Last Wednesday was busy. I had squeezed a quart of endeavour into a pint-pot of time and with a 20 minute walk down Regent Street between two meetings I reached for my iPhone to make a couple of pressing calls. No service - again. Since lunchtime I had consistently failed to get a signal and now things were beginning to stack up. Confident that a solution was at hand I made a quick pit stop at the Apple Store, where one of the smiley lads in blue can usually be relied on to sort out any such technical nonsense. But this time there was no joy to be had. Wilfred (an improbable name, but matching his nametag) sympathised. He was having the same issue. The O2 network was down and that was that. I scowled jealously at passers-by, happily chatting on their mobiles on other services.
Later in the evening, as the O2 network spluttered back to life, the social networks were buzzing like angry hornets. Dependence on these large wireless systems has infiltrated our daily lives, and so when some glitch or other takes the network down for an afternoon, our ability to carry on suddenly evaporates. We are left holding an expensive but impotent lump of metal and plastic.
In healthcare risk management, we are constantly on the lookout for the clinical equivalents to this. High Impact Low Probability events (HILPs) are those unreasonably unlikely banana skins that, in any normal walk of life, one would take a measured risk with.
So we all know that it is possible that our phone network will go down for a day or two, but most of us don’t think it worth mitigating this risk by always carrying two phones on different networks. We take our chances, and get hot under the collar on the one afternoon a year when the network goes 'phut'.
But in healthcare we often can't take that risk. Most of healthcare is about taking measured risks, actually. All the time healthcare professionals are balancing the risk of intervention with the risk of no intervention. And as patients with long-term illnesses are navigated into increasing levels of support, the potential catastrophic effect of a HILP becomes magnified. Statins, anti-coagulants, telehealth support, the visit from meals-on-wheels and even that reliable walking stick all become woven into a life, and any small failure in the one can have a domino effect elsewhere.
If I reflect on Wednesday's 'minor disaster' it makes me wonder how it impacted on the people reliant upon the 02 network for their own personal safety - not least within the telecare world. I wonder if that risk had been fully understood beforehand.
Good governance, quality assurance and risk management should be looked on as umbrellas we hope we never have to open. Often derided as a rising tide of tick-box silliness, good clinical risk management thinks through the possible HILPs awaiting a patient and tries to balance the costs and consequences of how these can be avoided or mitigated.
As we increasingly use mechanised and technological systems to support the lives of our patients, we need to invest in state-of-the-art risk avoidance systems to keep our patients safe. The science of patient safety largely grew out of risk management systems within pharmacy, and the use of aviation-inspired safety systems such as Crew Resource Management have been being introduced into surgery settings for many years now. But too often we at the Good Governance Institute (GGI) are seeing a reluctance to invest in great safety systems for IT supported patient care.
For example, only a handful of healthcare organisations have reached the cross-industry ISO 27001 standard for information security and information governance. As consumers, we'd expect nothing else of companies such as eBay or Amazon, but strangely most acquiesce to a lesser standard for the growing number of technological systems that support the lives of thousands of vulnerable patients.
Thankfully, no significant HILP has yet effected healthcare delivery on a national scale, but one would be foolhardy ignore the possibility. At GGI, we'd like to see all healthcare boards start to discuss the role patient safety needs to play when introducing technological systems to support the lives of patients, and to take responsibility for tracking down possible HILPs.
Last year, we published "Better care for people with long-term conditions: the quality and good governance of telehealth service" which can be downloaded free from our website. We suggest you do, and pass on a copy to each member of your board. This year we'll be publishing further guidance for healthcare boards, encouraging a safe and thoughtful introduction of the technology that will, without doubt, bring benefit to hundreds of thousands of patients over the coming years. Hopefully, without HILPs.
The Good Governance Institute is being developed as a reference centre to help push governance thinking forward and to help organisations improve their own governance.
www.good-governance.org.uk