FROM DIAGNOSING PROBLEMS TO IDENTIFYING SOLUTIONS: WHAT CAN HEALTHCARE LEARN FROM HIGH-RISK INDUSTRIES?
Healthcare organisations are encouraged to take on board lessons and tools from high-risk industries. Risk-assessment tools (e.g. root cause analysis; failure mode and effects analysis) are now well-established, but designing and implementing effective risk controls remains a challenge in healthcare. In the safety literature, the concept of a Hierarchy of risk Controls (HOC) has gained in popularity.
HIERARCHY OF CONTROLS WORKING PRINCIPLES
We classified 42 risk controls planned by clinical teams in four NHS hospitals using the HOC proposed by NIOSH. All of the teams had been trained in and were using the Safer Clinical Systems approach.
A total of 42 risk controls were implemented. One qualified as substitution (among the strongest type of risk control), 6 as engineering controls (moderately strong interventions). The vast majority (35) of risk controls features as administrative controls (weakest form of risk control).
Hierarchy of controls models cannot be straightforwardly exported to the healthcare context.
In healthcare, risk controls that are deemed ‘strong’ on the HOC are uncommon because risky processes/entities often cannot be eliminated completely. But ‘weak’ risk controls (e.g. training) have been shown to be very effective in some contexts. Valuable opportunities for tackling persistent challenges to healthcare safety may be lost if healthcare abandons such interventions. A sound link between hazards and risk controls – i.e. a clearly outlined theory of change – is key for successful safety interventions. Different models for categorising risk controls may have more to offer to healthcare.