Professional Risk and Working with People

Decision-Making in Health, Social Care and Criminal Justice

Andy Bain, David Carson

• Publisher: Jessica Kingsley Publishers
• Year: 2008
• ISBN:
  9781846427572
• Topic: Scienze sociali
• Subtopic: Lavoro in ambito sociale

Professional Risk and Working with People provides advice on assessing and managing risks for all those employed to take risks with or on behalf of other people.

The authors explore issues of risk assessment and management that provides readers with a broad knowledge of risk practices that can be applied across a range of disciplines. They detail the benefits of risk as well as the potential harm and explain relevant legislation and concepts of negligence in clear and accessible language. Examples of risk policies, systems and effective judgement in managing complex risk decisions are also included.

In the current climate of blame and readiness to pursue legal action against professionals, this book will prove essential reading for all practitioners who come into contact with risk, including doctors and other health and care professionals, probation officers and social workers. Leaders of professional courses and their students will also find this an invaluable guide.

CHAPTER 1

Risk: Making It Work For and Not Against You

Introduction

‘Risk’. It is such a short, abrupt, single-syllable, matter-of-fact, word. Everyone uses it, and regularly. Everyone takes risks, considered and unconsidered. So it must have a clear, agreed and easily understood meaning. Unfortunately not!

Many of the problems we have with risk-taking arise because we do not have an agreed, settled definition of ‘risk’, let alone for related concepts such as ‘risk assessment’, ‘risk management’ and ‘risk factors’. Meanings and practices vary within and between the human, health and social services. Indeed, some professional risk-takers effectively ‘shoot themselves in the foot’ when they adopt certain existing definitions of risk. They make it much more difficult to justify their decisions. So the key objectives of this chapter are to:

•identify problems with existing definitions of ‘risk’ and related concepts

•provide definitions which will work for you

•make the case for a ‘shared vocabulary of risk’.

This ‘risk vocabulary’ will be added to as we progress through the book. It is easier, and more appropriate, to explain some concepts later. It is recommended that professionals formally adopt this vocabulary. Not only will it improve their communication about risk, but it will make it easier to explain and to justify individual risk decisions. If you wish to criticise and find fault with professionals’ risk-taking then one of the easiest and most productive places to look at is risk communication.

This chapter offers a number of definitions of ‘risk’ and related expressions. It is not argued that these are the correct definitions. They are not prescribed by law. They differ, significantly, from some dictionary definitions. But they can, as will be explained, be justified. And, unlike some definitions, they work for, rather than against, professional risk-takers. A number of key working definitions have been grouped together at the end of the book.

‘Risk’

Risks are everywhere: at work, at home, at play, in both activity and inactivity. We take many risks each day, usually without thinking about them, even without realising that they could be analysed as such. For a bit of fun, next time you visit a supermarket, watch people choosing their wine and consider your own decision-making. There is a risk that the bottle chosen will prove to be a mistake, a waste of money. How long do they, and you, take to make your choice? How do you cope with the amount of information available: price, nationality, colour, grape varieties, alcoholic strength, year, label, name and so on? Are there any features which distinguish quick risk-takers from the more contemplative?

We take risks for ourselves and we impose them on others, such as when we drive our vehicles. Often, we perceive the risks as choices; should we travel by train or by car? Should we change our plans because there was a train crash last week? We give each other advice about which products to buy and what action to take. It could prove wrong; we might be blamed. We do not need special training or aids to help us to make these decisions, or most of them. (There is a considerable industry giving advice on minimising the risks of buying wine.) We get anxious about some risks, for example agreeing to surgery, flying or before buying something expensive. We rely upon other risks, in sports and entertainment, to provide us with excitement. We build amusement parks, with ever more dramatic rides to frighten ourselves, simultaneously insisting that they are very safe. We risk our money in gambling or investments. Indeed, we cannot live without risk-taking and yet, sometimes, it kills or injures us. We embrace risk and reject it, simultaneously. We condemn dangerous and reckless conduct, and yet we also condemn, as paternalism, attempts to restrict our ‘right’ to take risks. Risk-taking is commonplace. Everyone does it. Surely it is a simple concept to understand?

We may be experienced in risk-taking. We may be able to take most of the risks which confront us in our daily lives without detailed analysis and thought. But, whilst that provides our lives with excitement and vitality, it is also a major part of the problem. We are so used to taking risks that we do not seem to feel a need to examine the concept, and the practice, of risk-taking more closely. And when we do examine what different people mean by a ‘risk’, we discover considerable differences. This is important. Imagine, for example, that you are in court, in the witness box. If you mean one thing by ‘risk’, and the cross-examining lawyer and judge assumes another meaning, then you will have problems. You might, for example, be describing something which would be better analysed as a ‘dilemma’. If it is a ‘dilemma’, or emergency, then that should entitle you to extra consideration from the court. If you present the decision as merely a risk then you will have lost that potential benefit.

