Until recently, the management of safety in clinical practice was more informal than formal. Individual clinicians took steps to enhance the safety of their practice and a variety of quality improvement measures were in place at different times but there was no systematic approach to the understanding, measurement, monitoring and improvement of safety in clinical practice. Towards the end of the last millennium, a number of developments, including the emergence of clinical governance and the publication of To err is human and An organisation with a memory, brought about a major movement now known as ‘patient safety’. The need to address an increasing burden of litigation also led to the concept of risk management in health care. Risk management is sometimes still perceived narrowly by clinicians as avoidance of litigation but it is more profitable to see it as a tool for enhancing patient safety, which is what it really is.

Risk management systematically identifies and evaluates factors that could expose patients, staff, visitors and hospital property to harm and puts in place defences which minimise the likelihood that such hazards will produce harm. The instinctive reaction of some clinicians would be that risk management is stifling but this should not be the case. On the contrary, and particularly when there is appropriate ownership, risk management empowers clinicians to use their skills and expertise in maintaining a safe healthcare environment.