1. Clinical Governance

Diversity and high-risk groups

Action 1.15

The health service organisation:

a. Identifies the diversity of the consumers using its services

b. Identifies groups of patients using its services who are at higher risk of harm

c. Incorporates information on the diversity of its consumers and higher-risk groups into the planning and delivery of care

Intent

The diversity of consumers and high-risk groups are considered in the planning and delivery of care and services.

Reflective questions

What are the sociodemographic characteristics of the patient population?

How do these characteristics affect patient risk of harm?

How is this information used to plan service delivery and manage inherent risks for patients?

Key tasks

  • Periodically audit the clinical and administrative data systems to identify the diversity of the patients using the organisation's health services
  • Develop strategies to identify high-risk patients, and mechanisms to provide extra safety and quality protections for these patients.

Strategies for improvement

Hospitals

Understanding the characteristics of the patient population allows organisations to identify groups of patients who may be at greater risk of harm, or who are more likely to have a poor experience of health care because of their condition, age or gender; social, economic or geographic circumstances; cultural background, religion or preferred language; or sexuality.

Identify the groups of patients using the health service who have an increased risk of harm, and implement strategies to proactively manage these risks. This may involve:

  • Reviewing demographic data (such as age, gender, postcode or ethnicity) to understand the diversity of the patient population
  • Analysing relevant data to determine the key risks faced by different demographic groups
  • Conducting a risk assessment for groups of patients, procedures or locations of treatments that are known to be high risk
  • Discussing the strategies to overcome these risks with the clinical governance committee, the clinical workforce or representatives of the different risk groups.

Strategies for each group may vary widely, and may need to be tailored to individual patients.

Incorporate patient risk assessment processes in the organisation’s quality improvement system if there are specific risks associated with particular types of patients or locations of treatment.

Ensure that clinical guidelines and pathways for particular conditions or interventions incorporate risk management strategies (for example, preoperative anaesthetic assessment) relevant to known patient risk groups (for example, bariatric patients).

Monitor the health outcomes for at-risk patient groups and the actions taken to manage the risks.

Monitor the risk management system and relevant external sources of information (for example, coroners’ reports, published literature) to identify emerging risks affecting particular groups of patients.

Examples of evidence

Select only examples currently in use:

  • Demographic data for the health service organisation and community that are used for strategic planning purposes
  • Organisational risk profile that details patient safety and quality risks, and their potential impact
  • Results of an assessment or survey of local health needs
  • Strategic or business plans that reflect the diversity of the patient population
  • Training documents on diversity and cultural awareness
  • Consumer information that is available in different formats and languages that reflect the diversity of the patient population
  • List of local interpreters or consumer advocacy services, and reports on interpreter use and access
  • Examples of actions taken to meet the needs of high-risk patients (for example, cultural awareness events)
  • Health service organisation representation at local network meetings that reflect the local diversity of the patient population
  • Membership of committees with consumer representation that reflect the diversity of the patient population.
Day Procedure Services

Identify the groups of patients using the health service who have an increased risk of harm, and implement strategies to proactively manage these risks. This may involve:

  • Reviewing demographic data (such as age, gender, postcode or ethnicity) to understand the diversity of the patient population
  • Analysing relevant data to identify the key risks faced by different demographic groups
  • Conducting a risk assessment for groups of patients, procedures or locations of treatments that are known to be high risk
  • Discussing the strategies to overcome these risks with the clinical governance committee, the clinical workforce or representatives of the different risk groups.

In day procedure services, pre-admission screening processes for patients should include collecting demographic information and information on relevant risk factors. See Action 5.10 for more information about screening processes.

Strategies for each group may vary widely, and may need to be tailored to individual patients.

Incorporate patient risk assessment processes in the organisation’s quality improvement system if there are specific risks associated with particular types of patients or locations of treatment.

Ensure that clinical guidelines and pathways for particular conditions or interventions incorporate risk management strategies (for example, preoperative anaesthetic assessment) relevant to known patient risk groups (for example, bariatric patients).

Monitor the health outcomes for at-risk patient groups and the actions taken to manage the risks.

Monitor the risk management system and relevant external sources of information (for example, coroners’ reports, published literature) to identify emerging risks affecting particular groups of patients.

Examples of evidence

Select only examples currently in use:

  • Demographic data for the health service organisation and community that are used for strategic planning purposes
  • Organisational risk profile that details patient safety and quality risks, and their potential impact
  • Results of an assessment or survey of local health needs
  • Strategic or business plans that reflect the diversity of the patient population
  • Training documents on diversity and cultural awareness
  • Consumer information that is available in different formats and languages that reflect the diversity of the patient population
  • List of local interpreters or consumer advocacy services, and reports on interpreter use and access
  • Examples of actions taken to meet the needs of high-risk patients (for example, cultural awareness events)
  • Health service organisation representation at local network meetings that reflect the local diversity of the patient population
  • Membership of committees with consumer representation that reflect the diversity of the patient population.
MPS & Small Hospitals

Understanding the characteristics of the patient population allows organisations to identify groups of patients that may be at greater risk of harm, or who are more likely to have a poor experience of health care because of their condition, age or gender; social, economic and geographic circumstances; cultural backgrounds, religion or preferred languages spoken; or sexuality.

Identify the groups of patients using the health service who have an increased risk of harm, and implement strategies to proactively manage these risks. This may involve:

  • Reviewing demographic data (such as age, gender, postcode or ethnicity) to understand the diversity of the patient population
  • Analysing relevant data to determine the key risks faced by different demographic groups
  • Conducting a risk assessment for groups of patients, procedures or locations of treatments that are known to be high risk
  • Developing strategies to identify high-risk patients, and mechanisms to provide extra safety and quality protections for those patients
  • Discussing the strategies to overcome these risks with the clinical governance committee, the clinical workforce or representatives of the different risk groups.

Examples of evidence

Select only examples currently in use:

  • Demographic data for the health service organisation and community that are used for strategic planning purposes
  • Organisational risk profile that details patient safety and quality risks, and their potential impact
  • Results of an assessment or survey of local health needs
  • Strategic or business plans that reflect the diversity of the patient population
  • Training documents on diversity and cultural awareness
  • Consumer information that is available in different formats and languages that reflect the diversity of the patient population
  • List of local interpreters or consumer advocacy services, and reports on interpreter use and access
  • Examples of actions taken to meet the needs of high-risk patients (for example, cultural awareness events)
  • Health service organisation representation at local network meetings that reflect the local diversity of the patient population
  • Membership of committees with consumer representation that reflect the diversity of the patient population.
Last updated 30th May, 2018 at 09:45pm
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