Research at University College London
Research into adverse events began in 1985 at University College London when the Medical
Protection Society funded a two year study, later extended to five years, under the direction
of Professor R. J. Audley. Early studies examined the accuracy of detection of radiographic
abnormalities, the causes of major obstetric claims, junior doctors' experience of supervision
and training and the impact of adverse events on patients. This programme of research
culminated in the publication of an edited book, Medical Accidents.
North Thames Risk Management Project
From 1993 to 1994 the Directorate of Public Health in North Thames (West) Region funded a
programme of health services research into complaints, claims and risk management. Charles
Vincent was seconded from University College London to direct the research and Pippa Bark
was recruited as principal researcher. During this period, four projects were completed,
including a study on complainants' views of their care, a study on why litigants sued,
a study of senior clinicians' views of the causes and consequences of litigation[4,5,6],
and the development of an interview technique for investigating serious accidents. These
studies provided the foundation for the approach to risk management taken by the Clinical
Establishing the Clinical Risk Unit
In June 1994 the research team organised a conference on risk management at the Royal Society
of Medicine for invited senior staff from both purchasers and providers in North Thames Region.
The conclusions were that provider units saw a clear need for risk management, but felt they
lacked the necessary knowledge of the process, there was an urgent need to train managers and
clinical staff and a clear need for research into the causes and consequences of untoward
Following this conference, plans for establishing the Clinical Risk Unit were drawn up and
approved for funding by the Health Agencies in April 1995. Further funding for a fixed term
lectureship in Clinical Risk has since been provided by Healthcare Risk Resources International.
The training programme will be self supporting from January 1999 when the MSc programme is
established at University College London (UCL). Funding for future research will be sought
on a project by project basis.
The CRU Education and Training programme began in October 1995 as a series of one day training
sessions and has led to the introduction of formal qualifications in clinical risk management.
While some commercial training schemes are offered, until recently, few dealt directly with
clinical risk management and costs have not always been realistic for NHS staff. To meet this
demand, a series of non-profit making courses for North Thames staff were designed and run
from 1995. This is the first time a risk management programme has been run on a region wide
basis and demand from within and outside the region has been high.
As risk management has developed so has the need for formal training and professional
qualifications. To meet this demand, the CRU has designed graduate courses in collaboration
with CHIME (the Centre for Informatics and Multiprofessional Education at University College)
providing training in clinical risk from both an academic and professional perspective. Whilst
other institutions offer risk management training, as far as we know this is the only British
course with a strong clinical, rather than legal, focus. The contents of the courses are
described on the CHIME website.
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1. Vincent, C.A., Ennis, M., Audley, R.J. (eds) (1993). Medical Accidents. Oxford University Press.
2. Bark, P., Vincent, C.A., Jones, A., Savory, J. (1994) Clinical Complaints: A means for improving the quality of care. Quality in Health Care, 3, 123-132.
3. Vincent, C., Young, M., Phillips, A. (1994) Why do people sue doctors? A study of patients and relatives taking legal action. Lancet, 343, 1609-13.
4. Vincent, C., Bark. P., Jones, A., Olivieri, L. (1994) The impact of litigation on obstetricians and gynaecologists. Journal of Obstetrics and Gynaecology, 14, 381-7.
5. Vincent, C.A., Olivieri, L., Bark, P., Jones, A. (1996) Psychiatrists' views of litigation and risk management. Clinical Risk, 2, 103-6.
6. Bark, P., Vincent, C.A., Olivieri, L., Jones, A. (1997) Impact of litigation on senior clinicians: implications for risk management. Quality in Health Care, 6, 7-13.
7. Vincent, C.A., Bark, P. (1995) Accident Investigation: Discovering why thing go wrong. In Vincent, C.A. (ed) Clinical Risk Management, BMJ Publications, 391-410.
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This page was last updated on 8 October 2002.