088 - Risk Management Study Group
Autor(s): G. Casiraghi
Issue: RIMeL - IJLaM, Vol. 2, N. 3-S1, 2006 (MAF Servizi srl ed.)
Page(s): 88-93
Though lacking accurate statistics, many compensation claims are made every year in Italy in the health structures. In Lombardy a mapping study of accident occurrences during the 1999-2004 period has been made. This well known phenomenon has been studied in depth in some European countries and in Northern America. Called Clinical Governance, it showed the essential part played by Risk Management, the analysis of risk, especially in the case of clinical risk. These studies have produced a new way of interpreting error in health, which led to noticeable improvements where it has become institutional (Vanderbilt University, NHS, etc.) The mass of reports put together and the examination of the case study method made it possible to evidence a series of common elements, the repetitiveness of signaled suspected errors being the first, both in terms of typology and of specialist area. This led to consider the existence of situations, environmental conditions and elements which structurally concur to make error more likely and frequent. On the other hand, these same elements show that it is possible to act and prevent repetition of damaging situations through activities focused on risk management. It is in that frame of reference that the activity of the Risk Management Study Group developed, leading to various proposals, both didactic and applicative. An example is microbiology in the Lanciano Analysis Laboratory where, by adapting the Reason mo del, they looked for the latent errors and analyzed the active error, combining them during the pre-analysis step with the indicators for wards and laboratory related to the analysis and post-analysis steps. All this without neglecting the answer time (TAT), with its time and quality corollaries, which concur to give the best possible answer. Another example concerns a legal risk analysis related to privacy (196/ 2003- law in Italy): the law articles are grouped in several parts: a general one with the terms vocabulary, one with the citizen’s rights, and a third one with those aspects which concern the health operators and structures. The final step includes civil and penal obligations and penalties. The newsletter produced starting two years ago and distributed by mail and through the SIMeL partnership site is also presented.