title: Trust-level risk identification guidance in the NHS East of England.
abstract: BACKGROUND
  In healthcare, a range of methods are used to improve patient safety through risk identification within the scope of risk management. However, there is no evidence determining what trust-level guidance exists to support risk identification in healthcare organisations. This study therefore aimed to determine such methods through the content analysis of trust-level risk management documents.
  
  
  METHODS
  Through Freedom of Information Act, risk management documents were requested from each acute, mental health and ambulance trust in the East of England region of NHS for content analysis. Received documents were also compared with guidance from other safety-critical industries to capture differences between the documents from those industries, and learning points to the healthcare field.
  
  
  RESULTS
  A total of forty-eight documents were received from twenty-one trusts. Incident reporting was found as the main method for risk identification. The documents provided insufficient support for the use of prospective risk identification methods, such as Prospective Hazard Analysis (PHA) methods, while the guidance from other industries extensively promoted such methods.
  
  
  CONCLUSIONS
  The documents provided significant insight into prescribed risk identification practice in the chosen region. Based on the content analysis and guidance from other safety-critical industries, a number of recommendations were made; such as introducing the use of PHA methods in the creation and revision of risk management documents, and providing individual guidance on risk identification to promote patient safety further.
authors.affiliation: University College London, Department of Management Science and Innovation, London, UK.
authors.forename: M C Emre
authors.initials: MC
authors.lastname: Simsekler
authors.affiliation: Evidence-Based Health Solutions, LLC, Notre Dame, IN, USA.
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Card
authors.affiliation: University of Cambridge, Department of Engineering, Engineering Design Centre, Cambridge, UK.
authors.forename: James R
authors.initials: JR
authors.lastname: Ward
authors.affiliation: University of Cambridge, Department of Engineering, Engineering Design Centre, Cambridge, UK.
authors.forename: P John
authors.initials: PJ
authors.lastname: Clarkson
mesh_terms: D004739:England; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D061214:Patient Safety; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012308:Risk Management / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration*
keywords: Healthcare risk management; health policy; patient safety; risk identification