Trust‐Level Risk Evaluation and Risk Control Guidance in the NHS East of England

In recent years, the healthcare sector has adopted the use of operational risk assessment tools to help understand the systems issues that lead to patient safety incidents. But although these problem‐focused tools have improved the ability of healthcare organizations to identify hazards, they have not translated into measurable improvements in patient safety. One possible reason for this is a lack of support for the solution‐focused process of risk control. This article describes a content analysis of the risk management strategies, policies, and procedures at all acute (i.e., hospital), mental health, and ambulance trusts (health service organizations) in the East of England area of the British National Health Service. The primary goal was to determine what organizational‐level guidance exists to support risk control practice. A secondary goal was to examine the risk evaluation guidance provided by these trusts. With regard to risk control, we found an almost complete lack of useful guidance to promote good practice. With regard to risk evaluation, the trusts relied exclusively on risk matrices. A number of weaknesses were found in the use of this tool, especially related to the guidance for scoring an event's likelihood. We make a number of recommendations to address these concerns. The guidance assessed provides insufficient support for risk control and risk evaluation. This may present a significant barrier to the success of risk management approaches in improving patient safety.     

Ensuring the Quality of Occupational Safety Risk Assessment

In work environments, the main aim of occupational safety risk assessment (OSRA) is to improve the safety level of an installation or site by either preventing accidents and injuries or minimizing their consequences. To this end, it is of paramount importance to identify all sources of hazards and assess their potential to cause problems in the respective context. If the OSRA process is inadequate and/or not applied effectively, it results in an ineffective safety prevention program and inefficient use of resources. An appropriate OSRA is an essential component of the occupational safety risk management process in industries. In this article, we performed a survey to elicit the relative importance for identified OSRA tasks to enable an in‐depth evaluation of the quality of risk assessments related to occupational safety aspects on industrial sites. The survey involved defining a questionnaire with the most important elements (tasks) for OSRA quality assessment, which was then presented to safety experts in the mining, electrical power production, transportation, and petrochemical industries. With this work, we expect to contribute to the main question of OSRA in industries: “What constitutes a good occupational safety risk assessment?” The results obtained from the questionnaire showed that experts agree with the proposed OSRA process decomposition in steps and tasks (taxonomy) and also with the importance of assigning weights to obtain knowledge about OSRA task relevance. The knowledge gained will enable us, in the near future, to build a framework to evaluate OSRA quality for industrial sites.     

Risk Management of Domino Effects Considering Dynamic Consequence Analysis

Domino effects are low‐probability high‐consequence accidents causing severe damage to humans, process plants, and the environment. Because domino effects affect large areas and are difficult to control, preventive safety measures have been given priority over mitigative measures. As a result, safety distances and safety inventories have been used as preventive safety measures to reduce the escalation probability of domino effects. However, these safety measures are usually designed considering static accident scenarios. In this study, we show that compared to a static worst‐case accident analysis, a dynamic consequence analysis provides a more rational approach for risk assessment and management of domino effects. This study also presents the application of Bayesian networks and conflict analysis to risk‐based allocation of chemical inventories to minimize the consequences and thus to reduce the escalation probability. It emphasizes the risk management of chemical inventories as an inherent safety measure, particularly in existing process plants where the applicability of other safety measures such as safety distances is limited.     

Exploring the Conceptual Foundation of Continuity Management in the Context of Societal Safety

