Risk Assessment and Risk Register Policy. Contents

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1 Classification: Policy Lead Author: Paul Dodd Head of risk management Additional author(s): N/A Authors Division: Corporate Unique ID: RM6(06) Issue number: 3 Expiry Date: January 2017 Contents Section Page Who should read this document 2 Key points 2 What is new in this version 2 Policy/Procedure/Guideline 2 1 Risk Assessment Protocol 2 2 Deciding on Control Measures 2 3 Action Planning 3 4 Reviewing the Risk Assessment 3 5 Specific Assessments 3 6 Assurance on Controls 4 7 Risk Assessment Process 4 8 Risk Register and Assurance Framework 4 9 Risk Management Software system, Datix 5 10 Training 5 Explanation of terms/ Definitions 5 References and Supporting Documents 7 Roles and Responsibilities 7 Appendix 1 How to Complete a Risk Assessment 10 2 Risk Rating 12 3 Risk Assessment and Assurance Framework Documentation 13 4 Trust action plan template 14 Document control information (Published as separate document) Document Control Policy Implementation Plan Monitoring and Review Endorsement Equality analysis Page 1 of 15

2 Who should read this document? All trust staff who undertake risk assessments Key Messages Effective risk management is the foundation on which the Trust delivers its objectives. It is the key system through which all risks; clinical, organisational and financial risks are managed to ensure benefits to patients, staff, visitors and other stakeholders. This policy describes how staff will fulfil their role in risk assessment and the production of risk registers. All risks regardless of their nature or origin will be managed via this process. What is new in this version? Increase in frequency and stages for policy monitoring Clarification of review requirements for risk assessments as part of the policy implementation plan noting a consultation of defined timescales for review of risk assessments based on risk rating. Policy/ Guideline/ Protocol Risk Assessment Protocol Effective risk assessment is a core element in good safety management systems. A guide on How to Risk Assess is included as Appendix 1. The ratings which are applied to the risk being assessed are based on 3 criteria, Potential impact of the Risk, Likelihood of that impact resulting and the effectiveness of controls in place. The definitions for this are listed in Appendix 2 Likelihood + Impact + Control Measure = Risk Rating Risks should always be assessed as they are now, including any known foreseeable changes. Each risk is given a Risk Score which is the sum of the scores for Likelihood, Impact and Control Measure. The Risk Score is recorded on the Trust s Risk Register. The Risk Score determines at what level the risk needs to be managed, with what urgency and the extent to which control measures are required. Deciding on Control Measures Whilst risk can be controlled by putting in place control measures i.e. something that reduces the risk it is also important to make sure that the control measures remain in force and are relevant. To assist in this the hierarchy of controls shown below should be considered, with the strongest form of control (1 strongest 5 weakest). Page 2 of 15

3 1 Elimination, (e.g. removal of hazard) 2 Reduction, (e.g. try a less risky option) 3 Protection at source, (e.g. prevent access to the hazard) 4 Protection of individuals, (e.g. personal protective equipment) 5 Education/safe systems of work, (e.g. work routines, and information/instruction/training) While working through a hierarchy of control measures will help to ensure that the most effective and appropriate measures are used, it should be noted that combinations of different controls will in most cases be required. Action Planning A summary of actions to be taken to eliminate, reduce or control the risk will be documented on the Trust s Risk Assessment document, Appendix 3. Where detail actions, or multiple managers are responsible for some of the actions a separate and more detailed action plan will be required. The documentation to be used for this is included as Appendix 4. An electronic version (i.e. a word document ) should be attached to the entry on the Trust Risk Management Software (Datix) system. Reviewing the assessment This is a legal requirement. A review should be carried out if: there is reason to suspect that the assessment is no longer valid e.g. the risk no longer exists. there has been a significant change Each Risk Assessment will need its own review date which will be determined by the Rating of the risk and the actions required. However this review date should be 1 year maximum, even if this simply involves checking that the risk assessment remains valid and the control measures are deemed to be working and sufficient. In such cases a new review date will be set. Specific Assessments It should be noted that certain regulations require specific assessments. Such regulations include: Manual Handling Display Screen Equipment Regs Noise at Work Regs Control of Asbestos Regs Control of Substances Harmful to Health The employment of young workers (Welfare Regs) The employment of pregnant women and nursing mothers (Welfare Regs) In these cases the relevant policies or guidance documents should be consulted. Page 3 of 15

