Board affiliate blog – Hannah Hornby – April/May 2023 – Risk management
After being hopeful in my last blog post that Spring was on the way, April has felt like an extension of a very wet and cold winter – where is the sun? My garden is fully re-wilded as I can’t muster the effort to go outside, so the wildlife of Thame is thriving. On a more positive note, are we starting to finally see the light at the end of the winter pressures tunnel? This is certainly reflected in some of our metrics for the month so we will take the small wins for now and keep ploughing on – I will go as far as saying that things are feeling better.
Since starting my role as Board Affiliate, I often find myself reading through papers about risk management, which are then discussed at Board and committee meetings. Thinking about risk at a strategic level is not something I’ve done before so in order to improve my engagement in these discussions, I met with Jo James, our Trust Board Business Manager, to gain some insight into how risk management works at BHT.
In short, a risk is something that might happen (an important distinction from an issue – something that has already happened/is happening) and ultimately could have an impact on the Trust being able to care for our patients and colleagues. The likelihood of it happening and the impact that it could have varies, and each risk needs to be analysed and given a score based on the combination of likelihood and impact. The higher the score, the more urgent it becomes to implement controls to mitigate this risk, which means putting things in place to make sure the risk is reduced as much as possible. Every department in BHT has a risk register which it manages, but if the score goes above 15 it moves onto the corporate risk register (CRR) which is seen by the Board. Each risk also has an owner who is responsible for managing it and reviewing it on a monthly basis.
In addition to corporate risks, the Board also considers strategic risks. These are risks which, if they occur, would mean that the Trust cannot meet strategic objectives and priorities, for example, ‘Our buildings and facilities will be great places to work and contribute to the health and wellbeing of staff’. The Board uses a document called the Board Assurance Framework (BAF) which matches up the risks on the corporate risk register with relevant strategic risks, for example, the risk of a disrupted electrical supply to Stoke Mandeville Hospital would have an impact on our strategic objective relating to buildings and facilities. The Board Assurance Framework contains details of what is being done to reduce each risk, the controls, as well as any other things that need to be done, the gaps. The Board can then take assurance that risks are being managed appropriately or take action if more needs to be done.
Risk is such a big topic to try and summarise in two paragraphs, but I hope it goes some way to explaining how the Board has oversight of the risks in our organisation. Hopefully this also explains why it is so important to complete DATIX forms when things go wrong, as these are all matched up to our risk registers and can be used to triangulate risks and monitor when any issues need to be escalated.
Many of the risks on the corporate risk register are owned by Karen Bonner, Chief Nurse, and this month she has kindly answered some of my hard-hitting questions to help us get to know her a little better…
- What are your main responsibilities as Chief Nurse?
As a Chief Nursing Officer, I am responsible to the Chief Executive Officer and Trust Board for providing visible clinical, professional, compassionate and inclusive leadership of nursing, midwifery and allied health professional staff. I am the professional lead for maternity and children’s services. I have executive accountability for patient experience and patient safety. I have professional accountability to ensure the Trust discharges its legal obligation relating to safeguarding, infection control, mental health and end-of-life care, as well as overall governance for areas that fall within the scope of responsibilities.Whilst I have my individual portfolio as the Chief Nurse, I work as part of the unitary board of directors. This means that within the Board of directors, the non-executive directors and executive directors make decisions as a single group and share the same responsibility and liability. As such, as a director, along with my Board colleagues we have collective and corporate accountability for the performance of the organisation and across all areas, ensuring that the interests of patients remain central to what the Trust does.
- What does a typical day look like for you?
I don’t have a typical day but I start each day chairing the nursing, midwifery and AHP safety huddle where we review the safest staffing levels, and patient safety concerns, review quality data, agree on the ‘big 4’ safety messages to be cascaded and highlight and celebrate good practice. I do have some typical weeks around board governance. I chair and am a member of a number of committees including quality patient safety and operational meetings. I work with my Board colleagues to support the operational running of the organisation and ensure continuous visibility and oversight of patient safety.
- What is the biggest challenge that you face in your role?
Firstly I like to start by saying it is a real privilege to be a nurse and to be in people’s lives at their most vulnerable and joyous moments often from birth to the end of life. My career now extends 3 decades and I remain proud to be a nurse. The things that keep me awake at night are patient safety and colleagues’ well-being, both of which have seen a huge impact following the global pandemic response.
- What do you enjoy most about working at BHT?
There are many things I love about being the Chief Nurse at Buckinghamshire Healthcare NHS Trust. You have asked me to pick one and so I would say ‘Our people’- they are amazing so committed and caring. We have exceptional individuals who are doing amazing work which is outstanding.
- If you could only eat one meal for the rest of your life, what would it be?
I love salads and could eat a salad 365 days of the year. As a vegetarian, it has been my go-to meal, especially after a long day – you can create such a tasty and healthy variety – although I prefer warmer salads in winter.
- Tell us something about you that we might not expect.
Not to reveal all of my secrets, but I am a big music fan and dance fan and, whilst nursing was my childhood aspiration, I also dreamt of being a dancer – luckily nursing stuck so now I just dance for fun.