Dr Iniobong Enang and Professor Maureen Meadows, the Research Centre for Business in Society

Strategic Risk Management in Health: What’s the Problem?

Public health systems across the globe are under significant pressure, and the UK National Health Service (NHS) is no exception. The ongoing impact of the COVID-19 pandemic, workforce shortages, digital vulnerabilities and financial constraints have exposed critical gaps in existing risk management frameworks. The Scottish Public Health Observatory (2023) highlights that life expectancy in Scotland remains among the lowest in Western Europe.

This project asks, how can strategic risk management be strengthened to better safeguard public health, and provide assurance about the efficient use of health resources in Scotland?

CBiS colleagues (Coventry University) in collaboration with researchers at Edinburgh Napier University recently led a stakeholder engagement workshop to explore implementation of the Board Assurance Framework (BAF) by Scottish NHS Territorial Boards (SNTBs).

We explored how the BAF could be modified or improved to provide better governance, accountability, and strategic oversight. Members of the SNTBs and senior risk management practitioners from England and Scotland discussed the possible evolution of the BAF into a Strategic Risk Assurance Report (S-RAR), supported by a Strategic Risk Assurance Toolkit (S-RAT), to provide clearer guidance and more effective risk management tools for NHS Scotland.

Enhancing Board Assurance

The BAF is widely recognised as a tool to assure governing boards that strategic risks are being managed effectively. However, there is also a lack of consistency in how the BAF is understood and deployed across NTBs. For instance, the BAF is seen by some as an operational tool rather than a strategic governance report.

Existing literature reveals a gap regarding BAF implementation by NHS Boards. The importance of governance frameworks in managing public sector risks is well established. Yet little is known about the use of the BAF to support strategic decision-making in the NHS in Scotland, leading to an inconsistent approach to risk management across the 14 NTBs.

Listening to Expert Voices

The workshop revealed that the BAF, in its current form, is not being fully utilised as a strategic report. Instead, some NTBs use it in a more limited, operational capacity, which hinders its effectiveness in providing strategic oversight and assurance.

Participants noted the challenges of implementing a unified risk framework across all NTBs, given the varying levels of governance maturity, resources, and risk management expertise. More comprehensive tools are needed that can offer real-time insights into risks and provide clear guidelines for managing them.

The workshop highlighted that a well-structured, dynamic system like the proposed S-RAR and S-RAT has the potential to address these issues. The S-RAR can offer NTBs a high-level, real-time report on strategic risks, while the S-RAT can provide the necessary guidance to ensure consistency in implementation across NTBs.

Deriving New Approaches to Strategic Risk Management for NHS Scotland

The introduction of the new tools represents a significant shift in how strategic risk management is approached in NHS Scotland. By transforming the BAF into a more dynamic, real-time reporting system, NTBs will be better equipped to anticipate and manage strategic risks proactively.

The S-RAR will provide governing boards with evidence that strategic risks are being managed effectively. It will provide comprehensive risk visualisation, allowing boards to monitor strategic risks as they evolve and make informed, timely decisions. This real-time functionality will reduce the lag between risk identification and response, ensuring that strategic risks are managed before they escalate. The S-RAT will offer practical guidance for implementing the S-RAR, standardising risk management practices while allowing for customisation based on the unique needs of each NTB.

Together, these tools will enhance the governance capabilities of NTBs, providing greater transparency, accountability, and assurance that strategic risks are being effectively managed.

Action Planning to Improve Risk Management

The workshop noted that NTBs should prioritise comprehensive training in strategic risk management to ensure that all staff are equipped to utilise the new tools. Training should focus on strategic risk identification, the use of reporting tools, and the integration of AI-driven insights into decision-making processes.

Flexibility and adaptability are crucial. The S-RAR should be designed to accommodate specific governance needs of NTBs, while maintaining consistency in its core components. For the S-RAT, it is essential to provide clear, practical templates and guidelines to facilitate efficient and effective implementation across the organisation. These steps will ensure the tools meet the diverse requirements of NTBs while supporting robust governance.

Effective communication is another critical area of focus. The use of visualisation tools, such as dashboards, should be prioritised to present strategic risks to all stakeholders. This will ensure that key information is accessible for informed decision-making.

The alignment of new tools with NHS Scotland’s existing governance frameworks is essential for consistency and collaboration. Ensuring that these tools align with NHS Scotland’s directives will promote a cohesive approach to risk management across NTBs and facilitate stronger partnerships between territorial boards.

Shared ownership of the S-RAR will foster a culture of proactive risk management. Responsibility for the S-RAR should involve operational managers, governance teams, and senior leaders. This collective approach will embed risk management into the organisational culture, ensuring a unified and proactive response to strategic risks.

Striving for Real Benefits for Scotland

Strengthening strategic risk management within NHS Scotland is not just an operational necessity; it is a critical component of ensuring high-quality healthcare for the people of Scotland. The ability to identify, assess, and mitigate risks in real time will allow NTBs to allocate resources more efficiently, improve decision-making, and ultimately enhance patient outcomes.

By implementing the new tools, NTBs can improve governance and navigate the complex and evolving challenges facing the healthcare sector today. As risks continue to grow in complexity, such tools will provide insights to ensure that public health services remain resilient, accountable, and effective.

Through understanding the impact of organisations’ activities, behaviours and policies, the Centre for Business in Society at Coventry University seeks to promote responsibility, to change behaviours, and to achieve better outcomes for economies, societies and the individual.

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