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Implementing Enterprise Risk Management across NHG. Designated Risk Lead Training 8 February 2010 Stuart Emslie, UK. Stuart Emslie BSc(Hons) MSc CEng FIHM MIMechE. - PowerPoint PPT Presentation
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Implementing Enterprise Risk Management across NHG
Designated Risk Lead Training
8 February 2010
Stuart Emslie, UK
Stuart Emslie BSc(Hons) MSc CEng FIHM MIMechE
• Independent UK-based healthcare consultant specialising in corporate and clinical governance, board development, risk management and patient safety
• Formerly Department of Health head of controls assurance (governance/risk management) for the NHS in England
• World Health Organisation consultant to Malaysian Ministry of Health
• Adviser to Health Service Executive (Ireland), Hong Kong Hospital Authority and NHG, Singapore
• Honorary Fellow, Flinders University School of Medicine, Australia
• Visiting Fellow, Loughborough University Business School, England
• Fellow of the Institute of Healthcare Management (FIHM) and, by original profession (in the 1980’s), a chartered mechanical engineer
• Editor of www.healthcaregovernancereview.org
Learning and other objectives
• Understand the concept of enterprise risk management (ERM)
• Gain familiarity with ISO 31000:2009 Risk management: Principles and guidelines
• Be able to identify risk by a number of means• Be able to construct and maintain a Risk Register• Understand the principles underlying the setting of risk
management priorities• Understand the difference between governing risk and
managing risk• Contribute to the ongoing development of ERM in NHG
‘Designated person’ attributes
• Thorough understanding of the organisation and management of NHG and, in particular, the hospital/facility within which they work.
• Preferably working at middle-senior management or clinician level with sufficient authority (or having direct access to authority) to help ensure successful implementation and maintenance of the ERM system.
• A genuine interest in helping manage risk. • Preferably with an interest in quality management and
patient safety.• A working knowledge of Microsoft Office software,
especially Word, Powerpoint and Excel.
Programme
Q1 - What is risk?
31 March 2003
Q2 - What is enterprise risk management?
Enterprise risk management (ERM)
“[A] US term coined by the Committee of Sponsoring Organizations of the Treadway Commission (COSO, 2004) and defined as “a process, effected by an entity’s board of
directors, management and other personnel, applied in strategy setting and across the enterprise, designed to identify potential events that may affect the entity, and
manage risk to be within its risk appetite, to provide reasonable assurance regarding the achievement of entity
objectives.” The concept and practice of enterprise risk management is fully addressed by the requirements of ISO
31000:2009 in all but name.”Draft NHG Risk management policy
Risk ManagementPolicy
Risk ManagementPlan
Risk Register Guidelines
Senior Management/Board
Board/Senior Management/board
Designated risk leads
5.3.2 Risk management policy
The risk management policy should clarify the organization's objectives for and commitment to risk management and should specify the following:
• links between the risk management policy and the organization’s objectives and other policies;
• the organization's rationale for managing risk;
• accountabilities and responsibilities for managing risk;
• the way in which conflicting interests are dealt with;
• the organization’s risk appetite or risk aversion;
• processes, methods and tools to be used for managing risk;
• resources available to assist those accountable or responsible for managing risk;
• the way in which risk management performance will be measured and reported;
• commitment to the periodic review and verification of the risk management policy and framework and its continual improvement; and
• the means by which the risk management policy will be communicated appropriately.
5.3.3 Integration into organizational processes [Risk management plan]
• Risk management should be embedded in all the organization’s practices and business processes so that it is relevant, effective and efficient. The risk management process should become part of and not separate from those organizational processes. In particular, risk management should be embedded into the policy development, business and strategic planning and change management processes.
• There should be an organization-wide risk management plan to ensure that the risk management policy is implemented and that risk management is embedded in all the organization’s practices and business processes.
NHG Board
Risk
CEO
etc.Audit Board committees
CRO
M1 M2 M3 Mn Members/Institutions
Staff
Departments, etc.
DesignatedRisk Lead
1
2
3
4
5
6
7
CEOs
ERM - A journey, not a destination.
Q3 - In your opinion, what do you think the key BENEFITS
might be of implementing ERM across NHG?
INTRODUCTION TO RISK MANAGEMENT IN
HEALTHCARE
Stuart Emslie
Establish Context
Identify Risks
Analyse Risks
Treat Risks
Evaluate Risks
RIS
K A
SS
ES
SM
EN
T
Co
mm
un
icat
e an
d C
on
sult
Mo
nit
or
and
rev
iew
Risk management processAS/NZS 4360:2004 - Risk management
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
Depts.
