Examining the relationship between risk assessment and risk management in mental health

Risk assessment is crucial for developing risk management plans to prevent or minimize mental health patients' risks that will impede their recovery. Risk assessments and risk management plans should be closely linked. Their content and the extent to which they are linked within one Trust is explored. There is a great deal of variability in the amount and detail of risk information collected by nurses and how this is used to develop risk management plans. Keeping risk assessment information in one place rather than scattered throughout patient records is important for ensuring it can be accessed easily and linked properly to risk management plans. Strengthening the link between risk assessment and management will help ensure interventions and care is tailored to the specific needs of individual patients, thus promoting their safety and well-being. Thorough risk assessment helps in developing risk management plans that minimize risks that can impede mental health patients' recovery. Department of Health policy states that risk assessments and risk management plans should be inextricably linked. This paper examines their content and linkage within one Trust. Four inpatient wards for working age adults (18-65 years) in a large mental health Trust in England were included in the study. Completed risk assessment forms, for all patients in each inpatient ward were examined (n= 43), followed by an examination of notes for the same patients. Semi-structured interviews took place with ward nurses (n= 17). Findings show much variability in the amount and detail of risk information collected by nurses, which may be distributed in several places. Gaps in the risk assessment and risk management process are evident, and a disassociation between risk information and risk management plans is often present. Risk information should have a single location so that it can be easily found and updated. Overall, a more integrated approach to risk assessment and management is required, to help patients receive timely and appropriate interventions that can reduce risks such as suicide or harm to others. © 2011 Blackwell Publishing.

Investigating mental health risk assessment in primary care and the potential role of a structured decision support tool, GRiST

Aim: To explore current risk assessment processes in general practice and Improving Access to Psychological Therapies (IAPT) services, and to consider whether the Galatean Risk and Safety Tool (GRiST) can help support improved patient care. Background: Much has been written about risk assessment practice in secondary mental health care, but little is known about how it is undertaken at the beginning of patients' care pathways, within general practice and IAPT services. Methods: Interviews with eight general practice and eight IAPT clinicians from two primary care trusts in the West Midlands, UK, and eight service users from the same region. Interviews explored current practice and participants' views and experiences of mental health risk assessment. Two focus groups were also carried out, one with general practice and one with IAPT clinicians, to review interview findings and to elicit views about GRiST from a demonstration of its functionality. Data were analysed using thematic analysis. Findings Variable approaches to mental health risk assessment were observed. Clinicians were anxious that important risk information was being missed, and risk communication was undermined. Patients felt uninvolved in the process, and both clinicians and patients expressed anxiety about risk assessment skills. Clinicians were positive about the potential for GRiST to provide solutions to these problems. Conclusions: A more structured and systematic approach to risk assessment in general practice and IAPT services is needed, to ensure important risk information is captured and communicated across the care pathway. GRiST has the functionality to support this aspect of practice.

Quality planning based on risk assessment

Product quality planning is a fundamental part of quality assurance in manufacturing. It is composed of the distribution of quality aims over each phase in product development and the deployment of quality operations and resources to accomplish these aims. This paper proposes a quality planning methodology based on risk assessment and the planning tasks of product development are translated into evaluation of risk priorities. Firstly, a comprehensive model for quality planning is developed to address the deficiencies of traditional quality function deployment (QFD) based quality planning. Secondly, a novel failure knowledge base (FKB) based method is discussed. Then a mathematical method and algorithm of risk assessment is presented for target decomposition, measure selection, and sequence optimization. Finally, the proposed methodology has been implemented in a web based prototype software system, QQ-Planning, to solve the problem of quality planning regarding the distribution of quality targets and the deployment of quality resources, in such a way that the product requirements are satisfied and the enterprise resources are highly utilized. © Springer-Verlag Berlin Heidelberg 2010.