Public and private actors with critical roles for ensuring societal safety need to work proactively to reduce risks and vulnerabilities. Traditionally, risk management activities have often been performed in order to ensure continuous functioning of key societal services. Recently, however, business continuity management (BCM), and its analytical subcomponent business impact assessment (BIA), has been introduced and used more extensively by both the private and public sector in order to increase the robustness and resilience of critical infrastructures and societal functions and services. BCM was originally developed in the business sector but has received a broader use during the last decade. Yet, BCM/BIA has gained limited attention in the scientific literature—especially when it comes to clarifying and developing its conceptual basis. First, this article examines and discusses the conceptual foundation of BCM concepts, including practical challenges of applying the concepts. Based on recent conceptual developments from the field of risk management, a developed conceptualization is suggested. Second, the article discusses challenges that arise when applying BCM in the societal safety area and provides some recommendations aiming to improve the clarity and quality of applications. Third, the article provides suggestions of how to integrate the overlapping approaches of BIA and risk assessment in order to improve efficiency and effectiveness of proactive, analytic processes. We hope that the article can stimulate a critical discussion about the key concepts of BCM, their wider use in societal safety, and their connection to other concepts and activities such as risk assessment.     

Optimizing Risk Analysis Relating to External Safety in The Netherlands

Risk analyses in The Netherlands have been optimized so that they now express risks in a numerical form suitable for comparison to national safety standards. This factor is more important to national government than to local authorities; other factors relevant for local authorities are given less emphasis or even completely omitted from the results of the analysis. From a comparison of 16 risk analyses carried out during the last decade, it became clear that in the last 5 years the methods of risk analyses related to external safety have become unified. Results are now presented in terms of individual risk contours and in terms of F-N curves (accident frequency vs. exceeded number of fatalities). This unification seems to be a result of government policy. First, the implementation of the post-Seveso-directive (501/82/EC) in The Netherlands obliges a number of industries to provide the authorities with a quantitative risk assessment. Second, the government has set standards for the maximum permissible risk in residential areas. A unified type of risk analysis is a tool to achieve both these policies. From interviews with local government authorities, however, it has become clear that they need and use some quantitative risk information that is not provided by the unified analysis. They feel they need figures that provide insight into the effects of incidents and into the way effects may change as a result of safety measures. Ultimately, government policy may mean that local officials receive less information than before.     

Rethinking Risk Assessment for Public Utility Safety Regulation

To aid in their safety oversight of large‐scale, potentially dangerous energy and water infrastructure and transportation systems, public utility regulatory agencies increasingly seek to use formal risk assessment models. Yet some of the approaches to risk assessment used by utilities and their regulators may be less useful for this purpose than is supposed. These approaches often do not reflect the current state of the art in risk assessment strategy and methodology. This essay explores why utilities and regulatory agencies might embrace risk assessment techniques that do not sufficiently assess organizational and managerial factors as drivers of risk, nor that adequately represent important uncertainties surrounding risk calculations. Further, it describes why, in the special legal, political, and administrative world of the typical public utility regulator, strategies to identify and mitigate formally specified risks might actually diverge from the regulatory promotion of “safety.” Some improvements are suggested that can be made in risk assessment approaches to support more fully the safety oversight objectives of public regulatory agencies, with examples from “high‐reliability organizations” (HROs) that have successfully merged the management of safety with the management of risk. Finally, given the limitations of their current risk assessments and the lessons from HROs, four specific assurances are suggested that regulatory agencies should seek for themselves and the public as objectives in their safety oversight of public utilities.     

Safety Management and Public Spaces: Restoring Balance

Since 2000, the reputation of health and safety in the United Kingdom has been tarnished, so much so that it has become the subject of both a media circus and a government inquiry. This not only threatens the worthy goals of health and safety, but also impacts upon the associated tool of risk assessment itself such that "risk assessment" is increasingly seen by the public at large as a term inviting ridicule, even abuse. The main thrust of the government's examination of health and safety has been its concern that safety requirements were placing a disproportionate burden on business. However, there is another source of discontent, which is public chagrin over the impact of injury control measures upon life beyond the conventional workplace, in particular upon the public spaces that people frequent in their leisure time and on the activities they engage in there. This article provides a perspective on this second dimension of the crisis in confidence. It describes how many U.K. agencies with responsibilities for a wide portfolio of public amenities ranging from the provision of play spaces for the young to the management of publicly accessible countryside, the maintenance of urban and rural trees, the stewardship of sites of cultural heritage, and the pursuit of outdoor educational activities have responded to some conflicts posed to their services by the new safety culture. It concludes with a discussion of implications for the management of public space and for risk assessment itself.     

