Trust-level risk evaluation and risk control guidance in the NHS East of England

Risk Anal. 2014 Aug;34(8):1469-81. doi: 10.1111/risa.12159. Epub 2013 Dec 16.


In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.

Keywords: Patient safety; healthcare risk management; risk control; risk evaluation; risk matrix.

Publication types

  • Evaluation Study

MeSH terms

  • England
  • Humans
  • Likelihood Functions
  • Patient Safety
  • Risk Assessment / methods*
  • Risk Assessment / statistics & numerical data
  • Risk Management / methods*
  • Risk Management / statistics & numerical data
  • State Medicine* / organization & administration
  • State Medicine* / statistics & numerical data