CLINICAL RISK MANAGEMENT PLAN

Clinical Risk Management Plan



Clinical Risk Management Plan

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Introduction

Patient safety is identified as an important issue, particularly in view of the changing nature of health service delivery (Chassin 2000; DoH 2000:88; Institute of Medicine 2003b: 146; ACSQHC 2005b: 179). Over the last decade, there has been a shift away from acute care to community based service provision, delivered by complex teams of health professionals. This has demanded increased collaboration between the public and private sectors and changes in the accountability structures for service delivery (Auditor-General Victoria 2004: 156; DTF 2007: 121). This increasing integration of care has demonstrated benefits for patients including enhanced continuity of care, opportunities for self management and improved clinical outcomes (VQC 2003: 24; NSW Health 2005: 45). Benefits for the health sector are also identified; more efficient and appropriate service coordination, increased service capacity, effective utilisation of finite resources and opportunities to enhance preventative and early intervention strategies (NSW Health 1999; DTF 2007: 177). In the view of anticipated demographic changes1, developments in medical technology and service delivery, the complexities of health care are set to increase (Institute of Medicine 2001: 105; ACSQHC 2003b: 121). Subsequently, tensions will remain between the demand for service and organisation's capacity to provide safe, quality treatment (ACSQHC 2005a). This evolving culture of health care has a significant impact on the risks associated with service delivery. The understanding and management of these risks, requires a coordinated and thoughtful response (Moore et al. 2003; DTF 2007: 59). Clinical Risk is defined as “risks to the client during a course of care or treatment provided by a health service” (VHA 2008). The emphasis is on risk to the client and it is distinguished from others such as Occupational Health and Safety Risk or Corporate Risk. Clinical risk is an unavoidable part of health care (BMA 2002: 8; DoH 2003: 15; WA DOH 2005: 19). The complexity of service provision guarantees that adverse events inevitably occur across all health services (Institute of Medicine 2000; DTF 2007). The causes of clinical incidents however, remain contentious. It is acknowledged that adverse events can occur as a result of clinical decisions, procedures, systems or treatments (e.g. medication side effects, delayed or ineffective care and diagnostic errors) (Institute of Medicine 2001:105). While some studies report human error as the leading cause, others identify that errors most commonly occur as a result of deficiencies in the organisational systems and structures including insufficient governance arrangements, staffing and lack of resources (DoH 2000; Institute of Medicine 2000; Misson 2001; ACSQHC 2005a: 41; VMIA 2008b: 11)

The implications of clinical errors are widespread. The potential morbidity and mortality for individuals is clear. Among other outcomes, the associated loss of trust or confidence in the health sector and reduced patient satisfaction also need to be considered (Chassin 2000; Institute of Medicine 2000; Vincent and Coulter 2002:26). Clinical errors impact negatively on health professionals, health services and the broader community with substantial financial costs, reduced productivity and increased demand on health and community ...