Risks in dentistry rarely appear in isolation. There is often a ripple effect that can extend to the outer reaches of even the best-run practices. Dr Raj Rattan, Dental Director at Dental Protection, offers some advice on managing this interdependence
Estimated read time: 5.5 mins
Risk interdependence refers to the connection between risks in a particular environment. In dental care, risks are seldom isolated, and the connections can extend into many areas of everyday practice.
The different categories of risks include:
I have previously presented these risk categories as faces of a Rubik’s Cube. The same metaphor illustrates the interdependencies. Each time you turn any face of the cube, a new configuration results that is unique. The mixed faces create a pattern of interdependency (see figure 1).
This interconnectedness means that the impact of one risk may be contingent on another risk. In other words, there is always a blend of risks that are intertwined and do not operate in isolation.
Identifying risks that have a positive interdependence with others is a highly effective approach to risk management.
There is inherent synergistic value. Managing the risk of running late is a good example, as good time keeping can minimise the risk of human error seen when people work under time pressure.
We have often highlighted the risks associated with ineffective communication. The risks are cumulative and additive, and there is the threat of rapid, exponential escalation.
Where the risk cube shows a familiar and recognisable pattern, experience offers a solution. Pattern recognition, like in chess, is the key.
This is where the experience of our dentolegal teams comes into play. Recognising the interdependencies allows them to offer the best advice and course of action. For example, offering patients a refund of fees to avoid exponential escalation.
A report commissioned by the General Dental Council (GDC) on Risk in Dentistry sought to analyse the main competency, conduct, and contextual risk factors that affected the likelihood of a registrant departing from the GDC’s standards.1
Although the GDC report is informative, there is no specific mention of interdependency, even though many of the risks listed are connected.
For example:
Coined by James Reason, the terms "active failure" and "latent failure" are commonly used to describe error types.
Active failures stem from the actions (or inactions) of operators who are in the frontline and often in direct contact with patients. An active failure can lead to a series of adverse outcomes – for example, an error in diagnosis can lead to inappropriate treatment. Latent failures are unsafe conditions that lie dormant for long periods until, under certain conditions, they are triggered to contribute to an adverse outcome, highlighting the interdependency.
Silo-based risk management is less effective when risks are considered in isolation. It is important to recognise the interdependency that helps us to see the bigger picture and how risks relate to each other. If the risk interdependencies are overlooked or unrecognised, it can result in what appear to be unrelated risks, triggering more severe risk events.
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