Introduction to QI Standard 3

Clinical risk management is the process of improving the quality and safety of healthcare services by identifying the circumstances and opportunities that put patients at risk of harm, and then acting to prevent or control those risks.⁵ You need to foster a just, open and supportive culture in order to minimise and respond to near misses and adverse events.

Adverse events and near misses are events or circumstances that could have resulted, or did result, in unnecessary harm to a patient.⁶ Both are valuable learning opportunities from which you can gain insights into how to improve your practice and preserve life and health.

While individual accountability and integrity is essential, blaming individual practitioners is not necessarily going to help identify problems in your systems and processes. It is far more effective to be thoughtful and supportive.

Members of the practice team must know how and whom to report a near miss or adverse event, or an unanticipated patient outcome.

The clinical governance of your practice gives you management and organisational structure for continuously improving the quality of your services and patient care.⁷ It creates an environment where excellence in clinical care will flourish because all team members accept responsibility for the services and care the practice provides.^8,9