When is a risk not a risk?

Risks are ephemeral. Once identified they are no longer risks but problems to be solved. Risks that cannot or should not be problematized need to be abandoned.

In the most positive light, identifying risks should only be a first step in a long pathway of improvement. First, the risk must be linked to a behaviour or situation that is predictable. Second, services that are designed to intervene, should be reserved for high-risk/high-benefit situations. Whilst this sequence has been shown to be in stringently regulated environments such as financial markets, the jury is out about whether it is transferrable to health care.

Without abandoning some risks there can be little hope for any improvement in health care.

Not all health care risks identify an actionable problem. For example, it is inevitable that some patients will die in hospital. Every winter, despite vaccinations, emergency services will be overextended by influenza suffers. These are not situations where actions can be taken, but the inevitable consequences of a service which inherently cannot always provide the outcome people want.

Dealing with risks is a growing industry. Although called risk management, this growing industry it is mostly concerned with identifying catastrophic situations and forming committees to prevent them happening again.

Mainly dealing with administration issues around the ordering of drugs, sterilization of equipment and use of surgical instruments, risk management in healthcare bypasses any clinical approach to identifying which risks are worthy of intervention – let alone differentiating between those risks which are the inevitable consequences of a field of endeavour that has death as one of its outcomes.

One of the main barriers to determining what risks should be abandoned is the conflicting paradigms of evidence and individuality. Clinicians are trained to comfortable with weighing up the significance of risks for individuals. Conversely, managers take more of a global view, where all risks can lead to mistakes and are unacceptable. Similarly, errors, unavoidable or not, are equated with negligence leading to an abusive culture of bullying.

Without abandoning some risks there can be little hope for any improvement in the health care of individuals. More than ever, clinicians to take a leading role to establish which risks can become personalised problems and which ones need to be abandoned.

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