Dentro de la parroquia

While the exploratory interviews did generate detailed responses from all interviewees, the findings from such discussions nonetheless will have the limitations associated with them as follows:

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(i) Sampling issues – as the views of just a sample of trust risk managers are included in these interviews, there is clearly a risk that the views may not accurately reflect the views of all trusts which have undergone risk management level assessments since they were introduced.

(ii) Priority given in sample selection process to trusts which recently secured a risk management level increase – while this policy did succeed in gathering eight detailed viewpoints on the factors that contributed to this risk management level increase, it did not represent the general experience of all trusts with risk management levels i.e. many trusts have not changed their risk management level since they were introduced.

(iii) Limitations of telephone interview – telephone interviews proved to be the strong preference of interviewees compared to a personal interview, but such interviews do restrict an interviewer’s ability to obtain additional benefits of (face-to-face) interviews which include the ability to observe body language and an ability to develop a stronger rapport with the interviewee. (iv) Confidentiality concerns – while every effort was made from the initial communication process

with trusts (including the supporting letter from the author’s supervisor) through to the actual interviews to assure interviewees of the confidentiality of replies, the possibility exists that such concerns may have led to some information not being made available to the researcher.

(v) Exposure to the preconceptions and values of the author – while every effort has been made to negate this through careful planning and systematic execution of the interviews, it is appropriate to acknowledge that this also represents a limitation within the research.

5.8

Chapter Summary

This chapter has presented a summary of the experiences of nine NHS trusts in relation to their risk management levels: eight of whom successfully increased their risk management level in recent years. The views of an NHSLA risk manager were also gathered and the main findings were as follows:

• Risk management increases have occurred as part of a planned strategy (this involves capturing the reputational and financial benefits, and usually relates to more than one NHSLA assessment). However, achieving this goal is a considerable challenge across an entire trust – it

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will require a heavy workload for the staff who lead the assessment and other staff such as the board of directors and clinical staff must be engaged for such a strategy to succeed.

• There are a range of issues which can restrict a trust’s ability to obtain a risk management level increase – these include external factors such as restructuring activity as well as internal factors such as a lack of a risk management champion to drive a risk management level application. • Trusts that are in a position to commit financial resources to assist with an NHSLA assessment

typically will do so, although making such an investment is not a pre-requisite to obtaining a risk management level increase – however, there was a general consensus was that financially stronger trusts are in a better position to obtain risk management level increases.

• The NHSLA assessment is a stressful and arduous process for all involved at trust level. Those that prepare well are much better placed to have a successful outcome and this includes having a good relationship developed with one’s assessor in advance of the assessment visit.

• Risk management level increases should impact on future claims levels, although there is an uncertain time lag before this effect will become evident. In addition, there is limited support for the view that local trust management can affect claim values, and this implies that risk management level increases can reduce both the number and value of future claims.

• Risk management level increases are not being primarily sought to drive improvements in claims experience but this may be an indirect effect of improving quality systems in each trust. Such increases are being sought to improve a trust’s reputation for patient safety and to secure financial benefits in the form of reduced CNST premiums – this suggests that risk management levels are being used to indirectly improve claim levels and claim values (they are by-products of an improved trust quality level) rather than act as a signal of a trust’s quality level.

In short, these findings confirm some of the hypotheses expressed in the literature chapters, but have also uncovered new information relevant to risk management processes which were unknown to the author in advance of such discussions. This information will be added to that obtained from relevant literature to assist the development of appropriate empirical models – these will be addressed after the empirical data available for this study is described in the next chapter.

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CHAPTER SIX

DATA SOURCES, VARIABLES AND SUMMARY STATISTICS

6.1

Chapter Overview

This chapter introduces the dataset to be used for multivariate regression analysis in chapters seven, eight and nine – this was obtained from a combination of public sources and data secured from the NHSLA through the Centre for Risk and Insurance (CRIS) at the University of Nottingham. All of the variables for this study will be described including an analysis of major trends in recent years. The analysis will include tables, graphs and summary statistics with supporting material being included as appendices.