Anne Smillie, RN, MA (Applied) Nursing, Clinical Nurse Leader, Emergency Department, Taranaki Base Hospital, New Plymouth
Smillie, A. (2006). Historical investigations: Risk management in a New Zealand hospital 1888-1905. Nursing Praxis in New Zealand, 22(2), 33-38.
This article reports an historical research project in which four events within one hospital are examined from the point of view of what, today, would be termed ‘risk management’. The examples involve a nurse sustaining injury in the course of her work, a fire in the hospital and two instances of patient complaints – one concerning nursing care and the other relating to a time lag between admission to hospital and receiving medical attention. All would have their counterparts in situations dealt with by today’s Risk Management Departments. Analysis of the processes followed in investigating these occurrences reveals what seem to be two major differences when compared to present day practices. As well as being smaller in scale and less bureaucratic the earlier investigations were based on a culture of blame. It is argued that modern risk management approaches rather than being geared toward apportioning blame are more focused on understanding what can be learned from the incident with respect to preventing recurrence.
Key Words: Nursing history, risk management.
Modern hospitals and health boards have Risk Management Departments to deal with situations that could have adverse effects for patients and other members of the organisation. Risk management is in place to anticipate and investigate possible physical hazards, undesirable practices and questionable systems, any of which could have adverse outcomes and social consequences which expose the organisation to public disquiet. Modern day risk management ensures that there are systems in place to investigate adverse events, formalise a complaints process and ensure health professional competence.1 Around these systems a vocabulary and a variety of models to explain past and present attitudes to risk management have developed. For instance, a “sentinel event” is defined as “an unexpected occurrence involving death or serious physical and psychological injury, or the risk thereof”;2 and “credentialling” is “a process for assigning specific clinical responsibilities (scope of practice) to health professionals on the basis of their training, qualifications, experience and current practice, within an organisational context”.3 One study of the safety culture in New Zealand’s hospitals4 discusses the various models that can be applied in this context, and illustrates how modern day perception has moved from a blame culture to a more positive model that is called “Sharp end, blunt end” in which “the focus shifts from the individual at the sharp end, the practitioner, to others, primarily managers, in the system, the blunt end”.5