Use of Advances in Technology for Maritime Risk Assessment

The maritime industry is moving toward a "goal-setting" risk-based regime. This opens the way to safety engineers to explore and exploit flexible and advanced risk modeling and decision-making approaches in the design and operation processes. In this article, following a brief review of the current status of maritime risk assessment, a design/operation selection framework and a design/operation optimization framework are outlined. A general discussion of control engineering techniques and their application to risk modeling and decision making is given. Four novel risk modeling and decision-making approaches are then outlined with illustrative examples to demonstrate their use. Such approaches may be used as alternatives to facilitate risk modeling and decision making in situations where conventional techniques cannot be appropriately applied. Finally, recommendations on further exploitation of advances in general engineering and technology are suggested with respect to risk modeling and decision making.     

How to Design Rating Schemes of Risk Matrices: A Sequential Updating Approach

Risk matrices have been widely used as a risk evaluation tool in many fields due to their simplicity and intuitive nature. Designing a rating scheme, i.e., determining the number of ratings used in a risk matrix and assigning different ratings to different cells, is an essential part of risk matrix construction. However, most of the related literature has focused on applying a risk matrix to various fields, instead of researching how to design risk matrices. Based on the analysis of several current rules, we propose a new approach, namely, the sequential updating approach (SUA), to design the rating scheme of a risk matrix in a reliable way. In this article, we propose three principles and a rating algorithm based on these principles. The three principles, namely, adjusted weak consistency, consistent internality, and continuous screening, characterize a good rating scheme. The resulting rating scheme has been proven to be unique. A global rating algorithm is then proposed to create the design that satisfies the three principles. We then explore the performance of the SUA. An illustrative application is first given to explain the feasibility of our approach. The sensitivity analysis shows that our method captures a resolution‐reliability tradeoff for decisionmakers in choosing an appropriate rating scheme for a risk matrix. Finally, we compare the designs based on the SUA and Cox's axioms, highlighting the advantages of the SUA.     

Other Aspects of BSE Issues in East Asian Countries

Scientific risk estimates of BSE can be the same internationally; however, socioeconomic backgrounds, such as food supply (e.g., beef import status) and dietary life, are different between East Asian countries (i.e., in this article, Japan, Korea, and Taiwan) and Western countries, which may account for differences in risk perception of people. Since political and social backgrounds also differ among these East Asian countries, they will also influence people's attitudes toward food safety. Psychological factors such as “dread” and the “unknown” are considered to be important in risk perception, but socioeconomic, and in some cases political, situations (e.g., attitudes of politicians and political pressures in trade) may strongly influence the perception and acceptance of various risks by citizens. With regard to the BSE issues, latter aspects may contribute a lot to risk perception, but have not been examined in depth until now. Although protection of health is the key element to food safety, sometimes business factors can overwhelm safety issues in international trade. Appropriate risk governance in food safety issues, such as BSE, can be attained not only through application of outputs of scientific assessment, but also through deliberation of various aspects, that may have strong influence on people's risk perception, and improved communication among stakeholders and also among countries.     

Identification and Review of Sensitivity Analysis Methods

Identification and qualitative comparison of sensitivity analysis methods that have been used across various disciplines, and that merit consideration for application to food-safety risk assessment models, are presented in this article. Sensitivity analysis can help in identifying critical control points, prioritizing additional data collection or research, and verifying and validating a model. Ten sensitivity analysis methods, including four mathematical methods, five statistical methods, and one graphical method, are identified. The selected methods are compared on the basis of their applicability to different types of models, computational issues such as initial data requirement and complexity of their application, representation of the sensitivity, and the specific uses of these methods. Applications of these methods are illustrated with examples from various fields. No one method is clearly best for food-safety risk models. In general, use of two or more methods, preferably with dissimilar theoretical foundations, may be needed to increase confidence in the ranking of key inputs.     

