Organizational interventions to promote risk management in primary care: the experience in Warwickshire, England

Primary care organizations are under-represented in research on quality improvement and risk management (RM), yet the potential for improving patient safety is possibly greater given the extent that clinical judgement is required to achieve a service tailored to the individual's personal health and lifestyle. This paper examines how a health authority in England promoted interventions to improve RM in General Practice that included the practices' own initiatives, significant event audit (SEA) and the Medical Defence Union's workshops which included SEA. All 75 practices were approached before the programmes and when they were finished, eight months later. The practice manager from each practice completed an audit of RM activities, from which a RM competence score was derived. Up to six staff per practice completed the Learning organization Culture Questionnaire (LCQ) at both times. There was evidence of improved competence in RM over the period of the study, particularly through a widening breadth of staff involved and in formal recording systems. There was little evidence that these improvements were mediated by organizational culture. It is argued that future interventions should more closely target specific competences (e.g. recording systems for adverse events, root cause analysis to understand error generation) and enable staff to see tangible personal and organizational benefits for the extra effort involved.