4 Assurance on Controls Assurances are the means by which the organisation, executive director, manager, or clinical lead responsible knows that the controls which are thought to be in place are being implemented and are effective. E.g. Monitoring reports presented to a committee or a confirmation of works completed to the responsible manager/clinician. The level of the assurance should be proportional to the level of risk. Risk Assessment Process Once complete the Risk Assessment form, should be forwarded to the lead manager/lead Clinician for the area. The Manager/Lead Clinician will ensure the Risk Assessment is entered on the Trust s Risk Management Software system (Datix). Any Risk Assessment Rated as 10 or above must also be forwarded along with any supporting documentation, immediately, or as soon reasonably practicable, to the Divisional Governance Manager and Divisional Director of Nursing, or in nonclinical divisions, the relevant senior manager. They will then review the risk rating and if it remains 10 or over will bring to the urgent attention of the Divisional Managing Director. The Divisional Managing Director will ensure that Risk rated 10 or over are presented to the Executive Risk and Assurance Committee via the risk register. All risk assessments will be reviewed and approved at Divisional level, by a Divisional Manager, the Governance Manager. Risk Register and Assurance Framework A Risk Register is a summary of collated risk assessments. All Risk Assessments must be entered on to the Trust s Risk Management Software system (Datix), which is used to compile the risk register. The Departmental Risk Registers with all risks rated 6 or above must be reviewed at least twice a year by the Divisional Governance Committee, and its consideration minuted. The Divisional Risk Registers must be reviewed by the Divisional Governance Committees at least twice per year. The Divisional Risk Registers and the risk registers of the supporting corporate departments (e.g. Facilities, HR, Learning and Development, IM&T) that must include, but maybe not exclusively, all risks rated 9 or above, must be presented at least twice a year to the Executive Assurance and Risk Committee. Page 4 of 15

5 The Corporate Risk Register with all risks rated 12 or above must be reviewed by the Executive Assurance and Risk Committee and reported to the Board of Directors four times a year. Risk Management Software system, Datix Training All Risk assessments, will be logged onto the Trust s Risk Management Software system, known as Datix. The Datix system records and facilitates effective management of all Risk Assessments across the Trust. Training in the use of Datix risk management software system for Risk Assessments Risk Registers/assurance framework is provided. Access to this training is via Divisional Governance Managers or equivalent General Risk Assessment training is available in the Trust s training centre. This course can be accessed via, Training in the inputting, monitoring and reviewing of Risk Assessments and production of Risk Registers/assurance framework is available from the Corporate Risk Team (Ex 61570) Explanation of terms & Definitions Hazard A Hazard is something that has the potential to cause harm or adverse outcome. In terms of business risk it is what is seen as a threat to not achieving corporate objectives. Risk A Risk is the chance or likelihood that harm or adverse outcome will arise from a hazard (or threat) and includes the severity of the injury or the impact on the Trust. Control Measures (Controls) Control Measures sometimes referred to just as Controls are the precautions that are put into place to reduce the risk. Risk Profiling Risk profiling is a tool which allows risks to be analysed and rated. The process is based on three factors; Likelihood of exposure to risk and of harm being caused. Impact or the severity of harm caused Controls in place (and their effectiveness) to manage the identified risk. Page 5 of 15

