In my last blog, I looked at the issue of staff safety versus patient safety risk. I am going to start this blog with a sad story I shared in that earlier blog. But don’t shut down on me just yet-I am looking at the incident from a different angle. Imagine that an otherwise healthy 80-year old man is admitted onto a medical ward in an NHS hospital for a severe chest infection. This man who walked into hospital on his own becomes bed bound and now needs assistance with changing his posture and repositioning in bed. A patient moving and handling assessment states that the use of low friction slide sheets is the safe method of moving the patient to keep the risk to patient and staff as low as possible.
Conspiracy of Failures
The ward is short staffed (human resource issue) and there were no slide sheets in sight (resource issue) due to budget cuts (finance issue). So staff regularly ignore the assessment and use a bed sheet for repositioning the patient; and they end up causing friction burns. One thing leads to another causing a) the death of the patient from a secondary infection which resulted from a pressure ulcer; this was reported on a clinical incident form and b) shoulder injury to a nurse from overexertion; this was recorded on a ‘non-clinical’ accident form. Both of these reports and data were filtered to and considered by separate committees- the Clinical Governance and Corporate Governance Committees respectively. The context of the incident, the connection between patient and staff safety and the opportunity to take an integrated approach to learning from the event were all lost.
If you are a risk, assurance, or quality manager; moving and handling practitioner or are involved with the subject in any way, you may recognise the scenario I just described. This sad story raises the issue that I want to address in this blog: The way that moving and handling risk is usually classed as non-clinical risk within the broader risk management structures in health and social care.
Presentation of Moving & Handling Risk
In my experience, most NHS Trusts structure their governance arrangements broadly under clinical or corporate governance, with a separate committee reporting to the board responsible for each aspect. Usually, quality and clinical issues are allocated to clinical governance and supposedly non-clinical governance issues like finance, information, and research governance and non-clinical risk management are classified under corporate governance. The anecdote above shows the flaw in this arrangement and the interdependence between clinical and non-clinical elements of governance.
I understand, but cannot possibly excuse the reason why we have done things this way. In my own experience there are two reasons why we class risk as clinical and non-clinical and put moving and handling in the latter group. The first is that, even though the evidence blatantly shows us the opposite, we somehow subconsciously act like moving and handling is a staff safety issue with little bearing on patients. Historically, anything that involves staff is classed as non-clinical and whatever involves patients is grouped as clinical. For us to present moving and handling risk management as something mainly aimed at staff safety is wrong. Moving and handling is first and foremost about patient safety and then staff safety.
The second is that we see moving and handling as an ancillary service and traditionally other services in this group are classed as non-clinical. The anecdote above shows the error of both of these ways of thinking. It goes against common sense to distinguish between clinical and non-clinical risk. Risk is risk, full stop! Our patients do not care what label the risk goes by; what they care about is safety. And it makes much more sense if we adopt an integrated approach to risk since it is the same group of people who suffer whenever things go wrong-patients and staff.
Before I go
Before I close this blog, I want to leave you with a few final words:
Avoid unhelpful classification of risk into clinical and non-clinical
- Begin to work towards an integrated approach to your risk management not just in merging clinical and non-clinical risk but also in linking the management of the different risks to which patients are exposed-moving and handling, tissue viability, infection control and falls all have very common grounds
- See moving and handling first as a patient safety and then a staff safety issue