Risk Assessment Can Be a Game‐Changing Information Technology—But Too Often It Isn't

The printing press was a game‐changing information technology. Risk assessment could be also. At present, risk assessments are commonly used as one‐time decision aids: they provide justification for a particular decision, and afterwards usually sit on a shelf. However, when viewed as information technologies, their potential uses are much broader. Risk assessments: (1) are repositories of structured information and a medium for communication; (2) embody evaluative structures for setting priorities; (3) can preserve information over time and permit asynchronous communication, thus encouraging learning and adaptation; and (4) explicitly address uncertain futures. Moreover, because of their “what‐if” capabilities, risk assessments can serve as a platform for constructive discussion among parties that hold different values. The evolution of risk assessment in the nuclear industry shows how such attributes have been used to lower core‐melt risks substantially through improved templates for maintenance and more effective coordination with regulators (although risk assessment has been less commonly used in improving emergency‐response capabilities). The end result of this evolution in the nuclear industry has been the development of “living” risk assessments that are updated more or less in real time to answer even routine operational questions. Similar but untapped opportunities abound for the use of living risk assessments to reduce risks in small operational decisions as well as large policy decisions in other areas of hazard management. They can also help improve understanding of and communication about risks, and future risk assessment and management. Realization of these opportunities will require significant changes in incentives and active promotion by the risk analytic community.     

Predictors of Parental Risk Perceptions: The Case of Child Pedestrian Injuries in School Context

The objective of this article is to explore the factors that influence parental risk perceptions of child pedestrian injuries in the elementary school context. Parents (n= 193) from six different schools responded to a questionnaire on road safety, including a measure of their risk perception. Results of bivariate analyses show that eight variables are significantly related to risk perception. Environmental variables, as we measure them, were not significant, contrary to our initial hypotheses. Only three variables, parent's gender, perceived primary source of danger, and sense of control remained significant in OLS regression analyses (adjusted R² of 0.16, F= 9.27; p= 0.00). Since parents’ perceptions of road risks are an important factor in their road safety practices and in their choice of transportation mode used for their child's journey to school, our analysis elucidates factors underlying these choices. Our results can help decisionmakers to design traffic injury prevention measures and to promote physical activity through the use of active modes of transport.     

Variability and Uncertainty Meet Risk Management and Risk Communication

In the past decade, the use of probabilistic risk analysis techniques to quantitatively address variability and uncertainty in risks increased in popularity as recommended by the 1994 National Research Council that wrote Science and Judgment in Risk Assessment. Under the 1996 Food Quality Protection Act, for example, the U.S. EPA supported the development of tools that produce distributions of risk demonstrating the variability and/or uncertainty in the results. This paradigm shift away from the use of point estimates creates new challenges for risk managers, who now struggle with decisions about how to use distributions in decision making. The challenges for risk communication, however, have only been minimally explored. This presentation uses the case studies of variability in the risks of dying on the ground from a crashing airplane and from the deployment of motor vehicle airbags to demonstrate how better characterization of variability and uncertainty in the risk assessment lead to better risk communication. Analogies to food safety and environmental risks are also discussed. This presentation demonstrates that probabilistic risk assessment has an impact on both risk management and risk communication, and highlights remaining research issues associated with using improved sensitivity and uncertainty analyses in risk assessment.     

