Case Study

“HQA has made it effective and efficient and given the organisation confidence and competence in its approach to risk management”

“The team no longer feels that the review process is either a burden or something that may not be completed”

Risk Management and Working in Partnership

The potential benefit of a structured, prioritised risk management process was evident but senior managers and clinicians finding the time to address this was much more difficult…


Developing a new approach to risk management for Primary, Community and Secondary Healthcare for the British Forces population living in Germany.

Supporting colleagues from two organisations working together in a Limited Liability Partnership, the SSAFA GSTT Care LLP (the LLP) (link to to manage risks while working in a complex contractual and commercial healthcare environment with numerous stakeholders including a large NHS foundation trust, a renowned military charity, the Ministry of Defence and multiple German, Belgium and Dutch hospitals and other healthcare providers.

Positive Results:

  • High levels of contractual performance and patient satisfaction
  • LLP Board well-informed of risks, supportive of action plans proposed by senior management and visible link from risk management to decisions
  • Continued strong progress with risk mitigation actions
  • Team work and joint input to resolve difficult commercial and clinical risks
  • Cohesive, inclusive approach adopted with engagement of senior contract delivery colleagues
  • Rolling cycle of risk management review three times per year now standard practice


The LLP wanted to reinvigorate its risk management process as it commenced a challenging period of transition into a new contract. The LLP was facing new staffing structures, a substantial programme of redundancies, new contractual performance indicators with associated high financial penalties, financial uncertainties, potential clinical risks associated with as yet untested clinical providers, extensive new reporting requirements with systems still under development, pressure from commissioners to agree to further expansion across other European areas, and differing cultures between the two partner organisations.

Senior managers and clinicians recognised effective risk management would be hugely beneficial but were extremely time pressured.

What We Did:

Initially workshops and meetings were held with various staff groups to gain wide input into risk identification and develop a risk register including all significant risks to the organisation’s objectives. Risks were grouped into themes and all were framed as risk, cause and impact to inform the next stages.

Further facilitated sessions helped build a joint approach to risk evaluation, grading and prioritisation of the identified risks and develop a core group of colleagues who would continue to be actively involved in the process.

A risk grading tool including consequence, likelihood and proximity scoring definitions was developed and adopted to support the prioritised planning and implementation of mitigation actions.

A standardised format for the risk register and accompanying board reports were introduced and updated every three to four months.

Senior management meetings scheduled at least three times a year to review the risks facing the LLP and review and refresh the mitigation actions required.

Client Testimonial:

“In short, HQA took the problem away. They gently led us through a very constructive process which included focusing the team on the different elements of the Risk Register in a very clear manner, encouraging us to really think about the magnitude of each risk and our levels of tolerance for each risk. By prompting the group with questions, the leadership team now has a sense of ownership of the risks but more importantly the members of that team no longer feel that the review process, which is carried out 3 times a year, is either a burden or something that may not be completed. HQA has made it effective and efficient and given the organisation confidence and competence in its approach to risk management”

Alastair Scarborough, Delivery Board Chair, SSAFA GSTT Care LLP