Risk management paradigms in health and social services for professional decision making on the long-term care of older people

Risk management systems and structures are developing rapidly within UK health and personal social services. However, the risk management strategies of organizations need to take into account the conceptual frameworks used by professionals. This grounded theory study used data from nineteen focus groups and nine semi-structured interviews (ninety-nine staff in total) to explore perspectives on risk and decision-making regarding the long-term care of older people. Focus group participants and interviewees comprised social workers, care managers, consultant geriatricians, general medical practitioners, community nurses, occupational therapists, home care managers and hospital discharge support staff. Social work and health care professionals conceptualized risk and its management according to six paradigms that appeared to be in a state of reciprocal tension: (i) Identifying and Meeting Needs; (ii) Minimizing Situational Hazards; (iii) Protecting this Individual and Others; (iv) Balancing Benefits and Harms; (v) Accounting for Resources and Priorities; and (vi) Wariness of Lurking Conflicts. The effective translation into practice of risk management strategies needs to address the complex and often contradictory issues facing health and social services professionals.