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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.

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.

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.

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.

The purpose of this study is to improve compliance with clinical risk procedures across a United Kingdom based mental health trust.

A cross‐sectional audit was carried out in April 2010. In total, 70 Risk Assessment Proformas (RAPS) were measured against an agreed “gold‐standard”. The standards were a combination of Department of Health recommendations as well as the current Hertfordshire Partnership NHS Foundation Trust (HPFT) policy on clinical risk assessment.

Only 53 (out of a possible 70) RAPS were completed. The acute and community psychiatric service stream samples on the whole provided more information within their RAPS than other parts of the service. There were overall low levels of documentation regarding service user and carer involvement.

To strengthen the clinical management of risk (and thus reduce harm) in mental health settings a systematic approach to risk assessment should be present. This involves clinicians working in partnership with both service users and carers. Based on the results, more needs to be done to actively involve carers and the service user in formulating the risk management plan. Not only will this promote positive risk management within the organization it will also enable individual “recovery”.

By auditing the organizational processes that underpin the management of risk, deficiencies in clinical care can be identified. Mental Health Trusts can promote positive risk management within their organization by engaging service users and their carers in managing risk.

The current risk management system for community mental health patients in England is based around the Care Programme Approach (CPA). This system is not responsive to changes in risk for community patients. This paper aims to introduce a practical system to manage risk that has been developed for an Early Intervention Service in East London on the basis of need.

Coding of red, amber and green is associated with specific criteria agreed by all disciplines in the team. The change of a code leads to a rapid change in risk level and management. An agreed clinical and non‐clinical action plan leads to a whole team response. The limitation of use is dependent on the size of the case load and the number of clinical staff attending a daily clinical briefing.

Zoning according to the traffic lights system could complement the CPA system and support a clinical governance structure utilising a whole team response.

The risk management system described has not been tested empirically. Currently it has been used in early intervention mental health teams but will need to be adapted for other teams with bigger case loads.

This practical risk management system is aligned with the statuary CPA requirements. A dynamic and flexible management of risk is central to early intervention in psychosis teams but the risk management system described can suit any community mental health team and fits well with the distributed responsibility model of functionalised teams according to new ways of working.

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.

This paper aims to present a systematic literature review (SLR) to investigate how supply chain risk management (SCRM) is applied to the healthcare supply chains and which improvement opportunities are being missed in this segment.

This SLR used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method to answer three research questions: (1) Which are the main gaps concerning healthcare supply chain risk management (HCSCRM)? (2) What is the definition of HCSCRM? and (3) What are the risk management techniques and approaches used in healthcare supply chains?

The authors present a complete summary of the HCSCRM body of research, investigating research strings like clinical engineering and high reliability organizations (HROs) and its relations with HCSCRM; (1) This research revealed the five pillars of HCSCRM; (2) The authors proposed a formal definition for HCSCRM considering all the literature blocks explored and (3) The authors generated a list of risks present in healthcare supply chains resulting from extensive article research.

The authors only reviewed international journal articles (published in the English language), excluding conference papers, dissertations and theses, textbooks, book chapters, unpublished articles and notes. In addition, the study did not thoroughly investigate specific countries' particularities concerning how the healthcare providers are organized.

The contribution of this article is threefold: (1) To the best of authors knowledge, there is no other SLR about HCSCRM published in the scientific literature by the time of realization of authors’ work, suggesting that is the first effort to fulfill this research gap; (2) Following the previous contribution, in this work the authors propose a first formal definition for HCSCRM and (3) The authors analyzed concepts such as clinical engineering and HROs to establish the building blocks of HCSCRM.

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.

The assessment and management of risk towards others is an integral part of clinical practice, particularly in forensic and other psychiatric settings. Version 3 of the HCR-20 is the latest version of a comprehensive set of professional guidelines based on the Structured Professional Judgement model. It is the most widely used and best validated tool available to assess risk of violence; however, clinicians perceive it as an additional task with limited clinical usefulness, which requires undergoing expensive training and takes considerable time to implement. The paper aims to discuss these issues.

Training was delivered to 148 clinicians to improve perceptions with regard to risk formulation and the HCR-20v3 as an effective and clinically useful tool in generating individual and robust care plans to minimise risk of violence.

Results indicated significant score increase post-training, indicating higher regard for the HCR-20 in terms of its usefulness, anticipated impact upon working, anticipated impact upon managing risk, ease of completion and perceived relevance to clinical practice. This was also consistent with qualitative feedback indicating improved risk management and care planning with reference to how learning would support respective roles. Feedback also highlighted the added value of certain aspects of the training provided, which may be useful to consider when designing HCR-20 training packages.

This study demonstrates the importance of engaging clinicians in bespoke training on the practicalities of HCR-20 completion and the fundamentals of risk formulation.

This study highlights the importance of incorporating a training package for staff of all disciplines in changing perceptions of risk management tools and thus their use in the practical management of violence. The useful aspects of training may assist changing perceptions of the role that risk formulation and the HCR-20v3 play in the assessment and management of violence.

This research suggests that if this can be done successfully, it may lead to a change in the perception of the role that the HCR-20v3 can play in assessing risk of violence and generating meaningful management plans to reduce the future likelihood of violence.