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Adapting organisational behaviour to safeguard against the threat of
corporate manslaughter
Stuart Emslie BSc MSc CEng MIHM FIOSH
Healthcare Governance director & Visiting Fellow, Loughborough University Business School
Former Department of Health Head of Controls Assurance for the NHS in England
Outline…..
Ensuring compliance and implementing safeguards to minimise the risk of corporate manslaughter cases
Evaluating services and processes to reduce systemic risks Providing effective risk management training to engage all staff in
their responsibilities Promoting good management and the flow of decisions into policy Balancing the need to rewrite policies and procedures with day-to-
day compliance Managing financial constraints and associated risks to sustain Act
requirements in the long term
1992: Compliance with Health & Safety Laws & Regulations
Around 500 safety related statutes in UK Approximately 60 of day-to-day concern >100 authoritative codes of practice
Safecode…….
Issued to all UK NHS organisations 1994
Audit compliance against 60 key H&S statutes
Comprehensive module for setting investment priorities for safety/risk management
1994
38 pages…..
1999 Controls assurance H&S standard
www.cascara.co.uk
2004 Standards for better health
“While Standards for Better Health will synthesise a large number of existing rules and guidance, NHS bodies will continue to be subject to the wider regulatory framework, such as health and safety legislation.”
Organisational behaviour – a function of organisational systems
Systems make things happen – people make it work
Adapting organisational behaviour to safeguard against the threat of
corporate manslaughter
BSAQ Strategic Score
1.0.9.8.7.6.5
Su
rplu
s (£
mill
ion
)
10
8
6
4
2
0
-2
-4
r=.73, p<.001
BSAQ Political Score
.9.8.7.6.5
Qu
alit
y o
f w
ork
-life
ba
lan
ce3.7
3.6
3.5
3.4
3.3
3.2
BSAQ Political Score
.9.8.7.6.5
Po
sitiv
e f
ee
ling
with
org
an
isa
tion
3.8
3.6
3.4
3.2
3.0
2.8
2.6
BSAQ Political Score
.9.8.7.6.5
Job
sa
tisfa
ctio
n
3.7
3.6
3.5
3.4
3.3
3.2
BSAQ Political Score
.9.8.7.6.5
Inte
ntio
n t
o le
ave
job
3.0
2.9
2.8
2.7
2.6
2.5
2.4
2.3
2.2
Quality of job design (r=.59)
Job satisfaction (r=.53) Intention to leave job (r=.53)
Positive feeling with organisation (r=.62)
Norfolk and Norwich University Hospital NHS Trust
Male, mid-forties dies due to air embolism during routine cardiac angiogram
Injected with air rather than radio-opaque fluid
No ‘safety check’ carried out Trust successfully prosecuted
under Health and Safety at Work etc. Act 1974 for not having a ‘safe system of work’
Poor management…….
The Scotsman 14 October 2007 - http://news.scotsman.com/index.cfm?id=1641252007
‘UK: blunders by doctors kill 40,000 a year’Sunday Times, 19 Dec 1999
“Medical error is the third most frequent cause of death in Britain after cancer and heart disease…….kills four times more people than die from all other types of accidents.”
NB – USA approx. 98,000/year; Australia approx. 10,000/year
Failure Mode and Effects Analysis
FMEAHFMEATM
SFMEA
Failure Mode and Effect AnalysisFailure Modes and Effects Analysis
FMEA Steps…
1. Select a process (topic)2. Assemble your team3. Describe the process steps4. Identify the ways in which each process step can fail (failure
modes – e.g. drug maladministration; performing wrong site surgery; clinical mis-diagnosis; etc.)
5. Identify the root cause(s) of failure (Why?)6. Identify the most likely effect(s) (i.e. consequence of failure) of
each identified failure mode7. Assess risk associated with each failure mode (consequence and
likelihood – from risk matrix)8. Identify additional controls required (actions to effect
improvement)9. Implement additional controls10. Test process improvements
1
2a
2b
4b3b
3c
5
4a
3a
Ten steps to compliance?
1. Ensure that you have in place an effective health and safety/risk management system, e.g. see OHSAS 180001:2007; HSG 65, Successful Health and Safety Management (HSE); AS/NZS 4360:2004 risk management (See also IoD/HSE guidance).
2. As part of the management system, ensure that a robust health and safety policy is in place. Within that policy all health and safety roles and responsibilities should be articulated.
3. Job descriptions of staff should reflect their role in health and safety management, particularly at a senior level.
4. Senior managers should be trained to ensure they understand their role in the effective management of health and safety. Reflect upon the competencies of existing senior managers with respect to health and safety management. Provide additional developmental opportunities to address any deficiencies.
5. Line managers should receive training to enable them to manage health and safety within the part of the organisation for which they are responsible.
Adapted from Local Government Employers - www.lge.gov.uk
Ten steps to compliance?…..cont…
6. Board members should receive awareness training on their role and responsibilities within the health and safety system. This is particularly important for non-executive directors. To help ensure adequate representation of health and safety issues, consider designating an executive director with responsibility for the management of health and safety.
7. Ensure that health and safety performance, including compliance with health and safety legislation, is regularly considered at board level. Remember that health and safety law applies to everyone, including patients!
8. Mainstream health and safety into decision-making processes and ensure proper scrutiny of the health and safety implications of policy decisions.
9. Ensure health and safety (including patient safety) is firmly part of an integrated approach to risk management across the organisation.
10. Adopt a robust and transparent approach to prioritising investment in improving the management of health and safety and other risks.
Adapted from Local Government Employers - www.lge.gov.uk
