ABSTRACT
A critical aspect of improved quality of health care is obviously the prevention of medical errors, and this gives rise to the call for clinical risk assessment in the health sector. In this chapter, Karen Norman, formerly Nurse Director of a National Health Service Trust, explores the thinking underlying the approach to clinical risk assessment in the UK, pointing to how it reflects the same kind of systems thinking that underlies the current mode of public sector governance in general. Every health trust is required to have a risk assessment strategy and system, which is periodically inspected so that lessons may be learned from serous clinical incidents. The chapter identifies the retrospective and pro-active approaches to clinical risk assessment mandated by government bodies such as the National Patient Safety Agency. The pro-active approach, known as clinical risk profiling, requires the identifying of potential risk issues and their ranking according to a measure of seriousness so that the most serious may be targeted for preventive action. This retrospective approach involves the investigation of serious clinical incidents. The investigation, to be conducted by an objective and independent observer, follows linear step-by-step procedures meant to identify the facts about what actually happened and so uncover the root cause of the incident. This is then supposed to lead to action ensuring that it can never happen again. Norman shows how this approach leads to the apportionment of blame. A particular individual clinician may be blamed, or the blame may be ascribed to the ‘system’, or both may be blamed. This then means that all the other individuals who may have been involved in some way do not need to take personal responsibility for what has happened.
