Clinical Risk Management in Healthcare: Principles and Strategies

This presentation addresses clinical risk management (CRM) in healthcare, focusing on its critical role in patient safety. It defines CRM as a process to reduce potential harms, involving identifying errors, evaluating factors, learning from adverse events, and preventing recurrence. The presentation highlights the importance of CRM in healthcare settings due to the potential for fatal errors and financial implications. It explores various types of risks across healthcare professionals, departments, and facilities, including diagnostic errors, medication errors, and infections. The core principles of CRM, including establishing context, identifying risks, analyzing severity, evaluating factors, and mitigating risks, are outlined. Organizational strategies such as incident and sentinel event reporting, complaint management, and accreditation are discussed. Staff-based strategies, including education, documentation, and inter-departmental communication, are also emphasized. The presentation concludes by underscoring the multifaceted benefits of CRM, including improved patient outcomes and organizational efficiency, making it a joint responsibility of staff and management. The presentation is supported by numerous references to relevant research and guidelines.

Clinical Risk
Management in
Healthcare
CLINICAL RISK MANAGEMENT, PATIENT SAFETY
AND PRINCIPLES OF RISK MANAGEMENT

Introduction: What is Clinical
Risk Management?
It is the process of reducing and limiting the potential healthcare risks and harms to patients, via
(Government of Western Australia, 2019):
1. Identification of potential errors which may occur in healthcare,
2. Evaluating the factors influencing the occurrence of these errors,
3. Taking insights from previous experiences of negative health outcomes and adverse health
events,
4. Administering necessary action for preventing repetition of such outcomes, and,
5. Ensuring the prevalence of a system which are free from risks or where such risks are
reduced.

Why is it important for
Patient Safety?
1. CRM is crucial in healthcare due to the critical nature of work environments as well as
possibility of life or death in a patient.
2. Prevalence of preventable errors can inflict fatal patient health outcomes, loss of patient
satisfaction and trust, low patient influx and resultant financial losses in healthcare
organizations.
3. CRM strategies help healthcare organizations to avoid incurring large financial expenditures
both for the management as well as for the patients.
4. CRM strategies in healthcare is closely associated with reduced likelihood of errors, reduced
likelihood of adverse patient healthcare outcomes and thus, improved deliverance of
healthcare interventions which are safe, clinical effective and patient-centered (Trevino et al.,
2018; Walker et al., 2018).

Types of Risks in Healthcare
Risks across healthcare professionals
1. Absence of providing the correct diagnosis.
2. Absence of correctly interpreting or reviewing results of patient assessments (Flannigan,
2018).
Risks across healthcare outpatient as well as inpatient departments
1. Errors in correct medication administration.
2. Healthcare associated infections due to lack of adequate disinfection practices.
3. Lack of correct or timely handover communication practitioners, families, patients and staff
(Pankiewicz-Dulacz et al., 2018).

Types of Risks in Healthcare
(contd.)
Risks across elderly care, community care or residential healthcare facilities
1. Inability to reduce falls and pressure ulcer incidences across patients.
2. Inadequate fluid or food intake resulting in dehydration, malnutrition and choking (Tariq et
al., 2018).

Principles of Risk
Management in Healthcare
1. Step 1: Establishing the context or scenario where risks can occur.
2. Step 2: Identifying potential risks relevant to the context.
3. Step 3: Analyzing the severity and likelihood of risks.
4. Step 4: Evaluating the factors underlying occurrence of the risks.
5. Step 5: Treating or delivering interventions to mitigate the risks.
6. Healthcare staff of the organization must communicate and collaborate with each during
each of the above CRM steps and principles. The healthcare management must also engage
in repeating the above CRM process in regular intervals (Government of Western Australia,
2019).

CRM Process (Government of
Western Australia, 2019)

Organizational based Risk
Management Strategies
1. Incident Reporting: It is the process of timely documentation of accidents using specified
recording protocols for evaluation by quality control departments.
2. Sentinel Event Reporting: It is the process of reporting and documentation of unexpected
incidences like death or psychological trauma of a patient for prevention of future ‘never’ or
‘catastrophic events’.
3. Complaint/Conflict Management Protocols: It is the process of timely management as well
as documentation of complaints registered by patients which can be used to identify patient
expectations and causes of errors (Zadfallah, Bastan and Ahmadvand, 2017; World Health
Organization, 2020; Government of Western Australia, 2019).

Organizational based Risk
Management Strategies (contd.)
1. Coronial Investigations: The process of investigating the causes of a patient’s death by
coroners, for identification of the role of any preventable errors or malpractices.
2. Accreditation: The process of conducting quality control audits in an organization based on
certified standards such as the National Safety and Quality Health Service (NSQHS) Standards
or Work Health and Safety committee.
3. Credentialing: The process of practicing delegation based on a healthcare professional’s
competency and capability to deliver healthcare interventions such as the Decision Making
Framework by the Nursing and Midwifery Board of Australia (Zadfallah, Bastan and
Ahmadvand, 2017; World Health Organization, 2020; Government of Western Australia,
2019).

Examples of Complaints and Incident Reporting Formats

Staff or Performance based
Risk Management Strategies
1. Each staff and practitioner must be educated, trained and made aware of the CRM principles
and policies followed by the healthcare organization.
2. Each staff and practitioner must engage in regular documentation and recording practices at
every clinical step.
3. Each staff and practitioner must be educated, trained and made aware of adequate conflict
and complaint management and incident reporting strategies.
4. Each staff and practitioner must engage in inter-department communication at every step of
the CRM process (de Vries et al., 2016).

Conclusion
Implementation of correct, timely and comprehensive CRM strategies demonstrate multifaceted
benefits since it encourages the avoidance of preventable errors and malpractices and
deliverance of safe, quality and effective interventions, which in turn instill beneficial patient as
well as organizational benefits. To conclude, engagement in CRM strategies is the joint
responsibility of staff and overall healthcare management of an organization.

References
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Pankiewicz-Dulacz, M., Stenager, E., Chen, M., & Stenager, E. (2018). Incidence Rates and Risk of Hospital Registered Infections among Schizophrenia
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