HORMC
Cluster
Hospital
Aggregation
Aggregation
Aggregation
‘Front line’
Info
rmat
ion
Res
ourc
es/A
ctio
n/Im
prov
emen
t
Filtering/Escalation
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
LikelihoodMinor
2Moderate
3Major
4Extreme
5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
Likelihood
5 10 15 20 25
4 8 12 16 20
3 6 9 12 15
2 4 6 8 10
1 2 3 4 5
Minor2
Moderate3
Major4
Extreme5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
Risk perception
Risk perception
Risk perception
The healthcare risk ‘universe’
Financial
Human Resource
ITIntegrity
Patient careand safety Occupational
safety & health
Physical resources
Information for decision making
etc.
Legal
Environment
INTERNAL
EXTERNAL
PR
OA
CT
IVER
EA
CT
IVE
Risk Register
General riskassessments
Patient adverseincidents
Staff consultation
Internal auditsand
inspections
Complaints Claims Specialist riskassessments
Patient consultationStaff adverse
incidentsOther adverse
incidents
Hazard warnings
Safety alerts
Incidents etc.occurring ‘elsewhere’
Coronersreports
Inquiryreports
BenchmarkingAccreditationstandards
Externalstakeholderconsultation
External audits,reviews etc.
Some common sources of information used to populate a healthcare risk register
Facilitatedworkshops
Books
Root cause analyses
Conferences,Seminars, etc.
Suggestion scheme
FMEA
INTERNAL
EXTERNAL
PR
OA
CT
IVER
EA
CT
IVE
Risk Register
General riskassessments
Patient adverseincidents
Staff consultation
Internal auditsand
inspections
Complaints Claims Specialist riskassessments
Patient consultationStaff adverse
incidentsOther adverse
incidents
Hazard warnings
Safety alerts
Incidents etc.occurring ‘elsewhere’
Coronersreports
Inquiryreports
BenchmarkingAccreditation
standards
Externalstakeholderconsultation
External audits,reviews etc.
Some common sources of information used to populate a healthcare risk register
Facilitatedworkshops
Books
Root cause analyses
Conferences,Seminars, etc.
Suggestion scheme
FMEA
Environment riskEnvironment risk
Empowerment risk
A common risk language
Patient Care and Safety Risk Human resource risk
Physical resource risk
Integrity risk
Financial risk
Legal risk
Information for decision making risk
Patient and family rightsInformation & ConsentConfidentialitySecuritySatisfaction/complaintsPrivacyParticipationComfort / Convenience
Access and continuityAvailability / AccessAppropriatenessTimeliness / delayContinuityOver / under utilisationVolume / capacityInterfacesAssessment of patientsAdequacy of assessmentError (laboratory / reporting / interpretation)Appropriateness
Care planningCare of patientsStandard of care/BolamCompetenceSafetyCare/Treatment accident Prescribing accidentDrug admin. accidentEfficacyNosocomial InfectionClinical trial / new treatment
Patient /family Educ.Clear Communication Patient compliance
OtherDocumentation /recordingService development
Purpose . Structure . Leadership . Accountability . Authority . Boundary . Compliance . Resource allocation . Communication . Rate of change . Performance measurement
FraudCorruption Unauthorised use Unethical practice Illegal acts ReputationConflict of interest
Facilities / EquipmentCapacityAvailabilityBreakdown / Interruption UtilisationPerformanceEfficiency / EconomyCompatibilityMisuse / ImpairmentLoss OperatorTechnologyUtilities failure
EnvironmentEnvironmental Impact ConservationWaste
Regulatory compliance Litigation Contractual
Cash flow Budget control Cash collectionBad debtsPaymentInvestmentInsuranceCurrencyMisappropriationValue for money
Clinical . Operational . Financial . Strategic
Staff capabilities and educationQualifications /registrationProficiencyProfessional development
Maintaining a quality workforceLoss of key staffTurnoverRecruitment RemunerationIndustrial relationsWorkforce planningPerformanceProductivity EfficiencyTeamworkPerformance Incentives Coverage / skill-mix Absence / attendanceStaff morale
Occupational safety and health
Safe systems of workInstructions / training /supervisionSecurity / ViolenceStressHazardous exposure
Government funding / policy . Laws and Regulations . Economy . Demographics . Technology. Market share . Other providers . Customer needs and expectations . Public awareness . Suppliers . External disasters . External relations . Labour market
SuppliesDefective productsProduct /service failureEconomySupplier Stock-outObsolescence /shrinkage
Health and safetyAct of God Buildings / Equipment / GroundsFire / Explosion /FloodingHazardous substances/ RadiationMedical equipment and suppliesFood hygieneSecurityInfectious DiseaseInsects and rodentsContractor
Access . Availability . Accuracy . Timeliness . Completeness . Usability . Utilisation
IT risk: System failure /AvailabilityTechnologyIntegrityUnauth. access/useLoss of dataCost / time overrunsUser needs not met
Process riskProcess risk
P.15
RISK SUGGESTION SCHEME
DATE: PLEASE DESCRIBE THE RISK, INCLUDING THE POTENTIAL CONSEQUENCES FOR YOURSELF, YOUR COLLEAGUES, PATIENTS OR THE HOSPITAL/HA IF THE RISK WERE TO MATERIALISE. GIVE AS MUCH INFORMATION AS YOU CAN. IF POSSIBLE, CAN YOU SAY WHAT YOU THINK SHOULD BE DONE TO ELIMINATE OR MINIMISE THE RISK? THANK YOU FOR HELPING REDUCE RISK!
