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Principles and practice in an era of clinical governance
Although doctors have been described as natural risk takers,1 the assessment approach to their care of patients could more accurately be described as risk management. The broader postgraduate learning of pathologists adds to this clinical approach with topics such as health and safety and occupational health hazards. Despite all this, formal instruction in risk management is absent from the current training programme of the Royal College of Pathologists. This demands attention because in relation to patients and doctors, the risk reduction approach is a fundamental pledge made by the government, the medical profession, and the National Health Service (NHS).2 It is also reflected in the new Clinical Pathology Accreditation guidelines, which focus on continual improvement as a central and integral component of laboratory management. These developments have far reaching implications in the context of clinical governance because they ensure that all laboratories have a clear statement of intent with respect to their standard of service. This includes a commitment to good professional practice as recently published by the Royal College of Pathologists. The present contribution will review the principles and practice of risk management as they relate to the environment of pathology.
There is an explicit wish from the public and politicians for clear accountability and deliverability within the NHS. This is to be achieved through the mechanism of performance assessment against defined targets; the tools determining the structure within which pathology will operate being the same as for all other areas of the NHS. These are identified as a clear structure of core processes to guide action and are embodied in corporate governance, which embraces the three interrelated approaches of controls assurance,3,4 clinical governance,5–8 and risk management.9
Risk management is an iterative process …