Clinical Risk Management: What measures are available to hospital managers in order to control the frequency of clinical negligence claims and their ultimate cost? To what extent can they transfer that risk to others?

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trauma and may experience their treatment as a betrayal of trust. They may become angry, depressed, and bitter, and their problems are often compounded by a protracted adversarial legal process (Vincent, 1995a; Vincent, 1995b). Staff, on the other hand, may experience guilt, shame, and depression after making a mistake. Litigation and complaints impose an additional burden on them. A doctor, for example, whose confidence has been reduced will probably work less effectively and efficiently. Sometimes, doctors even abandon medicine as a career (Vincent, 1995b; Genn, 1995). 3. Clinical Risk Management

Risk Management can be broadly defined as the reduction of harm to an organisation, by identifying and, as far as possible eliminating risk. In a clinical setting, the primary focus is on malpractice, which causes financial losses but also affects the reputation and morale of a trust and its staff. Clinical risk management also involves the continuing care of the injured patients and rapid settlement of justified claims (Clements, 1995). According to a working definition by Dingwall and Fenn (1991), the aim of clinical risk management is threefold: (1) Prediction of losses and ensuring that adequate levels of reserves have been allocated to meet them.

(2) Active management in order either to prevent the lodging of a claim or to promote an early resolution which will limit the legal costs.

(3) Review of data on claims made as evidence of points of weakness in service or clinical practice which can be remedied by executive or professional action.