6 Risk Assessment Risk assessment involves: Identify the hazards, including tasks activities and situations Determine who may be exposed to the hazard Evaluate the risk Introduce control measures Record the findings Review the assessment It is a legal requirement for all significant risks Risk Register A Risk Register provides the repository for all risk assessments. It therefore allows the Trust to understand its risk profile as long as it is a dynamic tool and is used at all levels of the organisation. It is described as: A log of all risks of all kinds that threaten an organisation s success in achieving its declared aims and objectives. It is a dynamic document, which is populated through the organisation s risk assessment and evaluation process. This enables risk to be quantified and ranked, and information about risks to be collated and analysed. It therefore provides a structured approach to decisionmaking about whether or how risks should be treated. The Trust s Risk Assessment Process and Corporate Risk Register is used for strategic planning, the setting of corporate objectives and influencing business plans, procurement and service development. The format for all risk assessments and risk registers is available on the Risk Management website and is shown in Appendix 3. Once completed, an electronic version (i.e. a word document ) should be attached to the entry on the Trust Risk Management Software system (Datix). Risk Status For the purposes of this policy there are 3 statuses for a Risk Assessment; Open Closed Archived Open/active: An open, or active risk assessment is where there are actions which have not been completed, or are still being completed. The review dates for these assessments should reflect the rating identified for the risk. Closed/complete: A closed, or complete risk assessment is where all the actions required by the assessment have been implemented but their remains a residual risk rating. Whilst the review dates for these assessments should still reflect the residual rating identified for the risk, in most cases the residual risk rating would be the level of acceptable risk agreed at the relevant committee. Therefore the review date may be set for 1 year. Archived: An archived risk assessment is where the actions are completely implemented and there is no residual risk, the risk assessment is obsolete or superseded by another assessment Page 6 of 15

7 References and Supporting Documents AS/NZS 4360:1999 Risk Management Health & Safety at Work Act 1974 The Management of Health & Safety at Work Regulations 1999 HSE Five steps to Risk Assessment Roles and responsibilities Chief Executive Accountable to the Board of Directors for ensuring that accurate and up to date risk registers are maintained using the risk assessment and risk register policy and that risks with a risk profile score of 12 and above are brought to the attention of the Board of Directors through via the Corporate Risk Register. Executive Directors. Responsible to the Chief Executive for ensuring that accurate and up to date risk registers, using the risk assessment and risk register policy, are maintained in all the areas for which they are responsible and that: risks with a risk profile score of 10 and above are brought to the attention of the Executive Assurance and Risk Committee; and risks with a risk profile score of 12 and above are brought to the attention of the Board of Directors within the Corporate Risk Register element of the Board Assurance Framework. Executive Nurse Director Accountable to the Board of Directors for ensuring compliance with this policy in all parts of the Trust. Associate Director of Corporate Affairs and Trust Secretary Responsible for ensuring integration between Divisional Risk Registers and the Corporate Risk Register element of the Board Assurance Framework. Associate Director of Governance and Quality Improvement Responsible to the Director of Nursing for operational and managerial implementation of this policy. Will ensure systems are in place for the assessment of risk, creation, and maintenance of the organisation s risk register. With operational and managerial responsibility for governance, clinical audit, health and safety, quality, litigation, complaints and patient advice and liaison will ensure that Page 7 of 15

8 there are systems in place for the completion and maintenance of the risk registers for these areas. Head of Risk Management Responsible for ensuring systems are in place for the accurate assessment of risk, completion and maintenance of risk registers in line with this policy in all parts of the Trust. Responsible for ensuring appropriate systems are in place to support the implementation of this policy. Responsible for ensuring appropriate monitoring of compliance with this policy. Responsible for ensuring adequate training in risk assessment is provided for staff Responsible for ensuring the administration of the Trust s software system to support the risk assessment, risk register and assurance framework. Will provide advice and support to managers in respect of risk assessment, risk registers and the assurance framework Divisional Managing Directors Responsible for ensuring that this policy is implemented in all areas within the Division for which they are responsible and for ensuring that risk assessments and risk registers are completed, up to date and maintained. Responsible for managing their Divisional Risk Register and ensuring that risk management is a key part of their management and business planning processes. Responsible for the confirmation of the accuracy of risk profile scores for risks identified within their Division. Responsible for ensuring suitable and sufficient resource is available for the implementation of this policy, including data entry and review of risk logs on the Trust s Risk Management Software system (Datix). Governance Managers Responsible to the Divisional Managing Director for: facilitating the accurate completion and maintenance of a contemporaneous Divisional Risk Register on the Trust s Risk Management Sortware system (Datix) and in line with the provisions of this policy ; ensuring all key departments, within each Division, have a Departmental Risk Register that is recorded on the Trust s Risk Management Software system (Datix) and in line with the provisions of this policy; for ensuring that risks identified within the Division that have a risk profile score of 10 or above are reported to the next meeting of the relevant Divisional Governance Committee. Page 8 of 15

