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Foul-up factors are the gremlins that bedevil every complex system. A simple way to explore FUFs is to draw a schematic model of the key business processes. (The principle can be used at every level from organisational and functional to project management or individual service tasks.)
- Each decision is represented by a square
- Each action by a triangle
- Each need for consultation with others by a circle
In many healthcare organisations, the system has three levels:
- A primary level – the main activity
- A supporting level – activities, decisions and consultations that precede the main activity or make it easier/ smoother
- A contingent level – activities, decisions and consultations that happen (or should happen) as a result of the main activity
So, for example, a primary system at the clinical level might be cost-effective and rapid screening of women for breast cancer. An important factor here may be maximising the use of expensive equipment. The support systems might include making appointments and ensuring that patients are relaxed before their appointment. A contingent system might be dealing with those patients, who do not receive an all-clear. From a service risk perspective, it is often the supporting or contingent systems that are most likely to give rise to problems.
Having mapped out the system, in as much detail as you feel appropriate, it is possible to consider the impact of a failure and the frequency or likelihood of failure at each point. Multiplying the frequency and the potential impact provides a figure, which helps put the risk at each point in perspective.
The value of the FUFs approach is that it allows both examination of each element of risk and an assessment of the total risk. In general, organisations are much better at managing the individual, obvious risks than they are at managing the cumulative smaller risks, which together can bring the whole system down.
Copyright – David Clutterbuck
