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1. Scope

1.1. The purpose of this policy is to outline the overarching clinical risk management framework for assessing, treating, and prioritising risk and opportunities in the delivery of services provided by Open Arms.

2. Context

2.1. Clinical risk management, clinical governance, and continuous quality improvement are complementary organisation-wide processes. This Policy should be considered in conjunction with Open Arms Governance Policy, Clinical Governance Policy, Continuous Quality Improvement Policy and the Organisational Risk Management Policy. These documents share a focus on identifying potential problems and implementing corrective actions, including the ability to protect people at risk, minimise errors, enhance efficiency and improve care and services.

2.2. Open Arms clinical risk management policy is aligned with the current national plan for preventing self-harm and suicidal behaviour (the Fifth National Mental Health and Suicide Prevention Plan 2017-2022). It is also aligned with the current national plan for preventing family and domestic violence (the National Plan to Reduce Violence against Women and their Children 2010-2022) and the DVA Family and Domestic Violence Strategy 2020 -2025.

2.3. The Open Arms workforce is multi-disciplinary, with a combination of clinical and non-clinical staff working together to provide an environment and processes to support the Open Arms Vision of an Improved quality of life for veterans and their families. Within this multidisciplinary approach, clinicians and peers collaborate to enable integration of both clinical and lived experience peer perspectives and practices, to identify and respond to both service level and individual level risks.

3. Principles

3.1. Clients have a right to receive mental health care in an environment that actively works to protect their safety, and Open Arms staff equally have the right to work in a safe environment.

3.2. Open Arms supports the active involvement of its workers in developing and enhancing systems and procedures to identify, mitigate and manage risk.

3.3. Risk is dynamic and can be affected by circumstances that can change over time. Therefore, risk assessment and management approaches need to include frequent review.

3.4. Open Arms leadership is committed to robust policy and processes that supports the integration of continuous quality improvement and enhanced organisational responses to clinical risk.

3.5. The Open Arms approach to individual clinical risk identification, assessment and management is recovery-oriented, focussing on balancing duty of care with dignity of risk, supporting a client’s right to self-determination and personal growth with the need to ensure safety and delivery of care in the least restrictive manner.

3.6. Open Arms supports and values the role of those with lived experience in contributing to risk management processes and procedures.

4. Clinical Risk Management

4.1. The Open Arms risk management approach in Figure 1 below is consistent with our obligations under Standard 2 - Safety of the National Standards for Mental Health Services 2010. The process provides a framework for assessing, treating and prioritising risks and opportunities at both and individual client and organisational level.

Figure 1: Open Arms Clinical Risk Management Framework

4.2. Open Arms employs a systemic approach to clinical risk management and has in place embedded structures, processes and tools to assist in identifying, analysing, evaluating and treating clinical risk at the organisational and individual level. The Open Arms framework emphasises the importance of communication and consultation as well as regular monitoring and review, 

4.3. This includes the use of a recovery-oriented framework for identifying, assessing and managing individual clinical risk, in addition to systemically identifying what can and does go wrong during care, understanding the factors that influence this, learning lessons from any adverse events and ensuring action is taken to improve system responses based on lessons learned.

4.4. A clinical audit framework is in place to ensure regular review points are built into the delivery of care, to monitor quality of service delivery at the individual, region and service levels. These audits are an integral part the Open Arms Continuous Quality Improvement Policy and enhance organisational capacity to identify, mitigate and respond to clinical risk.

4.5. Open Arms escalation responses recognise the value of integrated responses to risk management. The Open Arms Escalation Procedure guides workers to provide a proactive outreach response to clients identified as being at elevated risk to themselves, to others or from others, or whom have been otherwise identified as requiring assertive support.

4.6. In consultation with the Regional Director, Assistant Directors jointly oversee the quality of clinical risk management in the region, and provide clinical oversight and management of case escalations within a stepped-care model of service provision. Each Assistant Director has primary responsibility for clinical oversight of the service stream that they line manage. However, a flexible and collaborative approach to this is adopted within the regional leadership team on an as-needs basis, recognising that situations often arise where Assistant Directors must act interchangeably within service streams to support clinical staff and respond to service demand. Within each region, a Risk Consultancy Group (RCG) comprised of the ADCO, ADCOG, Duty Officer and ADCC meet regularly to discuss assessment, intervention and management of significant risk concerns within all service streams, with the view to escalate to Regional Director or National Office, as required.

4.7. Open Arms builds and maintains relationships with external partners, including ESOs, health professionals and facilities through our Community Engagement Teams to ensure we are positioned to support wrap around services for clients who are vulnerable or at-risk, and to enhance our approach to care coordination.

4.8. Open Arms invests in professional development and supervision of workers to ensure our skills, knowledge and practice are evidence-informed and consider risk in terms of how we support and connect with our clients. Consulting with internal and external supervisors and using defined escalation procedures where necessary further enhances our response to client risk and the way responsibliy for risk across our organisation is shared.

4.9. Open Arms recognises that teamwork is the best defence against clinical risk. Everyone who works for Open Arms is an essential and equal member of the team and is valued and empowered to work to the best of their ability. Communication between team members about clinical risk management, and consultation with clinical managers, is explicitly encouraged and fostered within a culture of trust, mutual respect and open communication.

