2. Aim of programme to apply the principles of risk management to practical situations and relate these to personal experiences to improve the quality of care by implementing initiatives to remedy deficiencies in the service provided.

3. Harvard Medical Practice Study New England Journal of Medicine 1991 3.7% patients suffered an adverse event 3.7% patients suffered an adverse event Of these 13% died Of these 13% died 58% events related to system errors 58% events related to system errors

5. Summary of New Complaints Procedure (1998, 9/12 period) MDU experience Failure or delay in diagnosis most common reason (28%) Failure or delay in diagnosis most common reason (28%) 24% of complaints made after bereavement 24% of complaints made after bereavement Non-clinical issues accounted for 34% of complaints Non-clinical issues accounted for 34% of complaints 10% of complaints related to attitude 10% of complaints related to attitude 93% settled at L.R. 93% settled at L.R.

6. MDU Settled Claims Against UK GPs Failure to diagnose - 51% Failure to diagnose - 51% Medication error - 26% Medication error - 26% Pregnancy including labour - 13% Pregnancy including labour - 13% Minor surgical procedure - 7% Minor surgical procedure - 7% Other - 3% Other - 3%

7. MDU Claims Settled Quality of medical care - 7% Quality of medical care - 7% Medical record issues -60% Medical record issues -60% System failures-33% System failures-33%

8. MDU complaints study 1999 33% complaints were due to failures in systems, procedures and communication e.g. rudeness/attitude staff or doctor administration problems prescription problems communication

9. Clinical Governance Clinical risk management Complaints procedures Adverse incident reporting Clinical audit Evidence- based practice Whistle blowing Performance review

10. RISK MANAGEMENT A careful examination of what 1.could cause harm 2.its significance and 3.what precautions are needed to eliminate the risk or reduce it to an acceptable level

11. Risk Management Benefits for patients – improved quality of care and service – enhanced patient safety – confidence in the service for health care professionals – protection of confidence and reputation – quality procedures and staff involvement – decreased numbers of complaints and claims

12. The four principles of risk management 1. Identify the risks – whats likely to go wrong? 2. Assess the risk – what are the chances of it going wrong, what could happen, does it matter? 3. Reduce/eliminate the risk – what can you do about it 4. Cost the risk – what are the costs of getting it right v. the cost of getting it wrong?

13. Risk Management Techniques Complaint handling Risk assessment Staff awareness/training Protocol and guidelines monitoring Good medical records Adverse incident reporting

14. Risk Areas Staff - especially locums Organisation adequate staffing regular guideline review Communication Consent Record keeping

15. Clip 2 – Morning Surgery Identified Risks Breaches of confidentiality – front desk/reception area etc. Health and safety issue. Lack of systems. Phone call interruptions. Verbal requirements regarding nurse visit. Inappropriate roll/responsibilities of receptionist. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

16. Clip 3 – Test Result / Minor Surgery Identified Risks Dealing with smear results. Aseptic techniques. Lack of chaperones. Unreasonable patient request. Lack of informed consent. Disposal of clinical waste/needles. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

17. Clip 4 – Home Visit Identified Risks Examination. Response to collapsed patient. Communication regarding hospital admission. Communication with mother. Dealing with request for repeat prescription. Dealing with aggressive patient. What action do you suggest the practice takes in order to avoid/minimise these risks (in priority order)?

18. Aims of Assessment Improve patient care Ensure safe standards of practice Ensure patient/staff safety and well being Decrease the number of complaints and claims Lessen the stress associated with litigation

19. The MDUs risk management pack Part one - Communication How to use it

20. Each part contains: Case history examples Checklist Reference sections Action plan Score/evaluation sheet

21. How to complete Team approach set aside protected time read questions and reference section undertake the review (yes or no answers) consider action needed complete action plan complete the anonymised answer sheet return sheet to PCG offices

22. Scoring system Yes - undertaking the activity No - area needs review Score 3 = essential Score 2 = important Score 1 = good practice