Understanding risk

East of EnglandGeneric Health Relevance
Start Date: 1 Apr 2014 End Date: 31 Dec 2017

Understanding risk. PART 1: Development of a theory of risk management, a picture of risk practice and a new toolkit for assessing risk


Despite excellent efforts from its staff the NHS is sometimes an unsafe system, and currently suffers from an overly reactive stance to the management of safety (Health Foundation, 2012; Ward, 2010). Safety-critical industries place the balance differently between reactive and proactive safety management (e.g. ICAO, 2009). In essence the NHS lacks a proactive, systematic and system-wide stance on risk management (Robinson, 2012; Shebl, 2009; Ward, 2010). The aim of this project is to readdress the reactive/proactive balance. Risk assessment in the form of a proactive, systematic and holistic approach has been referred to as Prospective Hazard Analysis (PHA) (Ward, 2010). PHA has been little used in healthcare and is a new way of thinking about safety management (Ward, 2010) by taking a systems approach (DH, 2000). Until recently there was a lack of guidance to help NHS staff to perform PHA. To address this need a Toolkit of PHA methods (see BSI, 2010, for more information) was developed through funding from the Department of Health, and was published in a peer-reviewed report in 2010 (Ward, 2010). Through over a dozen evaluations (e.g. Card, 2012), the Toolkit is viewed by NHS staff to be both powerful and usable in helping to identify risk, up-front, before it can cause harm. However it is still in “prototype” form and it is unclear exactly how it should be integrated into the current NHS risk management system: it is not as yet a stand-alone toolkit. There is therefore a need to a) establish a more in-depth understanding of how risk management is practised – in the NHS and in other “good practice” safety critical industries, b) develop the toolkit further, c) strengthen its evidence base of use and d) integrate it into risk management practice across the NHS, with an initial focus on the Eastern Region.

Research questions / aims

This project is split into three Parts.

  • Part 1 will develop risk theory, the toolkit and a training package.
  • Part 2 will evaluate the toolkit in greater depth than before
  • Part 3 will disseminate and integrate this new practice into the NHS. Each Part describes the centre of gravity for the activities within them, but each activity will overlap into other parts of this project, where appropriate.

 Expected Output of Research / Impact and added value

The following outputs from the five Stages:

  • An interim report covering progress of the first part at the end of the first two years, showing an emerging picture of how risk is managed in healthcare an in other industries.
  • A workshop on risk in 2014 for CLAHRC partners and NHS staff. Other workshops will occur with NHS risk managers and risk experts from other industries.
  • A modified PHA toolkit, instructions for use and a prototype training course on PHA.
  • An average of 2-5 PHA case studies throughout the duration of the project (around 20 case studies in total. Each case study typically takes between 1 person-week and 3 person-months, depending on depth and complexity).
Dr James Ward