Organisational risk management: DipIMC practice questions

PHEM curriculum unit C.6 · Cross-cutting theme C: Clinical Governance

The DipIMC is blueprinted against phase 1 of the UK Pre-hospital Emergency Medicine (PHEM) curriculum. This page covers unit C.6, Understand and apply organisational risk management processes.

Below are 2 free practice questions from the DipIMC.Ninja bank, in the Part A single best answer format. Every answer names the textbook page, guideline or statute it was written from, so you can check it rather than take it on trust. The bank holds 22 questions on this unit.

Question 1 · Law, Ethics & Human Factors · Easy

Your ambulance service has adopted the Patient Safety Incident Response Framework (PSIRF). Which statement about it is correct?

AIt keeps the serious incident category but shortens its investigation deadline to 45 working days
BIt is mandatory for acute hospital trusts but only voluntary for NHS ambulance services
CIt requires a root cause analysis investigation for every incident that causes moderate harm
DIt replaced the Serious Incident Framework and removed the serious incident classification
EIt replaced the statutory duty of candour with a single organisational duty to learn

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Answer: D

It replaced the Serious Incident Framework and removed the serious incident classification

PSIRF replaces the Serious Incident Framework (2015) and makes no distinction between patient safety incidents and Serious Incidents: it removes the Serious Incident classification and the threshold for it, so there is no serious incident deadline left to shorten. It is mandatory for services provided under the NHS Standard Contract, including acute, ambulance, mental health and community healthcare providers, maternity and all specialised services. NHS England's guide to responding proportionately states that root cause analysis prompts simple linear cause-and-effect analysis and has consistently failed to deliver benefits; PSIRF methods explore multiple contributory factors instead, and the framework sets no further rules or thresholds for what must be investigated, so a mandatory investigation at a harm level is the opposite of its position. The statutory duty of candour is untouched: the same guide states that where incidents involve moderate or greater harm, organisations must fulfil their Duty of Candour obligations, even when no individual learning response is undertaken.

Where this comes from

Patient Safety Incident Response FrameworkNHS England, August 2022 (long-read edition)·What is PSIRF?“it removes the ‘Serious Incidents’ classification and the threshold for it”Open at this section
Patient Safety Incident Response FrameworkNHS England, August 2022 (long-read edition)·Who does PSIRF apply to?“mandatory for services provided under the NHS Standard Contract, including acute, ambulance”Open at this section
Guide to responding proportionately to patient safety incidents (PSIRF supporting guidance), v1.3NHS England·Is root cause analysis 'system-based'?“has consistently failed to deliver benefits of the scale and quality needed”Open PDF at page 4
Guide to responding proportionately to patient safety incidents (PSIRF supporting guidance), v1.3NHS England·Assessment to determine if a learning response is required“organisations must fulfil their Duty of Candour obligations”Open PDF at page 17

law-007 · Law, Ethics & Human Factors · Clinical Governance · Easy · v3

Question 2 · Law, Ethics & Human Factors · Moderate

A medicine is given by the wrong route on a rapid response car. The patient comes to no harm. This incident type is already well understood in your trust, it appears in the patient safety incident response plan, and an improvement plan is being implemented and monitored. Under the Patient Safety Incident Response Framework (PSIRF), what is the most appropriate response?

AA patient safety incident investigation, completed within six months
BA root cause analysis to identify the single root cause of the error
CAn after action review of this incident within the next three months
DAutomatic referral of the clinician to the HCPC for fitness to practise
EResources directed to improvement rather than a repeat investigation

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Answer: E

Resources directed to improvement rather than a repeat investigation

PSIRF is built on proportionality. NHS England's guide to responding proportionately says that where an incident type is well understood — previous incidents have been thoroughly investigated and improvement plans targeted at the contributory factors are being implemented and monitored for effectiveness — resources may be better directed at improvement than at repeat investigation or another type of learning response. That describes this incident exactly, so the proportionate response is to put the effort into the existing improvement work rather than open a new learning response. A patient safety incident investigation (PSII) is the in-depth response; PSIIs should take no longer than six months, but that ceiling must not become a default target, and nothing here calls for one. An after action review is a lighter learning response, but it is still a repeat learning response to a problem that is already understood. Root cause analysis is specifically criticised in the guide, which says it prompts simple linear cause-and-effect analysis and has consistently failed to deliver benefits of the scale and quality needed. A referral to the regulator is not a learning response at all, and nothing in the scenario raises a question about the individual's fitness to practise.

Where this comes from

Guide to responding proportionately to patient safety incidents (PSIRF supporting guidance), v1.3NHS England, August 2022·Improvement based on learning from incident response“resources may be better directed at improvement rather than repeat investigation”Open PDF at page 16
Guide to responding proportionately to patient safety incidents (PSIRF supporting guidance), v1.3NHS England, August 2022·Is root cause analysis ‘system-based’?“has consistently failed to deliver benefits of the scale and quality needed”Open PDF at page 4
Guide to responding proportionately to patient safety incidents (PSIRF supporting guidance), v1.3NHS England, August 2022·Timeframes for learning response methods“no longer than six months, but this must not become a new default target”Open PDF at page 19

law-008 · Law, Ethics & Human Factors · Clinical Governance · Moderate · v3

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Organisational risk management: DipIMC practice questions

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