Concepts and methods of quantitative assessment of risk to groundwater resources

This work presents a two-dimensional approach of risk assessment method based on the quantification of the probability of the occurrence of contaminant source terms, as well as the assessment of the resultant impacts. The risk is calculated using Monte Carlo simulation methods whereby synthetic contaminant source terms were generated to the same distribution as historically occurring pollution events or a priori potential probability distribution. The spatial and temporal distributions of the generated contaminant concentrations at pre-defined monitoring points within the aquifer were then simulated from repeated realisations using integrated mathematical models. The number of times when user defined ranges of concentration magnitudes were exceeded is quantified as risk. The utilities of the method were demonstrated using hypothetical scenarios, and the risk of pollution from a number of sources all occurring by chance together was evaluated. The results are presented in the form of charts and spatial maps. The generated risk maps show the risk of pollution at each observation borehole, as well as the trends within the study area. This capability to generate synthetic pollution events from numerous potential sources of pollution based on historical frequency of their occurrence proved to be a great asset to the method, and a large benefit over the contemporary methods.

Extreme weather events and construction SMEs:vulnerability, impacts and responses

Purpose – The UK experienced a number of Extreme Weather Events (EWEs) during recent years and a significant number of businesses were affected as a result. With the intensity and frequency of weather extremes predicted in the future, enhancing the resilience of businesses, especially of Small and Medium-sized Enterprises (SMEs), who are considered as highly vulnerable, has become a necessity. However, little research has been undertaken on how construction SMEs respond to the risk of EWEs. In seeking to help address this dearth of research, this investigation sought to identify how construction SMEs were being affected by EWEs and the coping strategies being used. Design/methodology/approach – A mixed methods research design was adopted to elicit information from construction SMEs, involving a questionnaire survey and case study approach. Findings – Results indicate a lack of coping strategies among the construction SMEs studied. Where the coping strategies have been implemented, these were found to be extensions of their existing risk management strategies rather than radical measures specifically addressing EWEs. Research limitations/implications – The exploratory survey focused on the Greater London area and was limited to a relatively small sample size. This limitation is overcome by conducting detailed case studies utilising two SMEs whose projects were located in EWE prone localities. The mixed method research design adopted benefits the research by presenting more robust findings. Practical implications – A better way of integrating the potential of EWEs into the initial project planning stage is required by the SMEs. This could possibly be achieved through a better risk assessment model supported by better EWE prediction data. Originality/value – The paper provides an original contribution towards the overarching agenda of resilience of SMEs and policy making in the area of EWE risk management. It informs both policy makers and practitioners on issues of planning and preparedness against EWEs.

Managing risk in information technology projects

There are several studies on managing risks in information technology (IT) projects. Most of the studies identify and prioritise risks through empirical research in order to suggest mitigating measures. Although they are important to clients for future projects, these studies fail to provide any framework for risk management from IT developers' perspective. Although a few studies introduced a framework of risk management in IT projects, most of them are presented from clients' perspectives and very little effort has been made to integrate this with the project management cycle. As IT developers absorb a considerable amount of risk, an integrated framework for managing risks in IT projects from developers' perspective is needed in order to ensure success in IT projects. The main objective of the paper is to develop a risk management framework for IT projects from the developers' perspective. This study uses a combined qualitative and quantitative technique with the active involvement of stakeholders in order to identify, analyse and respond to risks. The entire methodology has been explained using a case study on an information technology project in a public sector organisation in Barbados.

Risk management in build-operate-transfer projects

Construction projects are risky. A build-operate-transfer (BOT) project is recognised as one of the most risky project schemes. This scheme has been employed rather frequently in the past few decades, in both developed and developing countries. However, because of its risky nature, there have been failures as well as successes. Risk analysis in an appropriate way is desirable in implementing BOT projects. There are various tools and techniques applicable to risk analysis. The application of these risk analysis tools and techniques (RATTs) to BOT projects depends on an understanding of the contents and contexts of BOT projects, together with a thorough understanding of RATTs. This paper studies key points in their applications through reviews of relevant literatures and discusses the application of RATTs to BOT projects. The application to BOT projects is considered from the viewpoints of the major project participants, i.e. government, lenders and project companies. Discussion is also made with regard to political risks, which are very important in BOT projects. A flow chart has been introduced to select an appropriate tool for risk management in BOT projects. This study contributes to the establishment of a framework for systematic risk management in BOT projects.

