long or not being communicated with, to the patient having the wrong operation or
suffering permanent disability or wrongful death. This can be further applied to
health care settings where risk takes several forms, including:
. Patient injury while in the health care organisation's care resulting in extensive
resource utilisation to correct the injury
. Decreased productivity resulting from time and resources spent in clinical
negligence litigation
. Tarnished reputation of health care providers resulting from patient injury
. Clinical liability awards to injured parties and legal costs related to the litigation
process
. Patient unhappiness and dissatisfaction, often due to lack of information and
ineffective communication
. Hidden cost to the people in terms of pain and injury, locum cover costs, stress
suffered by the individual involved and reduction in the quality of care delivery.
The resource costs of replacement, facility downtime and improvements and
the reputation of the professionals, the facilities and the public relations to
improve local and public perceptions.
In each of these we can see elements of financial costs and decreased quality,
which can place providers at a distinct disadvantage within the health care system.
11.7 Risk modification
Modificationis the changing of circumstances, the environment and behaviour
ultimately to lower the potential for and amount of health care risk. The risk
management tools help to identify areas where health care continuous quality
improvements can be made. The result is improved outcomes, patient satisfaction
and the documentation of care delivery. Poor communication between profes-
sionals and with patients is the commonest reason for patients/relatives to make
complaints or even take out litigation in order to acquire the necessary explanation
and information. The Medical Protection Society estimates that in 90% of cases
presented to it over a three year period, failure to communicate featured as a major
component of the case. In addition, Action for Victims of Medical Accidents
9AVMA) estimates that more than 50% of the complaints it receives are due to
communication problems. In order to modify clinical risk and manage it appro-
priately our two best forms of risk prevention are effective communication and
excellent documentation.
Risk management is designing and directing activities that establish the condi-
tions for organisation success within the context of service delivery. Management
should evaluate the effectiveness of clinical practice, patient satisfaction and out-
comes and examine the frequency/severity and defensibility of claims. This does
not mean practising defensive medicine but having the best defensibility in place if
and when things do go wrong. Taken together, these definitions create a broader
interpretation of risk management and begin to present risk solutions ± through
the implementation of risk modification for providers of health care.
230 Nursing Law and Ethics