The management of risk has evolved into a management discipline in its own right (see for example the Health and Safety Executive’s extensive literature), where the ‘human element’ introduces what Hillison and Murray-Webster (2007: 13) suggest is an
Tony Kelly – September 2010 53 additional layer of complexity into the process. The psychometric paradigm theorises an individual’s perception and interpretation of risk and the mental strategies or rules that they might adopt when addressing risk. Such rules or ‘heuristics’ are often viewed as leading to ‘large and persistent biases’ (Slovic 1987: 281; Lupton, 1999: 19). For example, the ‘medical model’ of ageing might be regarded as labelling older adults as vulnerable and therefore at risk (Ballinger and Payne, 2002; Bland, 2005).
The attitude of those who might wish to take a particular risk and those who perceive that they have a statutory duty to manage that risk will depend upon their attitude towards the likely degree of uncertainty. Uncertainty in a particular situation is
mediated by underlying psychological influences known as heuristics (Greek heuriskein - to discover) which introduce subconscious and systematic biases into the decision process. Heuristics operate at the unconscious level and therefore represent a covert influence upon the management of risk and may be characterised by terms such as ‘rule-of-thumb’, ‘gut-feeling’, or ‘intuition’ (Hillison and Murray-Webster, 2007: 52).
Heuristics can operate at both the individual practitioner level influencing the decisions of managers or carers, and at organisational level, influencing shifts, entire homes or even whole organisations. The use of heuristics as a device to understand risk attitude forms part of the risk literature (see for example Kahneman et al, 1982; Reason, 1990;
Cox and Tait, 1991; Cox and Cox, 1996; Kemshall et al, 1997; Hillison and Murray-Webster, 2007). The ‘rule’ might be regarded as the conscious manifestation of the rule makers’ bias towards a perceived risk. Such biases could for example derive from professional standards or codes of conduct, subsequently adopted as ‘rules’ rather than aids to complex decision making (Ballinger and Payne, 2002: 307). For example, lifting and handling of people who couldn’t stand or move on their own used to be heavily influenced by adherence to Royal College of Nursing guidance. This guidance advised that manual handling should be eliminated in all but exceptional or life
threatening situations (RCN Code of Practice for Patient Handling, 1996). Thus, the right of an individual to choose how they might want to be assisted was apparently subordinated to a ‘rule of thumb’.
Taylor (2006) recognises that addressing hazards and risks is part of professional care practice. In exploring how care professionals made decisions about the long term care
Tony Kelly – September 2010 54 of older adults, he theorised that risk might be conceptualised and managed in terms of six distinct heuristics (which he calls paradigms), each with its own assumptions. He suggests that his paradigms appeared to be in a state of reciprocal tension, each standing alone as the ‘philosophical underpinning of a heuristic to simplify decision making within a particular framework’ (2006: 1424). Each paradigm was thus a coherent way of understanding a range of issues with a ‘dislocation’ between working within one paradigm and another. They might also be likely to play a part in the application of
‘street level bureaucracy’ (Lipsky, 1980), where policies and procedures were interpreted and applied according to some preconceived ‘model’.
Taylor called his first risk paradigm ‘identifying and meeting needs’ (IMN), which he suggests is about addressing ‘risks now’, but not ‘risks tomorrow’. IMN is therefore a proactive or pragmatic paradigm for dealing with immediate situations, for example, admitting a person considered ‘at risk’ in their own home into residential care. The second paradigm is called ‘protecting this individual and others’ (PIO), which
encompassed situations where individuals may harm others, for example a person with dementia whose mental functioning was seen as a key component in shaping their perception of ‘risk’. In the PIO paradigm, the management of risk may be imposed on the individual, rather than meeting their expressed needs (IMN). Minimizing situational hazards (MSH), Taylor’s third paradigm, appears to derive directly from health and safety law, which imposes a duty upon individuals to take all reasonably practicable steps to minimise risk. The health and safety requirements relating to employees were thus applied by extension to service users in order to avoid creating a double standard.
Taylor’s fourth paradigm ‘balancing benefits and harms’ (BBH), is based on the premise that risk taking is an intrinsic part of life. The mandate for the BBH approach derives from the right to make choices regarding hazards and risks, as well as the opportunities that life presents. The fifth paradigm, accounting for resources and priorities (ARP), was said to dominate the development of policies for ‘risk
management’ in some organisations, which might take little account of appropriate risk taking (Kemshall, 2000).
Taylor’s sixth and final paradigm is wariness of lurking conflicts (WLC), which acknowledges the concerns of staff and their sense of vulnerability to legal action.
Tony Kelly – September 2010 55 This paradigm might derive from a greater focus on accountability and public scrutiny of services (Kemshall and Pritchard, 1997) which might cause providers or their staff to act defensively. Taylor acknowledges the possible role played by a perceived ‘blame culture’ (Douglas, 1992; Furedi, 1997) within this paradigm. This acknowledges the role played by the socio-cultural environment within which risk is perceived,
understood and acted upon.