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P-221 Risky business – A fresh approach to managing your risk register
  1. Wendy Lancaster
  1. St Michael’s Hospice (Hastings and Rother), St Leonards-on-Sea, UK


Like many organisations, the hospice found it challenging to stay on top of its risk register and difficult to effectively use it for informing business decisions. In fact, the senior team found that with over 70 discrete risks, with overlapping controls and actions, on an Excel spreadsheet, managing the risk register had become a ‘risk’ or ‘mission impossible’.

In 2022 an external organisation was commissioned to review the governance of the organisation and made a recommendation to adopt a governance assurance framework and move away from a traditional ‘Corporate Risk Register’ at Board level. Sample templates were shared with the senior manager responsible for maintaining the risk register and a new framework was developed and approved for use in March 2023 by the Board.

The new Board Assurance Framework seeks to display ‘a risk on a page’ with sufficient evidence of:

  • Risk mitigation, and assurance that the mitigations are effective.

  • Data and evidence to quantify and qualify the level of risk and overall score.

  • Actions that will aim to reduce the risk to a tolerable or acceptable level.

The first task was to streamline and stratify the risks. The approach taken initially was ‘what keeps the senior team awake at night’ and from this, three risks to our strategic aims were identified:

  1. The building.

  2. Workforce.

  3. Funding.

The successful development of the Board Assurance Framework has led to the concept being adopted for each governance committee, and the safety and clinical governance frameworks are now in development, with ‘people’ and ‘finance’ to follow later in the year. Links between the risks and the frameworks will be embedded to allow for updates to be made in one place and changes propagated through. It is hoped that this fresh approach will make risk management less daunting and support informed decision making.

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