Towards a working definition of ‘risk’

Here are a few questions for you to reflect on your understanding of the term ‘risk’.

•What are the essential ingredients without which it would not be a ‘risk’?

•Which words and phrases are synonymous with ‘risk’?

•How does ‘risk’ differ, if it does, from ‘fate’, ‘gamble’, ‘chance’, ‘dilemma’, ‘choice’, ‘decision’?

•Do you take ‘risks’, or do you ‘gamble’, with your patients or clients?

•Why did Shakespeare use ‘fate’ (frequently) but not ‘risk’? (For an entertaining history of ‘risk’ see Bernstein (1999). He maintains that serious study of risk only began during the Renaissance (p.3).)

•Do you use ‘risk’ in the same way in both your professional and your private lives?

•Does your employer or professional association have an official or agreed definition of ‘risk’ or ‘risk-taking’?

•Are your assumptions about the nature of ‘risk’ consistent with the law?

•Does your definition of ‘risk’ help or hinder you when you come to make and to justify your decision?

When we have problems understanding the meaning of a word we can consult a dictionary. These tell us how different words are, or were, used at the time the compilers completed that edition. Dictionary definitions can, and do, change over time to reflect changes in usage. They are helpful but they are not binding. There is no legal requirement that we adopt, or limit ourselves to, dictionary definitions. The issue is communication. If we do not use words in consistent ways, which others understand, we will not communicate efficiently, if at all. The working definitions of ‘risk’ which we develop are similar but not identical to those articulated in several dictionaries. So this book has to convince you that it is both possible and proper to communicate using our slightly but significantly different meanings.

Consult a dictionary on the meaning of ‘risk’ and you are likely to be given a definition that highlights three other concepts. These are:

•harm

•likelihood

•uncertainty.

Of course, different dictionaries will use different words; ‘uncertainty’ may not be included but it will be implicit. There are lots of synonyms for, and different ways of describing, each of the three concepts listed above. ‘Harm’ or damage might be described as the consequences, or the outcome, of risk-taking. ‘Likelihood’ may alternatively be described as chance or possibility. But those are the three key ideas: outcome, likelihood and uncertainty.

Blackburn (2000), an eminent British forensic psychologist, says:

Risk generally refers to the possibility of loss or costs when an outcome is uncertain, but in clinical and criminal justice settings, it means the chance of an adverse outcome. (Blackburn 2000, p.177, emphasis in original)

The first key argument of this book is that such dictionary definitions are inadequate, and are thus wrong to use in this context. They make risk-taking with people more difficult. Clearly, some people do use ‘risk’ in the way that the dictionary suggests. Blackburn (2000) clearly does. And, as will be seen in later chapters, legal definitions of risk are very similar to these dictionary definitions. Perhaps the dictionaries are correct in terms of what they set out to do, that is, to describe how the terms are commonly used. There is no doubt that Blackburn was reflecting normal usage in the settings to which he referred. However, a change in the usage of ‘risk’ is discernible, and it is towards the ways in which we use the terms. Ideally, these new usages should find their way into new editions of dictionaries. Words and definitions should be tools rather than obstacles.

Several organisations, as well as individuals, have developed definitions of risk and associated concepts. The Royal Society is arguably the premier group of leading academics in the UK. The Society examined the issues in a 1992 report. For the Royal Society ‘risk’ is ‘the probability that a particular adverse event occurs during a stated period of time, or results from a particular challenge’ (Royal Society 1992, p.2). The Health and Safety Commission, and its Executive (HSE), has statutory responsibilities for health and safety at workplaces in the UK. Arguably, the HSE is the premier practical authority on risk-taking in the UK. Encouraging good, and discouraging poor, risk-taking is central to its work. Therefore the HSE definition of ‘risk’ should be of considerable practical significance. The HSE has defined ‘hazard’ and ‘risk’ as:

•A hazard is anything that may cause harm, such as chemicals, electricity, working with ladders, an open drawer, etc.

•The risk is the chance, high or low, that somebody could be harmed by these and other hazards, together with an indication of how serious the harm could be. (HSE 2006, p.2, emphasis in original)

This definition identifies two factors. First, there are the outcomes or consequences – these are the references to people being harmed and the seriousness of the outcome. Second, there is the likelihood – the references to chance and its level being high or low. The hazards are the causes of the harm. There is no reference to uncertainty but it is implicit.

‘Risk’ has variable ‘elements’ and ‘dimensions’

These definitions of ‘risk’ are very similar. They may use different words, and some may treat uncertainty as implicit, but they agree on the two core features of risk-taking: the potential outcomes and their possibility. Clearly, there is much more to it but these are the two key features, which are referred to here as the two elements of risk-taking.

