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2018IncidentManagementFrameworkCare|Compassion|Trust|LearningISBN:978-1-78602-064-2ForewordThemajorityofservicesprovidedbyhealthandsocialcareorganisationsaresafeandresultingoodoutcomes,bothforthosereceivingandforthoseprovidingtheseservices.Therearetimeswhenthingsgowrong.Theseincidentsoccurduetoacombinationoffactorsincludingthevulnerabilityofthosereceivingcare,thefallibilityofthoseprovidingcareandthedynamicandcomplexnatureofthehealthcareenvironment.Incidentswhentheyoccurcancauseharm.Theseincidentsrangefromtheneedforadditionalmedicaltreatmentoranextendedhospitalstay,tomoresignificantharm,uptoandincludingdeath.Whereasthosedirectlyaffectedbeartheprimaryburdenofthisharm,staffwhoseprimarymotivationistoassistandsupportpatientsandusersofourservices,canalsobesignificantlyimpactedinthesesituations.Thereareotherincidentswhereitisourstaffwhoareharmed.Itisthereforeincumbentonhealthandsocialcareproviderstorespondtoincidentsoncetheyoccur,inamannerwhichseekstosupportthoseaffected.Thisincludespatients,usersofourservices,theirfamiliesandstaff.Thissupportisnotconfinedtotheimmediateaftermathoftheincident,butshouldextendthroughouttheperiodwhentheincidentisbeingreviewed.Timelyreviewswillinturnallowustounderstandwhathappened,whyithappenedandwhatneedstochangetoreducetheriskofitsrecurrence.Whenanincidentoccurs,wehavetheopportunitytodemonstratetheHSE’sValuesofCare,Compassion,TrustandLearningandthisshouldbemarkedbyopennessandtransparency.Fromthetimeoftheincidentandthroughoutthemanagementprocess,theresponseofmanagers,cliniciansandotherfrontlineworkersmustbetoseektodemonstratethesevaluessoasnottodamagetheconfidenceandtrustofanypersonaffectedbytheincident.ThisIncidentManagementFramework2018replacestheHSESafetyIncidentManagementPolicy2014.Itisdesignedtoprovideserviceswithapracticalandproportionateapproachtothemanagementofincidentsandseekstoplaceaparticularemphasisonsupportingtheneedsofserviceusers,familiesandstaffintheaftermathofanincident.ServicesatallorganisationallevelsarerequiredtoaligntheirprocessesforincidentmanagementwiththerequirementsandprocessessetoutinthisFramework.TheQualityAssuranceandVerificationDivisionwilllead,inpartnershipwithotherDivisionsandourserviceorganisations,onthedevelopmentoffurtherresourcestoassistandenableimplementation.IwouldliketotaketheopportunitytothankthelargenumberofstaffacrossthehealthserviceandoutsideofitwhocontributedtothedevelopmentoftheFramework.Inparticular,Iwouldliketoextendmyappreciationtothepatientsandstaffwhosharedtheirpersonalstories.Inacknowledgingthepainfulexperiencestheyshared,itismyhopethatthroughimplementingthisFramework,wewillinsomewaybeabletodemonstratethattheirexperienceshavebroughtaboutrealchange.TonyO’BrienDirectorGeneralHealthServiceExecutiveHSEIncidentManagementFramework1CLICKTOGOƒBACKCLICKTOGOTOIMFSTORIESCLICKTOGOTOIMFGUIDANCECLICKTOGOTOCONTENTSHSEIncidentManagementFramework2ContentsIntroduction4KeyDefinitionsusedintheIncidentManagementFramework5Acronymsusedinthisdocument7PolicyStatement8Purpose8Scope8RolesandResponsibilitiesforIncidentManagement9WhentousetheIncidentManagementFramework9PrinciplesuponwhichtheFrameworkisbased11Governancearrangementsforincidentmanagement12Processformanaginganincident12Step1.Preventionthroughsupportingaculturewheresafetyisapriority14Step2.IncidentIdentificationandimmediateactionsrequired(forpersonsaffectedandto...