0
20
40
60
80
100
120
140
160
180
0
20
40
60
80
100
120
140
160
180
Trend for Adverse Events, Start Date: 04/01/96
Daily Telegraph 20 August 2002
Failure Mode and Effects Analysis (in the context of wider risk management
and quality improvement activity)
FMEAFMECA
HFMEATM
SFMEA
Failure Mode and Effect AnalysisFailure Modes and Effects Analysis
Failure Modes, Effects and Criticality Analysis
FMEA Steps…1. Select a process (topic)
2. Assemble your team
3. Describe the process steps
1
2a
2b
4b3b
3c
5
4a
3a
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
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
LikelihoodMinor
2Moderate
3Major
4Extreme
5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
Risk Management Risk Management Experience Sharing Experience Sharing
from KWCfrom KWC
Risk Management Risk Management Experience Sharing Experience Sharing
from KWCfrom KWC
Dr Joseph LuiDr Joseph Lui
CCC (Risk Management), KWCCCC (Risk Management), KWC
Medical Stream Clinicians
• Premature discharge of patients leading to death or poor outcome due to bed shortage
Surgeons• Delay or missed diagnosis/treatment
resulting in increased mortality & morbidity• Risk of harming patients associated with
invasive procedures• Long waiting lists resulting in increased
morbidity & complaints• Medication error• Harm to staff due to violent patients
Anaesthetists (1)• Risk associated with equipment failure• Risk associated with inadequate
supervision of trainees• Risk of giving the wrong drug to patient
due to mislabeling• Risk of overdosing patient due to
malfunctioning of PCA• Risk of making unsound judgement after
long hours of duty
Anaesthetists (2)• Risk of malfunctioning of resuscitation
equipment due to lack of maintenance• Risk of improper use of Level I rapid transfuser
in emergency due to inadequate training• Risk of staff injury and equipment failure due
to cables & power cords lying on the OT floor • Risk of injury to staff
– Bumping of head against theatre light– Slip & fall after mopping of OR
Radiology/Pathology• Risk associated with missing specimen or X
ray films• Patient Identification
– Medication, Xray & Path reports– Miss labeling of specimen
• Risk associated with Equipment Maintenance & Validation
• Risk associated with Manual handling• Risk associated with chemical waste handling• Risk associated with understaffing
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
Describing risk – the ‘3 C’s’1. Risk is inherently negative, implying the
possibility of adverse consequences. Describe the potential consequences if the risk were to materialise
2. Describe the causal factors that could make the risk materialise
3. Ensure that the context of the risk is clear, e.g. is the risk ‘target’ well defined (e.g. staff, patient, department, hospital, etc.) and is the ‘nature’ of the risk clear (e.g. financial, safety, physical loss, perception, etc.)
Which of the following are adequate descriptions of risk?
• Risk to patients due to errors and unsafe clinical practice caused by reduced skill base and competence of junior and middle grade medical staff
• Needlestick injury• OSH• Reduced staff retention and increased sickness
absence due to reduction in morale caused by increased workload, pressure and stress to achieve targets
• Inadequate patient transfer• Budget overrun and financial deficit due to cost of
introducing new technologies/medicines as required by NICE guidance
• Medication error• Loss of use of ICU due to fire
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
Patient falling off a trolley causing harm to patient ora member of staff.
Patient care and safety.
Occasional maintenance work carried out, but very inadequate. AIRS figures show that thistype of incident happens at least once per week. There Have been some reports of staff injury when a trolley breaks down.
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
LikelihoodMinor
2Moderate
3Major
4Extreme
5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
Patient falling off a trolley causing harm to patient ora member of staff.
Patient care and safety.
Occasional maintenance work carried out, but very inadequate. AIRS figures show that thistype of incident happens at least once per week. There Have been some reports of staff injury when a trolley breaks down.