‘Risk’ may be divided into its ‘elements’ (the features inherent in a risk proposal) and its ‘dimensions’ (features that may be influenced by the decision-maker). Both are important. Both must be considered when taking a risk decision. Both are relative; they involve matters of degree. The elements, the core ingredients or requirements of a risk, are particularly relevant to risk assessment. The dimensions are particularly important for risk management. As will be further discussed in Chapter 4, risk assessment is the stage in risk decision-making when information is collated. It is concerned with predicting the consequences of taking the risk decision and their likelihood. It focuses on the key elements of a risk. Risk management involves implementing, monitoring, influencing, controlling and reviewing the risk decision. This is discussed in more detail in Chapter 5. Risk assessment precedes the risk decision. Risk management follows it, for it is concerned with its implementation. A risk management plan, which deals with the risk dimensions, needs to be considered within the risk decision. The dimensions of a risk in particular relate to this controlling, implementation, stage (see Table 1.1).

The three concepts of the meaning of risk identified by many dictionaries and other sources – harm, likelihood and uncertainty – are variable. There can be many different degrees of harm, or loss, from the trivial to the catastrophic; from that which is not worth bothering about to that which could lead a court to award thousands of pounds in compensation. Likelihood is also variable. It can range from the nearly certain to the nearly impossible. Note that if something is bound to occur, or it could not possibly occur, then we would not describe it as involving a risk. There is no risk involved in a one horse race (assuming the horse does not fall or meander off the course). No bookmaker would be prepared to accept a gamble on that race.

The outcomes, and their likelihood, are the two elements involved in risk-taking. When a risk is taken with an offender, for example, we are concerned with (a) the possible consequences and (b) their likelihood. The possible consequences will vary from case to case and be of varying levels of seriousness. Similarly, the likelihood of those outcomes will vary from case to case and in degrees of probability. These two elements, the outcomes or consequences and their likelihood, relate to the references to harm and likelihood that are commonplace in dictionary and other definitions of ‘risk’.

Table 1.1 An overview of ‘risk’

Risk assessment	Risk management
Collating and assessing information about the risk elements	Discovering and manipulating the dimensions of the proposed risk into a plan to control the risks when implemented
Risk elements	Risk dimensions
Features inherent in the risk proposed:	Features of the risk that may be influenced by the decision-makers:
a) The outcomes, e.g. the harm possible b) Their likelihood (See Chapter 4, Risk Assessment, for a fuller discussion)	The resources available to manage the proposed risk, including uncertainty (i.e. the quantity and quality of knowledge about those resources and the risk elements) (see Chapter 5, Risk Management, for a fuller discussion)

What about ‘uncertainty’, the third concept in many dictionary and other definitions? Transferring a prisoner to an open prison involves risks. He or she might, among many other things, escape from that prison and offend again. Leaving a child with potentially abusive parents may lead to child abuse. We will never know for certain how likely or how serious that would be. (If abuse happens that does not – see the following arguments – prove that it was inevitable.) Uncertainty is certainly a feature of risk.

Uncertainty is a dimension, not an element, of risk-taking. It is relevant, it is something which we can and should take into account in relation to risk management. For example, we will often be able to delay taking a risk decision (travel during the spring rather than the winter) in order to reduce our uncertainty. Uncertainty is within our control – to an extent. We may be more ignorant, or more uncertain, about the risks with offender A than with offender B. (Perhaps we have more experience of offender B.) But, and this is a key point, that does not make the consequences of taking a risk with offender A any more serious or more likely. Offender A is not more likely to abscond or to remain unlawfully at large for longer, or both, just because we are more uncertain of the risks in relation to him than offender B. Something is not more (or less) likely to happen just because we know less about it. We need to be aware of our uncertainty when we make a decision. We could, for example, decide to adopt a wider ‘margin of error’.

Uncertainty is not directly linked to the likelihood or the seriousness of outcomes. Imagine that you are more ignorant of the safety record of Xanadone Airlines than Yillybilly Airlines. Does it follow that Yillybilly Airlines is the better risk, the safer airline? No, we do not know that, and cannot know that, until we become less ignorant. It could be that Xanadone Airlines has a much better safety record, we just do not know about it. If we get some information, for example that we are ignorant about Xanadone Airlines because it used to be called Zilly Airlines but changed its name because of a disastrous safety record, we can now make a better risk assessment. That new knowledge was directly relevant to one of the elements of risk-taking, likelihood. We might decide to devote some of our resources, for example time, to investigating the safety of both airlines. That would be an example of risk management.

MacC...

Table of contents

• Cover Page
• Of Related Interest
• Title Page
• Copyright
• Contents
• Preface
• Chapter 1: Risk: Making It Work For and Not Against You
• Chapter 2: Map and Model
• Chapter 3: The Law: From Judging to Supporting Decision-making
• Chapter 4: Risk Assessment
• Chapter 5: Risk Management
• Chapter 6: Risk Communication
• Chapter 7: Risk Procedures
• Chapter 8: Risk Policies
• Chapter 9: Risk Strategies
• Chapter 10: Conclusion
• Appendix: Shared Vocabulary Of Risk And Risk-Taking
• References
• Subject Index
• Author Index
• Index Of Legislation
• Index Of Case Law