Learning from high risk industries may not be straightforward: a qualitative study of the hierarchy of risk controls approach in healthcare

Abstract

ObjectiveThough healthcare is often exhorted to learn from ‘high-reliability’ industries, adopting tools and techniques from those sectors may not be straightforward. We sought to examine the hierarchies of risk controls approach, used in high-risk industries to rank interventions according to supposed effectiveness in reducing risk, and widely advocated as appropriate for healthcare.DesignClassification of risk controls proposed by clinical teams following proactive detection of hazards in their clinical systems. Classification was based on a widely used hierarchy of controls developed by the US National Institute for Occupational Safety and Health (NIOSH).Setting and participantsA range of clinical settings in four English NHS hospitals.ResultsThe four clinical teams in our study planned a total of 42 risk controls aimed at addressing safety hazards. Most (n = 35) could be classed as administrative controls, thus qualifying among the weakest type of interventions according to the HoC approach. Six risk controls qualified as ‘engineering’ controls, i.e. the intermediate level of the hierarchy. Only risk control qualified as ‘substitution’, classified as the strongest type of intervention by the HoC.ConclusionsMany risk controls introduced by clinical teams may cluster towards the apparently weaker end of an established hierarchy of controls. Less clear is whether the HoC approach as currently formulated is useful for the specifics of healthcare. Valuable opportunities for safety improvement may be lost if inappropriate hierarchical models are used to guide the selection of patient safety improvement interventions. Though learning from other industries may be useful, caution is needed.

Occupational health and safety hazards faced by healthcare professionals in Taiwan: A systematic review of risk factors and control strategies

“…20 Nonetheless, many researchers and professionals agree that all such controls should be applied collectively, in order to minimize the effects of hazards. 20,[70][71][72] Work-related stressors have a detrimental impact on worker's health and safety, in terms of mental, musculoskeletal, chronic degenerative disorders, metabolic syndrome diabetes, and cardiovascular diseases. 61 Psychological hazards at work were associated with heart disease, depression, physical health problems, and psychological strain.…”

Infection control measures, in situ simulation, and failure modes and effect analysis to fine-tune change management during COVID-19

“…Containment measures were classified and grouped according to the Hierarchy of Controls (HoC) approach [ Figure 1 ]. [ 27 ] This approach is often used to manage and control exposures to workplace hazards, including in the health-care setting. The three principles of HoC relevant to our management of the pandemic response are: (a) elimination and control of the “hazard” is the most effective option; (b) errors due to human factors can occur and thus we must use techniques and approaches to reduce and mitigate these errors; and (c) management of risks due to human behavior is very challenging.…”

“…The three principles of HoC relevant to our management of the pandemic response are: (a) elimination and control of the “hazard” is the most effective option; (b) errors due to human factors can occur and thus we must use techniques and approaches to reduce and mitigate these errors; and (c) management of risks due to human behavior is very challenging. [ 27 ] With the COVID-19 pandemic, faced with a primarily respiratory pathogen, the attainment of process control can be achieved via innovation/engineering, administrative measures, and PPE (inclusive of other nonpharmaceutical approaches).…”

Can we import improvements from industry to healthcare?

“…Healthcare quality improvement owes its existence to other industries. Process re-engineering and systems improvement tools such as lean production, 29 plan-do-study-act cycles, 5 statistical process control, 30 and failure modes and effects analysis 31 have been imported into healthcare almost wholesale.…”

“…Reviews suggest that they are not always consistently or effectively applied in healthcare. 5 31 This might be partly because individuals and teams are not appropriately trained or experienced in the particular method. 5 But more fundamentally, it points to the importance of having appropriate organisational systems, resources, and culture in place to support the systematic application of improvement methods.…”