National cultures and safety orientation: A study of seafarers working for Norwegian shipping companies

Up to now, little work has been conducted on safety in relation to national culture. This paper examines the association between national culture and the safety orientation of seafarers on Norwegian-owned vessels. Safety orientation is the result of cultural, organizational, and contextual factors that create attitudes and behaviours that in turn influence safety. In this study a safety culture/orientation questionnaire was designed and used to determine risk and safety characteristics. Survey data was collected from 2,558 seafarers from 27 countries. The sample used consisted of seafarers from the 10 countries for which there were more than 10 respondents. Five national (cultural) characteristics were calculated using Hofstede's Value Survey Model 94. Multivariate analysis of variance revealed that (a) the number of nationalities represented on a vessel was related to their attitude towards safety issues, such that two-nation vessels obtain relatively negative scores regarding these issues, and (b) national culture was related to safety culture, such that high power distance, high uncertainty avoidance, and high individualism were positive for safety. The implications of these findings for practice and future research are discussed.     

Practice-Specific Risk Perceptions and Self-Reported Food Safety Practices

The relationship between risk perception and risk avoidance is typically analyzed using self-reported measures. However, in domains such as driving or food handling, the validity of responses about usual behavior is threatened because people think about the situations in which they are self-aware, such as when they encounter a hazard. Indeed, researchers have often noted a divergence between what people say about their behavior and how they actually behave. Thus, in order to draw conclusions about risk perceptions and risk avoidance from survey data, it is important to identify particular cognitive elements, such as those measured by questions about risk and safety knowledge, risk perceptions, or information search behavior, which may be effective antecedents of self-reported safety behavior. It is also important to identify and correct for potential sources of bias that may exist in the data. The authors analyze the Food and Drug Administration's 1998 Food Safety Survey to determine whether there are consistent cognitive antecedents for three types of safe food practices: preparation, eating, and cooling of foods. An assessment of measurement biases shows that endogeneity of food choices affects reports of food preparation. In addition, response bias affects reports of cooling practices as evidenced by its relation to knowledge and information search, a pattern of cognitive effects unique to cooling practices. After correcting for these biases, results show that practice-specific risk perceptions are the primary cognitive antecedents of safe food behavior, which has implications for the design of effective education messages about food safety.     

The Use of Human Experience Data in the EU Risk Assessment Process

The incorporation of human experience data (HD) into the risk assessment process is encouraged by various authorities with the aim of improving the robustness of the subsequent findings. HD, however, can present in many forms, ranging from epidemiological studies to the accumulated experiences from poison centers. This diversity of the human experience, combined with the manner in which it may (or may not) present, creates several challenges for risk assessors if they are to give available HD due weight in the RA process. An evaluation was made of how HD has been cited and used within the 64 human health RAs published by the EU to the end of 2005. In all RAs, HD had been cited to some degree. But there was no consistency between how cited data had subsequently been taken forward and used in the evaluation of different endpoints, either between the RAs authored by the same or different EU Member States. The lack of any accepted guidance for addressing the role that HD can play within the RA process appears to lead to this situation. Recommendations are provided on the scope and focus such guidance could usefully be expected to take.     

A general guideline for management of risk from carcinogens

A simple relationship is formulated that helps to discriminate between acceptable and unacceptable individual lifetime risks (RL) to populations that are exposed to chemical carcinogens. The relationship is an empirical one and is developed using objective risk data as well as subjective risk levels that have found substantial acceptance among those concerned with carcinogenic risk assessment issues. The expression sets acceptable levels of lifetime carcinogenic risk and is a function of the total population exposed to the carcinogen. Its use in risk assessment and risk management provides guidance in distinguishing those carcinogens that should be regulated because of the health hazard they pose from those whose regulation may not be needed.     

食品安全事件中的公众风险感知及应对行为研究——以问题奶粉事件为例

近年来频发的问题食品事件使食品安全日益成为公众关注的焦点。本文以2008年曝光的三聚氰胺问题奶粉事件为例,以风险感知为切入点,构建了问题奶粉事件中公众的风险感知与应对行为关系模型,揭示了问题奶粉事件中的风险信息对消费者风险感知和控制感的影响,剖析了风险感知、控制感等对人们的抵制和积极应对行为的作用机理,并根据研究结论提出了管理实践方面的可资借鉴的建议。