Trust-Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem-focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution-focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational-level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety. © 2013 Society for Risk Analysis.

Modeling mode i fracture of bitumen films

The fracture behavior of thin films of bitumen in double cantilever beam (DCB) specimens was investigated over a wide range of temperature and loading rate conditions using finite-element analysis. The model includes a phenomenological model for the mechanical behavior of bitumen, implemented into a special-purpose finite-element user material subroutine, combined with a cohesive zone model (CZM) for simulating the fracture process. The finite-element model is validated against experimental results from laboratory tests of DCB specimens by comparing measured and predicted load-line deflection histories and fracture energy release rates. Computer simulation results agreed well with experimental data of DCB joints containing bitumen films in terms of peak stress, fracture toughness, and stress-strain history response. The predicted "normalized toughness," G=2h, was found to increase in a power-law manner with effective temperaturecompensated strain rate in the ductile region as previously observed experimentally. In the brittle regime, G=2h is virtually constant. The model successfully captured the ductile and brittle failure behavior of bitumen films in opening mode (tension) for stable crack growth conditions. © 2013 American Society of Civil Engineers.