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Executive Summary: MORPH UK Project Survey, February-May 2003

The Project

Management of Risks and Practices in Healthcare (MORPH) is a trans-national study examining risks in healthcare institutions, focusing on the implementation of best practice training. The Project is co-funded by the European Commission under the Leonardo da Vinci Programme and involves Partners in four countries, Bulgaria, Ireland, Poland and the United Kingdom. The Project coordinator and project originator is the Interesource Group (Ireland) Ltd. Partners involved include the Health Care Association, Burgas, Bulgaria; the Division of Legal Medicine, University College, Dublin, Ireland; the Foundation for Promotion of Entrepreneurship, Lodz, Poland and the Dept. of Medical Physics, University of Dundee, UK.

MORPH aims to identify trends and practices in healthcare institutions and increase awareness of risk management across Europe. In order to equip practitioners and professionals involved in healthcare with the necessary risk management skills, the project will produce:

• an educational tool for training that consists of reports and a collection of essays
• an interactive CDROM comprising of best practice video interviews
• a series of case studies
• a multilingual website will also be developed to share information across the partner countries
• an e-learning guide

The Survey

A comprehensive survey was designed and distributed in each of the four countries identified above. Over 850 completed responses were recorded. The survey was carried out between early February and early May 2003 and was targeted at healthcare practitioners in both the primary and secondary sectors.

In the UK, 1,650 copies of the questionnaire were dispatched to database addresses of healthcare practitioners and through mailings to members, organised by institutions in the healthcare field. 206 questionnaires were returned completed, of which 21 were filled in on line. 88% of the responses came from NHS Acute, Primary Care and Ambulance Trusts, with 10% originating in General Practice. 49% of respondents described themselves as risk managers, health & safety managers, risk coordinators or corporate governance managers. Other significant groups represented included senior administrators, executive directors and medical directors, 26%, consultants 13%, and general practitioners, 9%. The other 3% were made up of chief executives, academics and nurses.

Summary of Key Findings

The Risk Management Process

The survey sought to identify elements of the risk management process within organisations. Of the respondents:

• 92% have a specific risk management policy
• 93% have a defined risk management process
• Only 27% have a specific budget for risk management
• The most important projected outcome for having the process is quality of patient care
• 59% believed that the risk management process is satisfactory in their organisation

These findings demonstrate that the vast majority of organisations in the UK have a risk management process in place, with the majority satisfied with the process and the ability of it to improve quality of patient care.

Risk Management Education and Training

• 26% hold a risk management qualification
• 70% do not have a mandatory system of continuing education in place for risk managers whilst 75% do have such a system for clinical personnel
• 82% reported that the results of clinical audits are fed back to clinical staff

Medico-Legal Aspects of Clinical and Non-Clinical Risks

• Most respondent organisations provide training in patient consent, record keeping/data protection and health & safety legislation
• 90% reported having a health & safety statement
• 95% of clinical & non clinical personnel receive training in health & safety
• 76% report that this training is mandatory
• 44% of organisations reported an increase in clinical negligence litigation over the last three years, 15% a decrease and 41 % no change
• Of the 46% who could quote data on percentage of annual budget used in litigation, 20% reported 0.76-3%

Benefits, Outcomes and Impact

Since the introduction of the risk management process:

• Only 12% reported a reduction in litigation costs
• 25% a reduction in patient complaints
• 26% an increase in staff morale
• 35% an improvement of patient care

However in some of these cases, 40-55% of all respondents were not able to answer definitively with a figure for change, either increase or decrease. This suggests that more careful monitoring of the outcomes of the process is necessary in many cases.

• Only 15% reported a reduction in medical indemnity costs
• Public liability insurance costs were only reduced in 16% of cases
• However 41% reported that the risk management process would lead to a reduction in litigation costs and 82% an improvement in delivery of healthcare

All the findings in this section suggest that the benefits of the risk management processes that are in place in the UK have yet to achieve their full potential for positive change.

Role of the Courts and Government

• 63% believe that the Government should have a role in the regulation of the risk management process
• 69% believe that the courts provide a medium for a fair hearing
• The majority, 65%, report that clinical negligence litigation should be maintained within the court system and most favour the establishment of specialised medical courts
• 87% responded that the Alternative Dispute System (ADR) should be utilised in matters of clinical negligence

Concerns for the Future

• Funding
• Time constraints
• Bringing all to the same level of clinical governance and risk management skills
• The Compensation Culture
• Bureaucracy in the implementation of procedures and practices

This Survey reveals a fairly advanced and sophisticated system of risk management process is in place in the UK but the benefits are still to be fully revealed and there are legitimate concerns for the future.

page last modified 13th November, 2003

This web site is a product of the MORPH project which is made possible with the financial assistance of the European Commission under the Leonardo da Vinci programme. The content is the sole responsibility of its authors and in no way represents the opinions of the Commission or its departments.