultural and behavioural differences, and problems with inherited systems. Such barriers reflect the highly complex nature of healthcare. Staff adopted a variety of approaches to help resolve complexity, but negative emotional reactions to the use of design methods themselves invite further investigation into whether their cause is the tools themselves, the types of projects they are used in, or the conditions in which they are used. Conclusion This paper concludes that if design thinking is to become more prevalent in healthcare, there is a need for more awareness of, and investigation into, the interplay between pragmatic and emotional barriers to design.