Risk management is the system identification, assessment and reduction of risks
to patients and staff:
. through providing appropriate, effective and efficient levels of patient care
. prevention and avoidance of untoward incidents and events
. learning the lessons and changing behaviour/practices as a result of near
misses, incidents and adverse outcomes
. communication and documentation of care in a comprehensive, objective,
consistent and accurate way.
11.8 Controls assurance
Controls assurance [6] is a system of management which is fundamental to gov-
ernance in the NHS. It exists to inform NHS boards about significant risks within
the organisation for which they are responsible. It is intended to assist NHS staff,
including chief executives and board members, to identify risks, to help them
determine unacceptable levels of risk, and to then decide on where best to direct
limited resources to eliminate or reduce those risks. One of the fundamental
assumptions of controls assurance is that all statutory and mandatory require-
ments with which NHS organisations need to comply represent a risk of some sort.
That is, these requirements exist because they are designed to control a risk that
could threaten the organisation, the people, or the environment. Similarly, best
practice or good practice guidance exists to advise on accepted, although not
always evidence based', options for dealing with potential risks. Thusnon-
compliance' with standards and risk' are synonymous in the context of controls assurance. Controls assurance has a large part to play in meeting the governance and risk management agendas and is being implemented using the Australian and New Zealand risk standards, through a self-assessment process to allow Trusts to prioritise and assess the severity of their own risk exposure. Controls assurance is aholistic concept based on best governance practice which conforms with the Combined Code of Practice on Corporate Governance. It is a process designed to provide evidence that NHS organisations are doing theirreasonable best' to
manage themselves so as to meet their objectives and protect patients, staff, the
public and other stakeholders against risks of all kinds.
Fundamental to the process is the effective involvement of people and functions
within the organisation through the application of the self-assessment techniques
to ensure objectives are met and risks are properly controlled. Risk management
and internal control are firmly linked with the ability of an organisation to fulfil
clear objectives.
11.9 Developing best clinical practice
In order to establish best clinical, and in time, evidence based practice, health care
practitioners should identify areas in the practice from which clear clinical
Clinical Governance 231