Patient Safety Workshop 2: Healthcare risk management ( solid foundations to manage uncertainties that matter ) Workshop resource and reference manual Dr. Luke Feeney
Table of Contents About this manual and our workshop ................................................................................... 3 Workshop outline ................................................................................................................. 3 Activity 1: Setting workshop objectives ................................................................................ 4 A risk management framework ............................................................................................ 5 A risk management process ................................................................................................ 6 Activity 2: Learn by watching - the basics of risk management ............................................ 7 Activity 3: TEAM-based risk identification 1 ......................................................................... 8 Activity 4: TEAM-based risk identification 2 ....................................................................... 10 Activity 5: TEAM-based risk identification 1 - revisited ....................................................... 11 Activity 6: TEAM-based risk estimation .............................................................................. 11 Activity 7: TEAM-based risk evaluation ( Facilitator-led ) ..................................................... 15 Activity 8: TEAM-based risk control ................................................................................... 16 Activity 9: Workshop reflection and commitments .............................................................. 18 Final thoughts .................................................................................................................... 19 References ........................................................................................................................ 20 Appendix A: Risk metalanguage guidance ........................................................................ 21 Appendix B: The PRACT guide to critical control option assessment ................................ 22 Page 2 of 23 LF, July 2017
About this manual and our workshop This workshop resource manual accompanies the HMC Patient Safety Awareness Week practical, facilitator- led “ Healthcare risk management ” workshop. In our workshop today you will work in Teams to practically apply an evidence-based, international risk management framework ( adapted from ISO/IEC, 2011 ) within a healthcare case study context using a selection of evidence-based methodologies (adapted from Hillson, 2010; ISO, 2009; ISO/IEC, 2011; National Patient Safety Agency, 2006 ) to promote/evolve your critical understanding of how risk management can truly be the foundation for effective patient safety. I hope you will also gain "insider" tips and techniques for potentially improving your existing risk management approaches, irrespective of their current frameworks and methodologies. Enjoy! Workshop outline 1. Workshop introduction, context, definitions and why managing risk is one of the most effective, proactive patient safety activiti es you can carry out… 2. An evidence-based risk management process ( step-by-step ) appropriate to meet the 1300 - 1715 ( with a break! ) requirements of a healthcare organisation facilitated through team-based practical hands-on activities, exercises and debate. 3. Workshop review, reflection and close. Please note: Not all of the activities presented in our manual may be completed in our workshop today as it has been designed to be highly practical, participant-centred with critical questioning and debate hugely encouraged! Page 3 of 23 LF, July 2017
Activity 1: Setting workshop objectives This activity is designed to identify what are the workshop objectives of you and your fellow participants ( INDIVIDUAL and TEAM-agreed ). We are “ beginning with the end in mind ”, the 2 nd habit of the “7 Habits of Highly Effective People” according to (Covey, 1989). INDIVIDUALLY reflect and identify what are your objectives for attending our risk management workshop. Share INDIVIDUAL expectations and work together to produce a single, TEAM-agreed objective: [ Please note: Each of TEAM-agreed objective shall be recorded by your facilitator to act as guiding “ performance scoreboard ” for our workshop]. [5 minutes to complete] Page 4 of 23 LF, July 2017
A risk management framework The evidence-base suggest that organisational risk management activities MUST be an integral part of the way that your healthcare organisation delivers its services to the extent that it is embedded in the very values and culture of your organisation - " just the way we do things around here! " (Health Services Executive, 2011; ISO, 2009; National Patient Safety Agency, 2006). The careful implementation of an evidence-based organisational ( enterprise-wide ) risk management framework can embed the key values and principles of risk management throughout your healthcare organisation - from senior management to the “sharp end” - as well as provide the solid foundations for its continuous effectiveness (ISO, 2009). Such a framework is presented in Figure 1 . Figure 1: A best practice risk management framework (Adapted from ISO, 2009) Page 5 of 23 LF, July 2017
A risk management process Implementing risk management, often described as the " risk management process " itself, is a key component of your organisational risk management framework and activities. The risk management process fits into the integrated and inter-dependent risk management framework presented in “ Figure 1 ” as component " 3. Implementation of risk management based on a best practice methodology ". Figure 2 details an evidence-based risk management process component which commences with establishing context, then executing risk assessment ( incorporating risk identification, estimation and evaluation ), identifying and applying risk controls and culminating in ensuring appropriate risk acceptance, with key decision points indicated in the process. The entire process is wrapped in continual monitoring and review to ensure rigor and consistency, with communication and consultation a crucial requirement throughout to ensure the engagement and involvement of/with the key, relevant stakeholders. Figure 2: A best practice risk management process (Adapted from ISO/IEC, 2011) 1. Establish context 2. Risk assessment 2.1 Risk identification Risk communication & consultation Risk monitoring & review 2.2 Risk estimation 2.3 Risk evaluation Decision point #1: NO Assessment satisfactory? YES 3. Risk control NO Decision point #2: Control satisfactory? YES 4. Risk acceptance Page 6 of 23 LF, July 2017
Activity 2: Learn by watching - the basics of risk management Hillson D. (2012), “ Risk management basics: What exactly is it? ” http://www.youtube.com/watch?v=BLAEuVSAlVM&feature=youtube_gdata_player, accessed 24.02.2017. “ The Risk Doctor ” explains how to structure risk processes by asking ( and answering ) six simple questions.… YOUR thoughts, top of mind, as you watch the video : TEAM- agreed key learning: [5 minutes to complete] Page 7 of 23 LF, July 2017
Activity 3: TEAM-based risk identification 1 3.1 Context: Laparoscopic surgery: Laparoscopic or “minimally invasive” surgery is a specialized technique for performing surgery which uses several 0.5cm - 1cm incisions called “port s ” . At each port a tubular instrument known as a “ trocar ” is inserted ( a trocar is a pen-shaped instrument with a sharp triangular point at one end, typically used inside a hollow tube, known as a cannula or sleeve, to create an opening into the body through which the sleeve may be introduced to provide an access port during surgery ). A camera ( laparoscope ) and specialized surgical instruments are then passed through the trocars to facilitate completion of the procedure. The “c losed- entry” ( classic ) laparoscopic technique involves creating a “ pneumoperitoneum ” by inflating the patient’s abdomen with carbon dioxide to create separation between organs as well as increase the internal space available for manipulation of surgical instruments. This “ insufflation ” process is often performed using a Veress needle prior to placement of the primary trocar. The Veress needle is inserted in the umbilical area, in the midsagittal plane, with or without stabilizing or lifting the anterior abdominal wall. Once insufflation is complete and the primary trocar inserted, a laparoscope is introduced and thereafter secondary trocars can be placed under direct laparoscopic observation to minimise risk of injury. 3.2 Identify 3 x risks: Critically consider and debate the risks associated with the “closed - entry” laparoscopic technique described in “ 3.1 Context ” and, as a TEAM , agree and record what you believe to be the TOP THREE (3) highest priority patient safety risks which will need to be addressed to ensure reliable, consistent and safe laparoscopic surgery will take place. Please record your risks in row 3.1A , 3.2A and 3.3A respectively on the next page ( P.9 ). Page 8 of 23 LF, July 2017
TOP THREE (3), TEAM-agreed , highest priority patient safety risks associated with the “closed - entry” laparoscopic technique ( please ensure you record in rows 3.1A , 3.2A and 3.3A only! ) A 3.1. B A 3.2. B A 3.3. B [7 minutes to complete] Page 9 of 23 LF, July 2017
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