standards and legal requirements), ‘What new controls are required to modify the risk?’, − Controls to reduce the severity of consequences, ‘What actions are required to implement the new controls?’, − Action prioritization by considering the criticality of the risks, − Management responsibility for these actions, ‘What are the findings and what lessons are learnt?’, − Limitations and assumptions made in the assessement, − A facilitator who has experience in risk assessment, − A multidisciplinary group of experts in the system to be assessed, ‘What can be learnt from historical data?’, − System diagrams or flow charts for system description, − Peer review and team discussions to improve judgement, − Brainstorming, SWIFT and the Delphi technique to identifiy all risks, − Bow-tie analysis to display the pathway of an event and to examine curent controls, − FMEA to identify the ways failure could occur and the way they could be treated, − Risk matrices to help determine risk tolerability and to allocate resources, − Specific risk assessment forms (e.g. In so doing, hospitals provide risk assessment guidelines and training to support their staff—often frontline and risk management staff—and external authorities support and investigate hospitals to deliver safe care [15, 17–19]. responsibilities for implementation). This paper, therefore, reports the design process for—and content of—a risk assessment framework (RAF). I4 found the framework to be well presented and simple to understand and stated that it could be used as a teaching aid. While the framework was recommended for use in practice, it was also proposed that it be adopted as a training tool. It uses simplified risk terminology to minimize misconceptions and encourages: convening a multidisciplinary team, describing the system to be assessed, defining potential undesired events based on the system description, determining a wide range of contributory factors, considering all potential consequences, determining tolerability of a risks by considering multiple factors and considering control actions to minimize the potential undesired events defined. A rural hospital was anticipating the opening of a new boarding school in its community. 800.241.0142 In addition to the responses of the user evaluation statements, participants provided brief comments on two open-ended questions to improve the initial version of the framework: ‘what is familiar and what is new about the RAF?’ and ‘what changes would you recommend to improve the RAF?’ and were given additional space to add further comments. Part I of this series outlined the power of simple risk assessment to identify, mitigate, and eliminate hazards in the day-to-day operations of a hospital. Is Your Healthcare Team Suffering from Initiative Fatigue? The characteristics of the interview participants for the evaluation. up to a risk score of 9 is generally tolerable) to decide whether or not the risk is tolerable and if there is any need to take any action. Copyright © 2020 International Society for Quality in Health Care and Oxford University Press. Even a good risk assessment does not lead to safe systems if the findings of the risk assessment are not implemented. We conducted multiple group discussions to pilot the framework through the use of a representative scenario and used our findings for the user evaluation. No single method is right for a given event. The second, quantitative technique uses the Council for Sponsoring Organizations (COSO) procedures to assist in the classification of a … This study presented an RAF to guide healthcare staff in undertaking risk assessment. Eliminative, detective and reductive control actions should be listed, 14. There are many risk assessment methodologies that promote thoughtful analysis of safety issues. In: Haskins C, Forsberg K, Krueger M (eds). Thus, a culture of safety is perpetuated and more risks are avoided, leading to higher levels of safety over time. Bow-Tie Analysis is one of many effective tools for communicating risk assessment. Committee of Sponsoring Organisations of the Treadway Commission; Oxford University Press is a department of the University of Oxford. The characteristics of the participants in the user needs interview. A number of studies have been published, such as in relation to safety culture  and the reduction of harm [5–8]. Interview questions were developed based on the literature findings, with further input from the research team and were then piloted with a healthcare researcher. However, it should also be noted that identifying many risks does not necessarily lead to better risk controls . For example, I10 stated, ‘The general framework is familiar. Simple risk assessment begins with the identification of a risk, either directly through adverse event reports, employee injuries, sentinel event alerts, or indirectly through patient satisfaction feedback or comments from staff at departmental meetings. One way to address current challenges is through providing good guidance on the fundamental aspects of risk assessment.
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