Major (4)
Almost certain (5)
Need a proper system ofplanned maintenance carried out on the trolleys to ensurethey don’t break down and accidentally harm patients orstaff.
Major (4)
Unlikely (2)
Operational risks identified by Clusters for 2004/05
1. Infection control2. OSH3. Medication error4. Resuscitation5. Transfer of patients6. Documentation of medical records, including
consent7. Patient identification (during consultation, blood
sampling, operation & for investigations)8. Wrong site surgery9. Proper use of infusion pumps10. Medico-legal risk (open disclosure)
Strategic Vs Operational risk?
Strategic
Operational
Strategic ‘challenges’ for Hospital Authority 2004/05
• SARS and review reports• Resources availability
• Funding• Beds• Staffing
• People capacity• Service expansion/demand• New technology• Evolution of cluster management
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
Depts.
HORMC
Cluster
Hospital
Aggregation
Aggregation
Aggregation
‘Front line’
Info
rmat
ion
Res
ourc
es/A
ctio
n/Im
prov
emen
t
Filtering/Escalation
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
Likelihood Minor2
Moderate3
Major4
Extreme5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
Likelihood
5 10 15 20 25
4 8 12 16 20
3 6 9 12 15
2 4 6 8 10
1 2 3 4 5
Minor2
Moderate3
Major4
Extreme5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
Patient falling off a trolley causing harm to patient ora member of staff.
Patient care and safety.
Occasional maintenance work carried out, but very inadequate. AIRS figures show that thistype of incident happens at least once per week. There Have been some reports of staff injury when a trolley breaks down.
Major (4)
Almost certain (5)
Need a proper system ofplanned maintenance carried out on the trolleys to ensurethey don’t break down and accidentally harm patients orstaff.
Major (4)
Unlikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
Low Medium HighRISK
Almost certain - 5
Likely - 4
Possible - 3
Unlikely - 2
Remote - 1
LikelihoodMinor
2Moderate
3Major
4Extreme
5
Consequence
Insignificant1
RISK QUANTIFICATION MATRIX
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
1. Risk type:
2. Risk description:
4. Initial consequences:
5. Initial likelihood:
6. Additional controls:
7. Residual consequences:
8. Residual likelihood:
3. Existing controls:
OSH
Staff sustaining needlestick injuries when resheatingdue to time pressures, unpredictable patients, etc.
-Staff induction training-Ongoing training-Reminders at team meetings
Major (4)
Likely (4)
-Improved induction and ongoing training-Promotion of greater awareness at team meetings and notices on noticeboards-Purchase ‘safe’ needles for sole use by all staff
Major (4)
Unikely (2)
Q4 - What are the issues or concerns that ‘keep you awake at night’?
1. Think about yourself and your colleagues – list 1 issue or concern you have at work.
2. Now think about patients – list 1 issue or concern you might have in relation to the safety or quality of care provided to patients in your department, hospital etc.
3. Finally, think about your organisation– list 1 issue or concern………..
NHG Risk Register
Aggregating risks……
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
RISK REGISTER Page 1 of ?Location/
Management unitDingley Dell AmbulanceTrust
RiskAssessor
Bodmin Moore Date 14/10/99 Date ofReview
1/12/99
ADEQUACY OF RISK ASSESSMENT
Risk EXISTING CONTROLS Consequences Likelihood RISK RATING RISK
Ref. DESCRIPTION OF RISK A I U (C) (l) (Cxl) RANKING
1 Back injuries to ambulance staff 3 4 12 32 Patient falling out the back of an
ambulance 4 1 4 6
3 Damage (and possible personalinjury) to new ambulances withpower-assisted steering
3 5 15 2=
4 Dangerous exhaust fume build upin main ambulance depot
5 2 10 4
5 Trust bankrupcy through policy ofnot charging for providing cover atlocal fairs
3 5 15 2=
6 Public outrage at charging forproviding local fair cover
1 5 5 5
7 'Putting people at risk' at fairthrough inadequate ambulancecover
5 4 20 1
Etc.A = AdequateI = InadequateU = Uncertain
Multiple fatalities 5Single fatality 4
Major 3Serious 2Minor 1
Negligible 0
Certain 5Likely 4
Possible 3Unlikely 2
Rare 1Impossible 0
Depts., etc.
Board/SeniorManagement
Member/Institution
Aggregation
Aggregation
‘Front line’
Info
rmat
ion
Res
ourc
es/A
ctio
n/Im
prov
emen
t
Filtering/Escalation
Aggregation of risk registers
Escalation of risks
Setting Risk Management Priorities
Q5 - In your opinion, what are the potential ISSUES that need
to be addressed in moving forward with implementing ERM
across NHG?
