What on earth is risk enablement? A conversation between 2 AHPs…

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This is a question that has come up many times in the past year isn’t it June?

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It certainly is Janet!

Screenshot 2019-12-10 at 08.44.21We’ve heard all sorts of definitions from different people as well as a few confused faces. It seems to mean something different to each AHP we ask?

Screenshot 2019-12-10 at 08.44.36Well….it’s tricky…people say to me it’s something that Occupational Therapists do and I think they wonder why a Dietitian (or any other AHPs for that matter) should be involved…

Screenshot 2019-12-10 at 08.44.21Well as an Occupational Therapist I’d agree that it sits very comfortably with person centred goal setting which is key to Occupational Therapy practice but…I would say it’s probably important for everyone in health and social care to think about how they can enable people to take risks that will enhance their quality of life.

Screenshot 2019-12-10 at 08.44.36I definitely agree but how do we explain to people who are unfamiliar with Risk Enablement just what it is and why they should think about it?

Screenshot 2019-12-10 at 08.44.21Well, let’s use some of the feedback from the recent Personal Outcomes Network meeting that really shone a light on Risk Enablement; they had some good ideas…

 “Managing risk is a balance between safety and promoting independence – it’s about getting that balance right for the person”.

So…what’s stopping people from taking risks that improve quality of life?

Screenshot 2019-12-10 at 08.44.36Do you mean “What’s the worry….and whose worry is it anyway?”

Screenshot 2019-12-10 at 08.44.21Precisely!

Screenshot 2019-12-10 at 08.44.36Well one of my colleagues recently asked me:

Is it risky for you as a professional to do risk enablement work with your patient? What if something went wrong? Would I be supported by the HCPC?”

Screenshot 2019-12-10 at 08.44.21The Personal Outcomes Network had some useful thoughts about that:

 

five bulb lights

“Professionals themselves need to feel safe.  It is not that workers don’t want to work [in a risk enabling way], but they need organisational support rather than fear of blame if anything goes wrong. Sometimes workers believe that policies dictate that they can’t take risks, but this is not always so.  There should be tools to record that risk has been discussed, negotiated and agreed”.

Screenshot 2019-12-10 at 08.44.36That leads us nicely into mentioning the Risk Enablement Toolkit that we’ve been working on as part of the AHP Careers Fellowship. It’s been great to have some dedicated time to build on the work started by our AHP colleagues; Angela Pointon from NHS Grampian and Christine Steel from NHS Greater Glasgow and Clyde. What a fascinating journey it’s been to date…maybe we should share some of the highlights?

Screenshot 2019-12-10 at 08.44.21Well…for a start we’ve toured Scotland…Aberdeen, Edinburgh, Glasgow, Dalmuir…having Risk Enablement conversations at every port of call. We’ve spoken to AHPs, Consultants, Medical Directors, Nurses, Care Managers, Carers and service users across different sectors in health and social care.

Screenshot 2019-12-10 at 08.44.36There’s certainly been lots of interest with great ideas from the people who’ve been involved so far. A good example is the flowchart that our local Stroke Rehabilitation Unit suggested. This has been very useful for students and new staff on the Unit and we’re starting to test it in other areas of practice.

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Screenshot 2019-12-10 at 08.44.21The level of interest in this work among different AHP groups has been really exciting.  I’m fascinated by the way teams are interested in adopting the approach as both uni and interdisciplinary groups. Feedback from staff has highlighted how this makes it so much easier to share clinical reasoning about risk within a team.

Screenshot 2019-12-10 at 08.44.36I agree it’s certainly been interesting to gather information from AHPs who have used the toolkit. The framework seems to really strengthen a team’s approach towards risk and also empowers AHP professions to be heard within a multi disciplinary environment.

Screenshot 2019-12-10 at 08.44.21This must impact positively on patient outcomes as well as helping build a strong MDT culture. Are you aware of any other resources that support this area of work June?

Screenshot 2019-12-10 at 08.44.36There was the fantastic website that we were introduced to at the Personal Outcomes Network meeting. It has some really great examples of enabling risk to improve quality of life and covers some real life examples (played by actors) some of which are quite unexpected.

Here’s the link to the SSSC’s resource “A Risk Worth Taking”: https://learn.sssc.uk.com/risk/

Screenshot 2019-12-10 at 08.44.21To my mind, one of the essential aspects of the risk enablement process is having really good support and supervision in place to help people work through the issues that surround each individual case. Without this there is a real danger of practitioners being either risk averse or enabling a risk that they then feel extremely stressed about. Not everyone has the benefit of a supportive multi-disciplinary team or colleague to discuss risk with.

Screenshot 2019-12-10 at 08.44.36So true Janet. Something that really strikes me is that as we take the toolkit to different groups of practitioners, the language people use in relation to risk enablement and personal outcomes is really quite different. Positive risk taking is risk enablement, in the same way that personal outcomes are person centered goals. The language needs to be demystified. Many practitioners are balancing risk Vs quality of life with their patients on a regular basis but are not calling it Risk Enablement to achieve Personal Outcomes!!

Screenshot 2019-12-10 at 08.44.21So the bottom line really is “What matters to my patient and how can my intervention help them reach that place?”

Screenshot 2019-12-10 at 08.44.36Certainly, and along the way considering where the “worry” about taking a risk lies. Is it the patients worry, their families worry……. or is it a worry that the practitioner has which is it standing in the way of the patient achieving something that is really important to them?

Screenshot 2019-12-10 at 08.44.21I suppose the most important thing to remember is that this is about AHPs ensuring that their practice enables people to get the very best they can out of life. Part of our role, no matter where we work is to ensure that we support people to identify and achieve their personal outcomes.

Screenshot 2019-12-10 at 08.44.36Hopefully our Toolkit will support AHPs to enable positive risk taking with their patients. Although at the moment it’s a work in progress, it is gradually coming together thanks to the constructive feedback we’ve had from so many AHPs and the wonderful opportunity to develop it during our AHP Careers Fellowship.

If you’re interested to see a copy of the draft toolkit, please get in touch – we would value your feedback and comments. Here’s a preview of what’s included:

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Screenshot 2019-12-10 at 08.44.21Janet Thompson, Senior Occupational Therapist, NHS Grampian

E-mail: jthompson3@nhs.net Twitter: @Humbletoft2001

 

Screenshot 2019-12-10 at 08.44.36June Gordon, Registered Dietitian, NHS Grampian

E-mail: june.gordon@nhs.net Twitter: @JuneGordonAHP

 

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