Use of the Generating Options for Active Risk Control (GO-ARC) Technique can lead to more robust risk control options

Abstract

BACKGROUND: Risk assessment is widely used to improve patient safety, but healthcare workers are not trained to design robust solutions to the risks they uncover. This leads to an overreliance on the weakest category of risk control recommendations: administrative controls. Increasing the proportion of non-administrative risk control options (NARCOs) generated would enable (though not ensure) the adoption of more robust solutions. OBJECTIVES: Experimentally assess a method for generating stronger risk controls: The Generating Options for Active Risk Control (GO-ARC) Technique. METHODS: Participants generated risk control options in response to two patient safety scenarios. Scenario 1 (baseline): All participants used current practice (unstructured brainstorming). Scenario 2: Control group used current practice; intervention group used the GO-ARC Technique. To control for individual differences between participants, analysis focused on the change in the proportion of NARCOs for each group. RESULTS: Control group: Proportion of NARCOs decreased from 0.18 at baseline to 0.12. Intervention group: Proportion increased from 0.10 at baseline to 0.29 using the GO-ARC Technique. Results were statistically significant. There was no decrease in the number of administrative controls generated by the intervention group. CONCLUSION: The Generating Options for Active Risk Control (GO-ARC) Technique appears to lead to more robust risk control options. A.J. Card et al. / Use of the Generating Options for Active Risk Control (GO-ARC) Techniqueof these approaches is that they are exclusively focused on problem exploration (risk assessment). They provide no direct support for the process of translating this problem-focused learning into solutionsfocused interventions (risk control) [2,9,13,14].The unexamined assumption behind this state of affairs is that successful risk assessment will necessarily lead to successful risk control. This approach may be successful in the industrial settings where these techniques were developed (the chemical process industry, for instance [15]), but recent evidence suggests that this success does not extend to the fields of healthcare [2] or occupational health and safety [16]. This may reflect that fact that the tools of operational risk assessment were created both by and for engineers, who are specifically trained to develop high-quality, robust solutions in response to identified requirements [17]. Healthcare workers are not trained in these skills [18], nor are they supported by risk management policies and procedures that provide adequate support for this function [14]. As a result, they face significant challenges in generating (and recognizing) high-quality risk controls [2,19,20].The strength of risk controls can be assessed using the three-tiered hierarchy of risk control [2]. The most effective and robust (i.e., prone to continue working over time) category is Elimination of the Hazard or the Target. The intermediate level is made up of Design Controls (aka Engineering Controls [16]), inter...

<p>Risk Management in Executive Levels of Healthcare Organizations: Insights from a Scoping Review (2018)</p>

“…Accept: Risk can be retained in cases where it cannot be avoided or transferred. 25,44,45,53,60 Moreover, theory of problem-solving by an inventive method, 25 Generating Options for Active Risk Control (GO-ARC) Technique 64 and dynamic systems development method (DSDM) 50 used to redesign the process and improve strategies.…”

Physician Burnout: Resilience Training is Only Part of the Solution

“…Not only is this unfair and unsustainable, but it is also likely to be ineffective 19 and sometimes counterproductive. [19][20][21] In recent years, a number of tools have been developed to help health care teams design stronger improvement interventions, 10,[22][23][24][25][26][27] but practice has been slow to change. As a result, administrators who do try to take action on physician burnout may fixate on resilience training without ever considering more effective, systems-oriented solutions.…”

“…Health care organizations also need to leverage the best available tools to design effective and sustainable treatments for the underlying organizational pathologies they uncover. 10,[22][23][24][25][26][27] Hospitals, and increasingly, other health care organizations, already have systems improvement infrastructure in place to help investigate and address causes of adverse outcomes 11 ; we simply have to make sure we are using those resources to protect clinicians as well as patients.…”

Rebalancing risk management—Part 2: The Active Risk Control (ARC) Toolkit

“…The Toolkit has 4 components: The Background section [Establish the Context], the Generating Options for Active Risk Control (GO‐ARC) Technique [Generate Risk Control Options], the Options Analysis worksheets [Analyze Risk Control Options], and the Options Evaluation Matrix [Evaluate Risk Control Options].…”

“…The remaining 2 are intended to ensure that users consider resilience (impact reduction), not just prevention (likelihood reduction). Evidence from a pilot study and an experimental evaluation of the GO‐ARC Technique suggests that use of this tool leads to the generation of a higher proportion of non‐administrative risk controls and that this result comes without the potential negative side effect of generating a reduced number of administrative risk control options.…”