4.10. Open Arms implements case review meetings to support best-practice and evidence informed treatments. Case reviews provide a mechanism for multi-disciplinary teams to work collaboratively to optimise health outcomes for clients. They offer an enhanced opportunity to identify and manage risk, particularly for vulnerable or at-risk clients. Reviews are also conducted on Outreach Provider Counsellor clinical records as part of broader quality assurance processes.

4.11. In managing direct clinical risk to individuals, the SafeSide Framework for Recovery-Oriented Risk Prevention (SafeSide) is used and enables Open Arms workers to consider individual factors within a broader context of clinical risk management.

5. Duty of Care

5.1. Open Arms workers are required to adhere to a standard of reasonable care while performing any action that could foreseeably result in harm to others. Duty of Care also encompasses the need to take positive action to ensure the provision of Open Arms services are in line with the National Standards for Mental Health Services (NSMHS) 2010. See the NSMHS Accreditation Instruction for additional information on this process.

5.2. Open Arms clinical and non-clinical staff, collectively and individually, have an obligation to ensure the safety and wellbeing of clients, employees and the public.

5.3. Open Arms maintains transparent communication with clients regarding Duty of Care responsibilities through practices and processes stipulated in the Open Arms Client Information, Rights and Records Policy. This includes use of Open Arms consent forms that explicitly communicate instances where confidentiality may be breached. See the Privacy and Confidentiality Procedure for further information.

6. Dignity of Risk

6.1. Open Arms recognises that a client’s right to self-determination is a vital part of successful treatment and recovery. The principles of recovery emphasise choice and self-determination within legal and ethical limits and duty of care.

6.2. Open Arms workers manage various and often complex tensions involved in making decisions on how they will respond to client risk. These include, maximising client choice, supporting positive risk taking, working in accordance with legal and ethical requirements, and promoting safety. Striking a balance requires Open Arms staff to understand the complex and sometimes discriminatory nature of the goal of reducing harmful risks.

6.3. Open Arms achieves a balance between duty of care and dignity of risk through strong clinical governance, maintaining good clinical records, and determining a measure of reasonable risk through management review and consultation processes that support informed decision making.

7. Open Disclosure

7.1. When adverse events are identified, Open Arms adopts an Open Disclosure approach within a Restorative Just Culture Framework (see the Adverse Events Review Procedure). Open Disclosure involves an open discussion with a client and/or family member about an incident that resulted in harm while they, or their family member, were receiving Open Arms support. 

7.2. The elements of Open Disclosure are an apology, or expression of regret, a factual explanation of what happened, an opportunity for the client or family member to relate their experience, and an explanation of the next steps being taken to manage the event and prevent recurrence.

7.3. The Open Arms approach to Open Disclosure is aligned with the Australian Commission on Safety and Quality in Health Care (ACSQHC) Open Disclosure Framework (2013).

8. Implementation

8.1. The National Manager:

  • promotes a focus on clinical risk management within Open Arms.
  • ensures effective clinical risk management systems are operating across all Open Arms sites and services.
  • reviews and consider recommendations following clinical risk incidents involving Open Arms clients.

8.2. The Assistant National Manager - Regional:

  • prioritises clinical risk management activities within the Regions and ensures escalation procedures are being followed.
  • ensures effective clinical risk management processes are operating across all Open Arms sites and services.
  • ensures professional development and supervision arrangements related to clinical risk management are in place for all relevant regional staff.
  • ensures oversight of and reporting mechanisms are in place in response to clinical risk management at a regional level.

8.3. The Assistant National Manager - National Operations:

  • maintains clinical risk management as a priority within the National Operations.
  • ensures training and skills development related to clinical risk management is completed by all relevant Open Arms staff.
  • ensures Open Arms policy and procedures related to clinical risk management is reviewed regularly.
  • monitors and evaluates the effectiveness of training related to clinical risk management.

8.4. Open Arms Leadership Teams:

  • ensure all workers undertake training and maintain skills related to assessing and responding to clinical risk.
  • establish clear expectations and embed mechanisms to ensure appropriate levels of oversight of cases where clinical risk exists.
  • support staff to attend professional development actitivies related to clinical risk management.
  • ensure staff are aware of support options such as external supervision, operational supervision, and employee assistance programs.
  • ensure recommendations following incidents are communicated and implemented.
  • provide clinical oversight and supervision of cases involving clinical risk.

8.5. Open Arms Clinicians:

  • ensure clinical risk is routinely assessed and managed in accordance with Open Arms policy and procedures.
  • collaborate with Open Arms Community and Peer Advisors in the identification and response to clinical risk.
  • actively support and contribute to the review of clinical incidents.

8.6. Open Arms Community and Peer Advisors:

  • respond to risk in an appropriate and timely manner by seeking clinical consultation.
  • participate in the implementation of risk management and safety plans as developed with, or approved by, the Assistant Director Clinical Coordination.
  • actively support and contribute to the review of clinical incidents.

9. Parent Policy

9.1. 200 Clinical Governance Policy

10. Directly Subordinate Procedures

10.1. 203 - 01 Clinical Risk Management Procedure