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While there is debate about the extent to which patients are harmed when they are cared for in hospital, it is clear that admission as an inpatient is not without risk. This paper presents works on the progress to date with identifying what these risks are and quantifying the likelihood and severity of the risk. The clinical risk profiling tool that has been developed as part of this exercise has assisted with the identification and prioritisation of clinical risks and is the first step in risk reduction and elimination.

Aims to identify awareness of and involvement in risk assessments, training, incident reporting, information giving and consenting in an acute health care context. Explores how nurse managers perceived risk management as a concept and if they saw advanced neonatal nurse practitioners having a role to play in this activity. The method used was a postal survey of 62 nurse managers or clinical specialists responsible for neonatal nursing care services within NHS Trusts in the UK. Results show that while the nurse managers studies understood the definition of risk management in general, they were more vague about certain aspects of that definition. The nurse managers appeared to be passive in their dissemination and taking forward of risk management strategies, rather than proactively “promoting and helping them forward” as may be expected in facilitative managerial behaviour. Concludes that the challenges of clinical governance demand more proactive approaches to effect and demonstrate change, and support ongoing clinical quality improvements.

Recent criticism of some aspects of current practice within the NHS has placed the role of clinical audit increasingly under the spotlight. In a recent publication, the National Institute for Clinical Excellence states that “the time has come for everyone in the NHS to take clinical audit very seriously”. This article considers the intimate link between clinical audit and clinical governance, a philosophy that has not yet been universally adopted. It describes the key principles of risk management within the context of clinical audit, and examines the audit burden imposed on primary and secondary care by assessors, National Service Frameworks and regulatory bodies. It discusses the challenges risk managers face in adopting a systematic review of care that seeks to avoid harm to patients, while improving outcomes and care standards.

Risk management is becoming an increasingly important topic in healthcare. The dangers of conducting clinical trials were brought to the attention of the public by the media in 2006 with the TGN1412 phase 1 clinical trial. Clinical trials are however important for the development of new drugs. There are a number of gatekeepers for the safety of trials but risk assessment is now becoming an important aspect. This paper aims to focus on clinical trials.

A new risk assessment tool was developed to collect data relating to the contributory factors and control measures associated with clinical trials. The responses to a series of 29 questions are then scored to inform a risk rating for the clinical trial

The theoretical model was converted into a Microsoft Excel spreadsheet with drop down boxes for the responses to the questions. Research management staff have found the tool simple and quick to use. A printout of the assessment can be placed in the study folder as evidence. Highlighted risks are then flagged up to the organisation's corporate risk register and an action plan developed.

The tool has been utilised to assess risks of all research projects from educational studies such as MSc, PhD to medical device trials and drug trials. Furthermore it has assessed risks in the acute, primary care and mental health sectors.

The England and Wales National Health Service (NHS) Executive's guidance on the discharge of mentally disordered people, including those with learning disabilities, requires that risk assessment is a component part of the Care Programme Approach (CPA). The guidance indicates that whenever possible, risk assessments should be carried out systematically using a standardised approach. For a number of reasons, practitioners are resistant to moving away from reliance on clinical judgements when making their assessments. This paper explores the issues underlying this tension. A solution is offered to the difficulty clinicians often experience in incorporating risk assessment tools into their clinical practice. A case example is given to illustrate how clinical assessments of offenders with learning disabilities can be utilised to estimate the risks presented. By demonstrating this procedure, a protocol for reaching clinically defensible decisions about the risks presented by clients is described, which also allows for the targeting of priority therapeutic and management interventions.

To improve the performance both in terms of patient safety and quality of treatments, this research studies one of the most delicate processes of health organizations, that is to say, the clinical risk management in maternal and child pathway. This paper aims to analyze the accidents that occurred in a complex health facility through the standard mapping of this pathway included in the CartoRisk, i.e. a risk assessment tool for the a priori analysis.

The research uses the case study methodology, as it explores a complex process in which a lot of variables and actors are involved. It analyzes the accidents occurred in the largest health facility at national and European level.

After a presentation of the regulatory framework and the studied health organization, the research analyzes the accidents occurred in maternal and child pathway from 2014 to 2018. It showed the main risks according to the standard mapping of the maternal and child pathway. Furthermore, it identified 11 new risks mainly associated with physiologic birth and Caesarean birth.

This study presents the regulatory framework, the health facility and the accidents of a health organization. Moreover, besides the accident analysis, the research integrates further risks into the standard mapping adopted to carry out this study and proposes a risk management approach. Therefore, the value of the research for operators will consist of the integration of the standard mapping used for a priori analysis to be reused in the hospitals where they work, while for researchers it will represent a deep knowledge of a real case.

This critical review considers the limitations and advantages of the clinical, actuarial and structured clinical judgement approaches as they are applied to the assessment of risk in general and sex‐offenders in particular. It concludes by endorsing an inclusive approach, acknowledging that a central ethic of clinical practice is that it should be based on a current knowledge of the research literature (Singer, cited in Douglas et al. 1999).

Risk assessment is a fundamental part of clinical practice in mental health and learning disability services in the UK. Most services use a tool or framework to structure their clinical judgments, but there does not appear to be a consensus on which risk assessment tool should be used. This paper aims to describe the development, implementation and evaluation of an evidence-based formulation informed risk management (FIRM) framework in mental health and LD services.

The development of FIRM and evaluation was based on the model for improvement, with an emphasis on co-production broken down into three distinct yet interdependent phases of co-production: co-design, co-create and co-deliver. Following the implementation of the FIRM framework, a post-implementation survey was distributed to a sample of clinical staff to capture experiences in the first three months post-implementation.

The three co-production stages were pivotal for successful implementation in clinical practice. The key ingredients for success seemed to be acknowledging human factors and varied responses to change, communication, engagement and involvement of stakeholders. Early evaluation post-implementation demonstrated the benefits in terms of confidence in use, formulation of risk, risk management and communication. Further quality improvement initiatives are underway to evaluate impact up to 12 months post-implementation and to improve the quality of FIRM in practice. Future research is planned to look at enhancing personalised risk assessment and management.

This paper describes and demonstrates the value of co-production with clinicians and stakeholders in service development. The FIRM has improved the clinical practice of risk assessment, formulation and management and use of digital technology.

This paper outlines the process and context in which the Clinical Risk Modification Project at Sligo Hospital, Ireland was established and focuses on the issues encountered from conception to implementation. The project is based in the emergency and orthopaedic departments and is of two years duration. The stated aim of this project is to design and test a framework incorporating the core components of a workable Clinical Risk Modification programme in the context of an Irish general hospital. This involved making an explicit commitment to the principles of a learning organisation including blame free risk reporting, providing education and awareness training to promote understanding of clinical risk management locally, and developing a clinical incident/near miss reporting system to address clinical risk in both a proactive and reactive way.

States that risk and risk management in general practice in the UK are now integral parts of the clinical effectiveness and clinical governance agenda, rather than being primarily concerned with negligence and malpractice. Notes that this has led to the introduction of a variety of technologies for improving care and thus reducing risk. Considers the frequency, nature and causes of adverse incidents in general practice, and the rise of evidence‐based practice and clinical practice guidelines, and then looks at some of those technologies currently in use. Concludes that technology seems to have a growing impact on the practice of primary care medicine and the management of clinical risk.