Background We recently reviewed and revised our methodology for risk management. The existing process was not intuitive or informative; did not demonstrate the seriousness of some risks or how much work had been invested in mitigating them. Critically, risks faced and the levels at which they were being managed were not well understood or appreciated by the Board of Trustees.

Aim To revise the methodology and format for recording clinical risks and controls, so allowing an improved understanding of the risks and enhance clarity around existing controls. To augment identification of areas where controls require enhancement and record the actions taken to allow this.

Method After agreeing the new format for the risk register and risk presentation, all existing risks were reviewed. This produced a clearer understanding of the new terms of ‘gross risk’, defining the level of risk with no controls in place and ‘net risk’, defining the level of risk with mitigation actions in place. The register additionally documented the controls in place to mitigate risks and the probability and potential impact of each risk.

Results Key risks were accurately and clearly highlighted, based on causes and consequences, to both the clinical team and Board of Trustees. This resulted in a better understanding of organisational risk appetite. The effect of existing controls was clearly evidenced and areas where further controls were required was demonstrated.

Conclusion This process has significantly enhanced our understanding of the risks faced by the hospice clinical team, clarified the work already undertaken to mitigate risks and identified areas where further controls are required. Improving our risk management process has put us in a better position to justify future investments. As a consequence of success with this new clinical risk management approach, all other institutional risks registers are to be put into this format.