Aim of programme

2. Aim of programme • to apply the principles of risk management to practical situations and relate these to personal experiences • to improve the quality of care by implementing initiatives to remedy deficiencies in the service provided.

3. Harvard Medical Practice StudyNew England Journal of Medicine 1991 • 3.7% patients suffered an adverse event • Of these 13% died • 58% events related to system errors

5. Summary of New Complaints Procedure (1998, 9/12 period)MDU experience • Failure or delay in diagnosis most common reason (28%) • 24% of complaints made after bereavement • Non-clinical issues accounted for 34% of complaints • 10% of complaints related to attitude • 93% settled at L.R.

6. MDU Settled Claims Against UK GPs • Failure to diagnose - 51% • Medication error - 26% • Pregnancy including labour - 13% • Minor surgical procedure - 7% • Other - 3%

7. MDU Claims Settled • Quality of medical care - 7% • Medical record issues - 60% • System failures- 33%

8. MDU complaints study 1999 • 33% complaints were due to failures in systems, procedures and communication e.g. • rudeness/attitude staff or doctor • administration problems • prescription problems • communication

9. Clinical Governance • Clinical risk management • Complaints procedures • Adverse incident reporting • Clinical audit • Evidence- based practice • Whistle blowing • Performance review

10. RISK MANAGEMENT • A careful examination of what • could cause harm • its significance and • what precautions are needed to eliminate the risk or reduce it to an acceptable level

11. Risk Management Benefits • for patients • improved quality of care and service • enhanced patient safety • confidence in the service • for health care professionals • protection of confidence and reputation • quality procedures and staff involvement • decreased numbers of complaints and claims

12. The four principles of risk management • Identify the risks – what’s likely to go wrong? • Assess the risk – what are the chances of it going wrong, what could happen, does it matter? • Reduce/eliminate the risk – what can you do about it • Cost the risk – what are the costs of getting it right v. the cost of getting it wrong?

13. Risk Management Techniques • Complaint handling • Risk assessment • Staff awareness/training • Protocol and guidelines monitoring • Good medical records • Adverse incident reporting

14. Risk Areas • Staff - especially locums • Organisation • adequate staffing • regular guideline review • Communication • Consent • Record keeping

15. Clip 2 – Morning Surgery Identified Risks • Breaches of confidentiality – front desk/reception area etc. • Health and safety issue. • Lack of systems. • Phone call interruptions. • Verbal requirements regarding nurse visit. • Inappropriate roll/responsibilities of receptionist. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

16. Clip 3 – Test Result / Minor Surgery Identified Risks • Dealing with smear results. • Aseptic techniques. • Lack of chaperones. • Unreasonable patient request. • Lack of informed consent. • Disposal of clinical waste/needles. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

17. Clip 4 – Home Visit Identified Risks • Examination. • Response to collapsed patient. • Communication regarding hospital admission. • Communication with mother. • Dealing with request for repeat prescription. • Dealing with aggressive patient. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

18. Aims of Assessment • Improve patient care • Ensure safe standards of practice • Ensure patient/staff safety and well being • Decrease the number of complaints and claims • Lessen the stress associated with litigation

19. The MDU’s risk management pack Part one - Communication How to use it

20. Each part contains: • Case history examples • Checklist • Reference sections • Action plan • Score/evaluation sheet

21. How to complete • Team approach • set aside protected time • read questions and reference section • undertake the review (‘yes’ or ‘no’ answers) • consider action needed • complete action plan • complete the anonymised answer sheet • return sheet to PCG offices

22. Scoring system • Yes - undertaking the activity • No - area needs review • Score 3 = essential • Score 2 = important • Score 1 = good practice