Risk management in social services Foto: Peter Senko (2006)

To this day, no methodology for risk management in social care facilities has been developed in Slovakia. Similarly, no professional literature on risk management in social services is available. This could easily create the impression that it is not even necessary to deal with this topic. However, our seven years of experience from the activities of the Institute for Quality of Social Services tell us otherwise. We consider risk management to be an important tool for ensuring and controlling quality in the social field, just as it is in other service sectors. Dozens of audits in social service facilities in Slovakia have revealed errors, misconduct, serious incidents, as well as threats that, given the new Social Services Act (Collection of Laws No. 448), can no longer be tolerated. Non-conformities and errors were in many cases excused by a lack of financial resources and unqualified staff at the bedside. However, audit evidence points to an alarming state of unprofessional management unrelated to financial resources but rather to the insufficient use of professional methods, procedures, and tools for managing quality, change, and risk.

Social service is a special set of activities aimed at satisfying individual and collective needs, carried out in a manner other than the transfer of material goods. Social services seek to help primarily individuals, groups, and communities in achieving the maximum degree of social, mental, and physical well-being.

Social services have their own specific environment within the service sectors. Their main activities are nursing, rehabilitation, therapeutic, and counseling processes, which cannot do without human relationships, professional staff expertise, nursing and care technology, the latest scientific knowledge from social counseling, and professional ethics. The gradual increase in demands for expertise, professionalization, and above all for an individual approach to social service recipients (SSR) brings with it the need to introduce tools for qualified and high-quality management. Both top and middle professional management are required to have knowledge of quality management, in which risk management has its irreplaceable place.

Risk management in social services is the process of identifying, evaluating, and addressing potential or actual risks that may be a source of:

  • deterioration of living conditions for people who cannot manage their life situation on their own;
  • deterioration of the health status of a natural person dependent on the assistance of another natural person;
  • failure to create suitable conditions that would prevent the emergence or increase of negative social phenomena;
  • failure to create supportive activities that would prevent adverse social development of an individual, family, or society;
  • financial loss for an individual or facility;
  • inefficient and ineffective management of financial, human, and material resources;
  • loss of good reputation of a social worker or social care facility.

As in quality management, risk management cannot do without defined standards, a process approach, and measurement and control tools, which include both external and internal audits.

If a process approach is implemented in a social service facility, then the management of such an organization will lead to:

  1. systematic definition of the necessary activities to achieve the desired results;
  2. determination of clear responsibilities and duties for the management of key activities;
  3. measurement and analysis of the capability of key activities;
  4. identification of the links between key activities and/or across the functions of the facility;
  5. focus on factors such as resources, methods, and materials that will improve the organization's key activities;
  6. assessment of risks, consequences, and impacts of activities on social service recipients, suppliers, and other interested parties (founder, family members, municipality, other community...).

As with systematic quality management, where a quality manager is appointed, it is necessary to have a qualified risk manager trained.

Risk manager = manages the process of risk identification, risk evaluation, creation of preventive strategies, and control of the effectiveness of corrective measures.

Risk management cannot do without decision-making based on data, information, and facts. This important principle of quality management can bring the following key results for a social service facility:

  1. increases the ability to demonstrate the effectiveness of previous decisions by the director or professional staff using references to factual records;
  2. increases the ability to review, challenge, and change opinions and decisions.

Applying the principle of fact-based decision-making will lead to:

  • ensuring that data and information are sufficiently accurate and reliable;
  • appropriate processing of data for those who need it;
  • analysis of data and information using valid methods;
  • execution of decisions and actions based on factual analysis, balanced with experience and intuition.

The basic tasks of a risk manager include:

  1. developing an effective change management process;
  2. establishing an effective process for reporting and preventing incidents;
  3. implementing controlled documentation and control of documentation systems;
  4. developing a database of current risks based on the legislative environment and societal requirements, demographic development, marketing research, and the labor market;
  5. implementing complaint management;
  6. introducing quality and risk measurement tools into all processes;
  7. training staff in risk management.

The most common risks in social services:

  1. Risk of leakage of confidential and personal data;
  2. Risk of ineffective communication;
  3. Risk of incorrectly maintained documentation;
  4. Risk of nosocomial infections from the external or internal environment (residential bacterial flora, colonizing bacteria; infected wounds – bedsores, respiratory infections, sepsis, hepatitis B);
  5. Risk of working with hazardous waste (disposal of waste with biological material = blood, other bodily fluids, objects contaminated with fluids...);
  6. Risk of weakened mental state (emotional distress) and mentally ill clients (SSR);
  7. Risk of error in the nursing, care, rehabilitation, or counseling process;
  8. Risk of untrained staff in the use of technology;
  9. Risk of emotional and work-related stress for staff (burnout syndrome);
  10. Risk of poor working conditions;
  11. Risk of client disappearance;
  12. Risk of an emergency situation from ecological or natural disaster.

