There are a number of challenges relating to risk in modern healthcare. These concern: the communication of risk (how do patients, or their guardians, understand and make informed decisions about the risks of particular treatments?); how risk is perceived (what precisely do patients and practitioners understand ‘risk’ to mean?); how risk is managed (how can an NHS Trust manage those risks to which it might be exposed?); and how risk is identified (what are the clinical, corporate and financial risks potentially affecting an NHS Trust?).

The programme

The Risk Programme is currently focusing on how a London NHS foundation trust can improve one method of aiding patient safety: the use of reports of patient safety incidents (accidents and near-misses) as a means of identifying risk.

Increasing the reporting of patient safety incidents has become a national policy priority. As a result, over two million incidents have now been reported to a national database of patient safety incidents (the ‘National Reporting and Learning System’). The move to collect information about accidents and near-misses as a means of improving safety builds on the use of such techniques in industries other than health care. In this connection, air transport, the nuclear and chemical industries, and defence have been seen as models for the NHS to follow, given that they must also aim for high levels of safety, sometimes in the face of considerable complexity and uncertainty.

The Trust has developed its own incident reporting system, which appears relatively successful in comparison to other Trusts’ systems. It falls within the top 20% of Trusts in terms of the number of patient safety incidents reported. In addition, the ratio of reported incidents which caused serious harm to those which caused little or no harm is relatively low, suggesting an open culture. However, no undisputed ‘benchmark’ currently exists to indicate whether a Trust (and units within it) has high levels of incident reporting or otherwise.

The project

The Risk Programme has identified twelve categories of factors which might affect rates of reporting of patient safety incidents. These relate to three levels (the national political context; the hospital itself and units within it; and individual health practitioners) which can be examined in relation to four elements (procedures, institutions, knowledge and understanding, and culture).

We hope to discover the extent to which these factors are relevant when it comes to explaining apparent differences in reporting rates across the Trust. We also hope to find out whether a ‘benchmark’ can be developed, to enable the Management of the Trust to explore relative reporting levels in different units of the Trust.

We will carry out this project by interviewing and surveying members of staff in three divisions at the Trust, using an analysis of the Trust’s incident report database as background. Throughout the project we will work closely with a range of staff at the Trust, to ensure that the research remains relevant and produces useful outputs.