9 Shall provide advice and support to managers and staff, in their area of responsibility, in respect of risk assessment, risk registers and the assurance framework. Managers and Lead Clinicians Responsible to the Divisional Managing Director for: ensuring that this policy is implemented in the areas for which they are responsible for ensuring contemporaneous Departmental Risk Registers exist, are recorded on the Trust s Risk Management Software system (Datix) and maintained in line with this policy providing current information relating to current risks, controls and action plans to the Divisional Governance Committee as requested. Responsible for reviewing their risk assessments and risk register, and ensuring that risk management is a key part of their management, clinical and business planning processes. Responsible for confirming the accuracy of risk profile scores for their areas of responsibility. All Staff Report all risks they identify to their lead clinician/manager so that it can be added to the risk register. Follow the Controls laid down in the assessments or registers. Trade Union Safety Representatives Trade Union Safety Representatives have the right to access information regarding Hazards and Risks which may potentially affect the staff they represent. This includes risk assessments. While there is a requirement for consultation with Trade Union Safety Representatives (TUSR), it is good practice to actively involve the TUSR in the initial undertaking and subsequent reviews of risk assessments for their area. Page 9 of 15

10 Appendix 1 - How to Complete a Risk Assessment Stage 1: Identifying Hazards, While undertaking an identification of hazards, involving others in the process is often beneficial in ensuring that a comprehensive and holistic approach is taken. Identification of hazards may involve a review of processes, or visual inspection of the work place etc. The following is a list of some categories of hazard which should be considered. Environment (e.g. workplace design, temperatures) Human, Tasks, Objects, Chemicals, Organisation (routines) Whilst this is being undertaken consideration will need to be given to the effect of the hazards on each other, i.e. when considering the environment, the tasks to be performed in that environment may affect its suitability. Identify who at risk: Those who may be exposed to or at particular risk from the hazard will need to be considered. Young workers, children, trainees, new and expectant mothers, disabled etc may create specific risks or be more prone to certain hazards. This may also apply to visitors, contractors and bank/locum staff who may not be familiar with the workplace and routines. Patients will also need specific consideration as their condition and capabilities will vary. Who may be at risk may affect the level and depth of the risk assessment as well as the control measures that are required. Stage 2: Identify existing controls: Once the hazard(s) have been identified, consideration should then be given to any control measures currently in place. This will help determine whether or what further actions are required. Evaluate Risk (Analyse the severity and likelihood of exposure) By analysing the severity and likelihood of exposure a Risk Rating can be given. Firstly, the realistic potential outcome should be determined. This should be done by using the Risk Ratings in appendix 2. Page 10 of 15

11 The likelihood of occurrence, of that consequence (i.e. the realistic potential outcome ), should then be determined. Again this should be done by using the Risk Ratings in appendix 2. Please Note: The likelihood recorded MUST be the likelihood of the identified realistic consequence used as the impact rating. The existing control measures are also rated, based on adequacy and whether they have been implemented. This should be done by using the Risk Ratings in appendix 2. The final rating is achieved by adding the 3 rating, impact, likelihood and controls. Stage 3: Likelihood + Impact + Control Measure = Risk Rating When measures to control the identified risk are being considered, the use of a hierarchy of control measures may help to ensure that the most appropriate action is taken. These are:- Elimination, (e.g. removal of hazard) Reduction, (e.g. try a less risky option) Protection at source, (e.g. prevent access to the hazard) Protection of individuals, (e.g. personal protective equipment) Education/safe systems of work, (e.g. work routines, and Information/instruction/training) While working through a hierarchy of control measures will help to ensure that the most effective and appropriate measures are used, it should be noted that combinations of different controls will in most cases be required. Risk treatment plans/action plans should:- Ensure action plans can be implemented. Ensure there is ownership and time frames. Ensure that the action plans meet the goals/objectives, and don t create bigger problems elsewhere. Include how relevant members of staff are to be informed of the risk and its control measures. Include how the risk treatment plan and it s implementation, is to be monitored. Stage 4: Once the risk treatment plan has been developed a review date for the risk assessment should be set. A re-evaluation should be performed to produce a revised Risk Rating once proposed actions are completed. This review date will depend on the rating of the risk and the complexity of the actions required to control it. At a maximum, this review date should be no more than 12 months in advance. Page 11 of 15