Risk based decision support system for effective implementation of projects

Conventional project management techniques are not always sufficient to ensure time, cost and quality achievement of large-scale construction projects due to complexity in planning, design and implementation processes. The main reasons for project non-achievement are changes in scope and design, changes in government policies and regulations, unforeseen inflation, underestimation and improper estimation. Projects that are exposed to such an uncertain environment can be effectively managed with the application of risk management throughout the project's life cycle. However, the effectiveness of risk management depends on the technique through which the effects of risk factors are analysed/quantified. This study proposes the Analytic Hierarchy Process (AHP), a multiple attribute decision making technique, as a tool for risk analysis because it can handle subjective as well as objective factors in a decision model that are conflicting in nature. This provides a decision support system (DSS) to project management for making the right decision at the right time for ensuring project success in line with organisation policy, project objectives and a competitive business environment. The whole methodology is explained through a case application of a cross-country petroleum pipeline project in India and its effectiveness in project management is demonstrated.

Cues and knowledge structures used by mental-health professionals when making risk assessments

Background: Research into mental-health risks has tended to focus on epidemiological approaches and to consider pieces of evidence in isolation. Less is known about the particular factors and their patterns of occurrence that influence clinicians’ risk judgements in practice. Aims: To identify the cues used by clinicians to make risk judgements and to explore how these combine within clinicians’ psychological representations of suicide, self-harm, self-neglect, and harm to others. Method: Content analysis was applied to semi-structured interviews conducted with 46 practitioners from various mental-health disciplines, using mind maps to represent the hierarchical relationships of data and concepts. Results: Strong consensus between experts meant their knowledge could be integrated into a single hierarchical structure for each risk. This revealed contrasting emphases between data and concepts underpinning risks, including: reflection and forethought for suicide; motivation for self-harm; situation and context for harm to others; and current presentation for self-neglect. Conclusions: Analysis of experts’ risk-assessment knowledge identified influential cues and their relationships to risks. It can inform development of valid risk-screening decision support systems that combine actuarial evidence with clinical expertise.

Development of a risk-oriented strategic sourcing (ROSS) framework for the construction and electronics manufacturing industries

Strategic sourcing has increased in importance in recent years, and now plays an important role in companies’ planning. The current volatility in supply markets means companies face multiple challenges involving lock-in situations, supplier bankruptcies or supply security issues. In addition, their exposure can increase due to natural disasters, as witnessed recently in the form of bird flu, volcanic ash and tsunamis. Therefore, the primary focus of this study is risk management in the context of strategic sourcing. The study presents a literature review on sourcing based on the 15 years from 1998–2012, and considers 131 academic articles. The literature describes strategic sourcing as a strategic, holistic process in managing supplier relationships, with a long-term focus on adding value to the company and realising competitive advantage. Few studies discovered the real risk impact and status of risk management in strategic sourcing, and evaluation across countries and industries was limited, with the construction sector particularly under-researched. This methodology is founded on a qualitative study of twenty cases across Ger-many and the United Kingdom from the construction sector and electronics manufacturing industries. While considering risk management in the context of strategic sourcing, the thesis takes into account six dimensions that cover trends in strategic sourcing, theoretical and practical sourcing models, risk management, supply and demand management, critical success factors and the strategic supplier evaluation. The study contributes in several ways. First, recent trends are traced and future needs identified across the research dimensions of countries, industries and companies. Second, it evaluates critical success factors in contemporary strategic sourcing. Third, it explores the application of theoretical and practical sourcing models in terms of effectiveness and sustainability. Fourth, based on the case study findings, a risk-oriented strategic sourcing framework and a model for strategic sourcing are developed. These are based on the validation of contemporary requirements and a critical evaluation of the existing situation. It contemplates the empirical findings and leads to a structured process to manage risk in strategic sourcing. The risk-oriented framework considers areas such as trends, corporate and sourcing strategy, critical success factors, strategic supplier selection criteria, risk assessment, reporting, strategy alignment and reporting. The proposed model highlights the essential dimensions in strategic sourcing and guides us to a new definition of strategic sourcing supported by this empirical study.

