title: Informal risk assessment strategies in health care staff: an unrecognized source of resilience?
abstract: BACKGROUND
  Recent reports indicate that approximately 10% of in-patients in UK hospitals are involved in an adverse event (these reports also state that 50% of these events are preventable). This is indeed a worrying finding, and indicates the need to look at how these incidents are handled or indeed, what is done to minimize their occurrence. The Department of Health, via the National Patient Safety Agency (NPSA) published a guide which is aimed at encouraging accurate reporting, learning from past events and changing the attitudes of key stakeholders (healthcare managers, frontline staf etc) towards risk taking and risk management.
  
  
  OBJECTIVE
  Our aim was to compare informally-learned and used risk assessment strategies volunteered by staff with the 'how to do it' guide published by the NPSA. We have compared each step of the NPSA guide with our empirical data relating to that activity.
  
  
  METHODS
  We interviewed forty-eight healthcare professionals (doctors from several specialties; nurses from a variety of settings; and an array of allied healthcare professionals). We used semi-structured interviews in order to discuss participants' views on their everyday working life, working relationships and patient safety.
  
  
  RESULTS
  Our results indicate that healthcare professionals develop their own unique way to approach the issue of patient safety and risk, based on their professional raining, seniority and role within the hospital. They did share the conviction that frontline and support staff need to have immediate and easy access to information about past adverse events. They see this as a powerful tool in minimizing the reoccurrence of the same errors/problems, as well as a vehicle to improve staff morale by feeling valued and having their opinion heard.
  
  
  CONCLUSIONS
  We believe that patient safety and welfare can benefit from the adoption of a more flexible and person-centred approach to how risk assessments are carried out. Enriching formal guidelines such as the 'Risk Assessment made easy' document with successful techniques and strategies which healthcare staff have informally developed has the potential to not only improve patient safety (since it will be based on the accumulated experience and knowledge of such staff) but also foster higher levels of self esteem amongst healthcare professionals.
authors.affiliation: Lancaster Patient Safety Research Unit, University Hospitals of Morecambe Bay Foundation NHS Trust, Royal Lancaster Infirmary, Lancaster, UK. konstantinos.arfanis@mbht.nhs.uk
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Arfanis
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
mesh_terms: D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D004282:Documentation; D004777:Environment; D006282:Health Personnel / Q000458:organization & administration*; D006801:Humans; D061214:Patient Safety; D018570:Risk Assessment; D017751:Safety Management / Q000458:organization & administration*; D006113:United Kingdom; D017132:Workplace / Q000458:organization & administration