Informal risk assessment strategies in health care staff: an unrecognized source of resilience?

RATIONALE: Recent reports indicate that approximately 10% of in-patients in UK hospitals are involved in an adverse event (these reports also state that 50% of these events are preventable). This is indeed a worrying finding, and indicates the need to look at how these incidents are handled or indeed, what is done to minimize their occurrence. The Department of Health, via the National Patient Safety Agency (NPSA) published a guide which is aimed at encouraging accurate reporting, learning from past events and changing the attitudes of key stakeholders (healthcare managers, frontline staf etc) towards risk taking and risk management. AIMS AND OBJECTIVES: Our aim was to compare informally-learned and used risk assessment strategies volunteered by staff with the 'how to do it' guide published by the NPSA. We have compared each step of the NPSA guide with our empirical data relating to that activity. METHODS: We interviewed forty-eight healthcare professionals (doctors from several specialties; nurses from a variety of settings; and an array of allied healthcare professionals). We used semi-structured interviews in order to discuss participants' views on their everyday working life, working relationships and patient safety. RESULTS: Our results indicate that healthcare professionals develop their own unique way to approach the issue of patient safety and risk, based on their professional raining, seniority and role within the hospital. They did share the conviction that frontline and support staff need to have immediate and easy access to information about past adverse events. They see this as a powerful tool in minimizing the reoccurrence of the same errors/problems, as well as a vehicle to improve staff morale by feeling valued and having their opinion heard. CONCLUSIONS: We believe that patient safety and welfare can benefit from the adoption of a more flexible and person-centred approach to how risk assessments are carried out. Enriching formal guidelines such as the 'Risk Assessment made easy' document with successful techniques and strategies which healthcare staff have informally developed has the potential to not only improve patient safety (since it will be based on the accumulated experience and knowledge of such staff) but also foster higher levels of self esteem amongst healthcare professionals.

Safety culture in anaesthesiology: basic concepts and practical application.

This article starts from a social science viewpoint and reviews the concepts and measurement of safety culture and climate in their original industrial settings and in health care. Typical items measured and generic characteristics of a positive safety culture are described. The role of personality, professional group membership and anaesthesiology-specific knowledge and expertise in shaping notions of risk and safety and safety behaviour are discussed. The difficulties of changing human behaviour are outlined, and the pivotal role which anaesthesiologists can play in promoting a positive safety culture, both individually and within their teams and organisations, is highlighted.

Risking safety or safely risking? Healthcare professionals' understanding of risk-taking in everyday work.

Current patient safety orthodoxy in the United Kingdom and beyond has tended to treat risk as something that should be assessed and estimated quantitatively. While this offers benefits to research and practice, there are added benefits from paying closer scrutiny to the underlying causes that influence such adverse events in healthcare. In this article, risk is seen as something subjective, or rather as part of the "lived experiences" of healthcare professionals. Results from this study indicate that the vast majority of healthcare professionals we interviewed understand risk as something intrinsic to healthcare; another variable one needs to prepare for. Risks were generally described in terms of acceptable versus unacceptable and avoidable versus unavoidable. In terms of identifying and dealing with risk, we found indications that the decision-making processes healthcare professionals use vary according to their training and experience. We suggest that the further examination of the apparent differences that exist in the perceptual awareness of risk can advance our knowledge on the possible impact they could have upon patient safety in the wider spectrum.

Checking in healthcare safety: theoretical basis and practical application.

PURPOSE: Healthcare includes important processes such as checking to reduce errors. Checking is a prescribed part of many patient care activities with many checks being performed during one hospital admission. Some may be standard but unwritten practices, whereas others are laid down in official guidance. Errors in the bedside checking procedure are the commonest cause of mis-transfusion, so more thorough checking could prevent adverse events. This paper aims to explore and enhance understanding regarding healthcare checking procedures. In doing so it seeks to identify a further research agenda. DESIGN/METHODOLOGY/APPROACH: The computerised databases CINAHL, PsycLIT, EMBASE, PubMed, PsycINFO and MEDLINE were searched using specific indexing terms and free text including "bedside, peri-operative safety, theatre checking and checklists". Only English publications were included. FINDINGS: Like any human activity, checking is part of personality and behaviour. There are several psychological factors relevant to patient safety, including: memory, prospective memory, automaticity and responsibility. All are relevant to healthcare. RESEARCH LIMITATIONS/IMPLICATIONS: Bandolier criteria have not explicitly been used within this review but have been met. It would be beneficial for future reviews to explicitly state how Bandolier criteria are met. This would possibly enhance the publications' scientific quality. PRACTICAL IMPLICATIONS: There is much to learn regarding interacting factors that influence healthcare checking procedures and ultimately checking performance. The authors recommend that relationships between checking and personality should be explored. Furthermore, exploring how healthcare "mindfulness" might be promoted and what reminder/checking strategies healthcare staff already use in their day-to-day work routines should be examined. ORIGINALITY/VALUE: Several psychological factors involved in checking and its relevance to healthcare and patient safety are identified. Additionally, recommendations for further research are indicated.