12 Appendix 2 Risk Rating Risk Profiling Protocol The process is based on three factors; Likelihood of exposure to risk and of harm being caused. Impact that is the severity of harm caused both to the Trust and to its stakeholders. Controls in place to manage the identified risk. In evaluating the risk remember to rate the likelihood (chance) of the hazard causing harm and then rate the severity of any injury that could result. Likelihood Ratings used are: Rating 1 = Rare- do not expect this to happen or to happen again Rating 2 = Unlikely- most probably will not happen Rating 3 = Occasionally 50:50 chance of occurring Rating 4 = Likely most probably will happen Rating 5 = Almost certain confident that this will happen Impact (Severity or consequence) Ratings used are: Rating 1 = almost none no obvious harm* Rating 2 = Minor - no permanent harm (recovery within one month)* Rating 3 = Moderate semi permanent harm ( recovery takes longer than one month but no more than one year) and /or adverse publicity for the Trust* Rating 4 = Major permanent harm not resulting in death or severe disability to a person or persons and /or start of a national investigation into the Trust and/or disruption of key Trust services which significantly prevent the Trust from meeting its responsibilities.* Rating 5 = Catastrophic death or permanent severe disability to a person or persons and/or significant loss of reputation for the Trust and/or loss of key Trust services which prevent the Trust meeting its responsibilities.* * Note that harm in all the above includes damage to the organisation, its finances, its reputation, its business, its patients, staff or visitors. Control Measure Ratings used are: 1 = risk is fully under control 2 = risk is adequately controlled 3 = action to control risk adequately has started 4 = action to control risk is agreed but no action started 5 = no actions to control risk is identified Each risk is then given a Risk Score which is the sum of the scores for "Likelihood", "Impact" and "Control Measure". The Risk Score is recorded on the Trust's Risk Register. The Risk Score determines at what level the risk needs to be managed. Control measures required and the risk rating should decrease. If it does not then the control measures will not work. Likelihood + Impact + Control Measure = Risk Rating Page 12 of 15

13 Appendix 3 Risk Assessment and Assurance Framework Documentation Salford Royal NHS Foundation Trust : Risk Assessment and Assurance Key L = Likelihood Score C = Control Score Department: Title of Assessment: Corporate Objective: Person Responsible: Source of Risk (i.e. incident, change in legislation etc) : Overall Review Date : Date Principal Objectives Principal Risks - Source of Risk L I Key Control Established Key Gaps in Control C Assurance on Controls Gaps in Assurance R I = Impact Score R=Risk Profile Score Action Plan Summary Review Date 1 = rare 2 = unlikely 3 = possible 4 = likely 5 = almost certain 'Likelihood score' (L) : "Impact score" (I) 1 = almost non 2 = minor 3 = moderate 4 = major 5 = catastrophic "Risk Control" (C) 1 = risk is fully under control 2 = risk is adequately controlled 3 = action to control risk adequately has started 4 = action to control risk is agreed but no action started 5 = no actions to control risk identified Page 13 of 15

14 Appendix 4 Trust action plan template Title: Action Plan Action Plan Lead: Action Plan Review Dates: Results Approach Deployment Assessment and Review Objective Action required (reference to detail) Action Lead responsibility Action implementation strategy (reference to detail) Start (S) Completion (C) Review (R) date Progress (reference to detail) Page 14 of 15

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