Quality management systems are managed and controlled on the basis of numbers, data, and facts. It is precisely measurement, analysis, and improvement that can ensure systematic and continuous improvement of the quality of social services. The task of top management and experts is to develop an appropriate procedure for review, measurement, and analysis at relevant points in process management. There is no need to fear modern statistical knowledge and other systematic methods that help monitor service quality. Measurement needs to be established where we can determine positive effects influencing service quality and client satisfaction.

The goal of the provided social service is to identify and fulfill the requirements of social service recipients as effectively as possible and, in the case of changed needs, to respond quickly and provide professionally and competently the services that their condition requires. To achieve a high degree of client satisfaction with our services, we need to implement several important measures:

  • identify information sources for conveying client satisfaction;
  • develop a concept for collecting this information and develop a concept for evaluating the conveyed information, which is updated according to the latest scientific knowledge;
  • cooperate with experts in social work on developing client satisfaction questionnaires;
  • introduce the quality tool "Complaint Management," whether as a process or as a guideline;
  • develop a concept for capturing errors, labeling errors, and handling errors within the framework of designated measures for their elimination;
  • determine the method for evaluating and reviewing information regarding identified errors (these may be random, systemic, critical, non-critical errors);
  • determine the method for marking erroneous performance and service within the documentation system;
  • develop a concept for dealing with emergency situations and communicate rules of staff behavior for emergencies (e.g., client disappearance, fire in the facility, emergency condition of the heating or water source, etc.).

By creating a comprehensive documentation system, we ensure the collection of data that needs to be processed so that the analysis of this data provides us with the information required by risk management.

Terminology used in quality management and risk management: (adopted and adapted from the healthcare sector and applicable STN EN ISO 9000 standards). Process deviation = any deviation from the standardized course of a process. Cause = An action that leads to an incident, error, or emergency event. Process = any activity or set of activities that uses resources to transform inputs into outputs. Safeguard = Procedures, documentation systems, and various types of control mechanisms used for the purpose of detecting and correcting a deviation or non-conformity in processes. Incident = An event that may threaten the safety of operations, employees, social service recipients, or direct social activity (performance) but does not result in harm to the health of the interested parties. Emergency event (adverse event) = any event in which an error occurred during the course of social care, performance, or procedure. An emergency event results in varying degrees of harm to the health of the social service recipient (temporary, permanent, or death). Error = Failure to perform an action according to the established plan or performing an action according to the wrong plan. Near miss = an error that was prevented (consciously or unconsciously) at the last moment. Carelessness = Failure to perform an action in the manner that an average worker in the same position, with the same education and the same qualifications, would have performed in the same situation. Negligence = Knowing violation of rules that cannot be tolerated. Danger = A source of possible threat or harm. Hazard = A property of an object or action that may cause a negative phenomenon, injury, or damage. Quality control = part of quality management that relates to the fulfillment of requirements. (Planning, directing, and controlling work techniques such as: preparing control plans, evaluating control results, and determining measures, improvement projects, etc.) Quality assurance = part of quality management that focuses on creating confidence that quality requirements will be fulfilled. (Planning, directing, controlling, and creating system documentation so that it is transparent and understandable for interested parties (Quality Manual, quality evidence).) Quality improvement = part of quality management that focuses on increasing effectiveness and efficiency. (Planning, directing, and controlling the active search for improvement opportunities and their implementation.) Traceability (of service) = The ability to follow the degree of service fulfillment. Non-conformity = failure to meet a requirement. Corrective action = action to eliminate a detected non-conformity. Preventive action = action to eliminate a potential non-conformity. Verification = confirmation and provision of evidence that specified requirements will be fulfilled. Validation = Confirmation and provision of evidence that requirements for a specific intended use or specific intended application are fulfilled. (e.g., individual care plan and care services provided, development of new...) Evaluation = activity to ensure suitability, operational capability, effectiveness, and efficiency of the observed unit so that established objectives are achieved. (e.g., management review, development review, evaluation of care performance, error evaluation) Audit = systematic, independent, and documented process for obtaining evidence and its objective evaluation to determine the extent to which audit criteria have been fulfilled. Change management = processes, tools, and techniques for managing the human side of change in order to achieve the desired outcome of the change while effectively operating within the social infrastructure of the workplace. = designed for radical improvement of organizational results. (Burnes 2000)

Author: Mgr. Mária Kovaľová, PhD. Academy of Education and Research in Social Services, Bernolákova 4, 908 51 Holíč www.avvss.sk

List of References

[1] ŠKRLA, Peter - ŠKRLOVÁ, Magda. Řízení rizik ve zdravotníckych zařízeních. Praha : Grada Publishing a.s., 2008. ISBN:978-80-247-2616-8.

The lecture was presented at the scientific conference Social Services in the Region. Proceedings of the Scientific Conference, held on November 18, 2010 in Skalica, and was published in the conference proceedings: MÁTEL, Andrej – KOVAĽOVÁ, Mária – ŠTEPANOVSKÁ, Martina (eds.) Published by St. Elizabeth University of Health and Social Work in Bratislava, ISBN 978-80-970567-0-4, EAN 9788097056704