11.5 Risk management
Risk management is the lynch-pin which pulls together all the different elements of
clinical governance. It also pulls together the accountability frameworks and clear
reporting mechanisms to meet the corporate governance and controls assurance
requirements. The clinical governance framework encompasses all the aspects of
high quality provision such as quality assurance strategies, continuous quality
improvements, clinical effectiveness, clinical audit, risk management and organi-
sational and staff development. Good risk management awareness and practice at
all levels is a critical success factor for any organisation. Risk is inherent in
everything that an organisation does: treating patients, determining service
priorities, managing a project, purchasing new medical equipment, taking
decisions about future strategies, or even deciding not to take any action at all.
Risk management provides the best service for patients through obtaining a
synergy between risk management, quality and the law. It also allows for the
establishment of multidisciplinary standards of care and best practice guidelines
to enhance professional development of nursing and medicine. The changes in
health care delivery, with much higher expectations from patients, greater clarity
of roles and responsibilities of clinicians and the emphasis on devolving decision
making as close to the patient as possible, are meant to affect the entire perfor-
mance of health care delivery. For most senior managers, nurses and doctors, the
environment in which they operate has grown increasingly turbulent and complex
with increasing demands on resources and increases in workload. They must
contend with the more universal issues of monitoring patient activity, quality and
evaluation through clinical audit, cost control, providing accessible and equitable
services with relevance to the local population health care needs and social
acceptability, as well as efficiency and effectiveness ± all while ensuring their
organisations' survival.
The commissioners of health care, on behalf of their clients, look for the best and
most efficient health care delivery systems giving the best value for money by
improving access, equity and quality of care without increasing the cost of services.
To improve value, providers must understand and maximise the linkages between
its two basic components ± cost and quality. Both the cost and quality of care are
components in determining the value of the health care delivered, and both are
elements of health care risk. To begin to manage these elements of risk, the process
of health care risk modification can be applied. The focus of health care risk
modification is intensely on the systems and practices that affect patient care in
order proactively to manage overall cost and appropriateness of care delivered. All
aspects of the system ± physical works, equipment, security, training, manage-
ment, nursing, medicine, allied health professionals, etc. ± have a role in increasing
or modifying health care risk.
11.6 Risk
Risk in its simplest form is the potential for unwanted outcome. This is a very
broad definition which ranges from patient dissatisfaction with having to wait too
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