Linking risk management to strategic controls:a case study of Tesco plc

Definitions and perceptions of the role and styles of risk management, and performance management/strategic control systems have evolved over time, but it can be argued that risk management is primarily concerned with ensuring the achievement of strategic objectives. This paper shows the extent of overlap between a broad-based view of risk management, namely Enterprise Risk Management (ERM), and the balanced scorecard, which is a widely used strategic control system. A case study of one of the UK's largest retailers, Tesco plc, is used to show how ERM can be introduced as part of an existing strategic control system. The case demonstrates that, despite some differences in lines of communications, the strategic controls and risk controls can be used to achieve a common objective. Adoption of such an integrated approach, however, has implications for the profile of risk and the overall risk culture within an organisation.

Developing a probabilistic graphical structure from a model of mental-health clinical risk expertise

This paper explores the process of developing a principled approach for translating a model of mental-health risk expertise into a probabilistic graphical structure. The Galatean Risk Screening Tool [1] is a psychological model for mental health risk assessment based on fuzzy sets. This paper details how the knowledge encapsulated in the psychological model was used to develop the structure of the probability graph by exploiting the semantics of the clinical expertise. These semantics are formalised by a detailed specification for an XML structure used to represent the expertise. The component parts were then mapped to equivalent probabilistic graphical structures such as Bayesian Belief Nets and Markov Random Fields to produce a composite chain graph that provides a probabilistic classification of risk expertise to complement the expert clinical judgements. © Springer-Verlag 2010.

Defining an OWL ontology that could be used to integrate mental-health risk information within a decision support system

In the field of mental health risk assessment, there is no standardisation between the data used in different systems. As a first step towards the possible interchange of data between assessment tools, an ontology has been constructed for a particular one, GRiST (Galatean Risk Screening Tool). We briefly introduce GRiST and its data structures, then describe the ontology and the benefits that have already been realised from the construction process. For example, the ontology has been used to check the consistency of the various trees used in the model. We then consider potential uses in integration of data from other sources. © 2009 IEEE.

Impacts of flooding on SMEs and their relevance to chartered surveyors:

This is the final report of the RICS Education Trust funded “Developing Flood Expert Knowledge in Chartered Surveyors – DEFENCES” research project. The UK has endured a number of major flood events in recent years, and the UK Environment Agency (2009a) identified that about 5.2million properties in England, amounting to one in six, are at risk of flooding. The impacts of flooding include direct and indirect impacts and can be particularly devastating for small and medium-sized enterprises (SMEs) who are generally more vulnerable to such events than larger business organisations. Recent flood events have established how costly flooding can be to the SME sector (Pitt, 2008, ABI, 2010), which has given greater impetus to the need to improve the resilience of at-risk SMEs. A lack of professional advice on flood protection and adaptation measures represents a potential barrier to the uptake of such interventions by SMEs. A recent Royal Institution of Chartered Surveyors (RICS) survey, as quoted in Defra (2008) notes that, although a majority of chartered surveyors would like to work in this area of practice (flood risk assessment and adaptation), they are conscious of gaps in their competency, knowledge and understanding. The research project sought to contextualise this broader issue and investigate how chartered surveyors can bridge the gap in providing professional flood advice to SMEs. Further, a shift in the UK government policy on flood risk management is evident, where at-risk communities are urged to adapt to flooding. This places greater emphasis on property-level flood adaptation, providing further impetus for Chartered Surveyors to be involved. Findings of the research will be of interest to the RICS, the RICS Flood steering Group, practicing surveyors generally, SMEs, business support and policy making organisations.

Emerging of human factor in risk analysis of home care service

Risk management in healthcare represents a group of various complex actions, implemented to improve the quality of healthcare services and guarantee the patients safety. Risks cannot be eliminated, but it can be controlled with different risk assessment methods derived from industrial applications and among these the Failure Mode Effect and Criticality Analysis (FMECA) is a largely used methodology. The main purpose of this work is the analysis of failure modes of the Home Care (HC) service provided by local healthcare unit of Naples (ASL NA1) to focus attention on human and non human factors according to the organization framework selected by WHO. © Springer International Publishing Switzerland 2014.