When did something last go wrong in your pharmacy? Did you put it down to bad luck?

Understanding risk and having measures in place to minimise it is an important part of pharmacy practice. Risk is omnipresent. It is an important part of daily life.

We all live with it, in our personal, business and professional lives. If fact, we would not achieve anything without taking some risks, because we can never be sure exactly what will happen when we do something new. It is impossible to eliminate risk entirely.

It is a mistake to think you have eliminated risk, even when you have gone to great steps to do so. In fact, this can lead to complacency and the adverse events you are eager to avoid. By the same token, you must be are prepared to take calculated risks in all situations.

However, it is important that these risks are understood and managed. Your actions should be considered and the potential risks assessed before you take them. You should be clear about the risks you take and understand the possible consequences, the likelihood of those consequences and the possible effects on others.

In every situation, the decision to take a risk should be based on good information and analysis. Taking unqualified risks or high risks is unacceptable. Taking risks with no plans to mitigate them or having no clear idea of how to deal with the potential negative consequences is also something you should avoid.

Three areas of governance

The management of risk is known as governance, and in pharmacy, we think about three elements of governance:

• Clinical
• Corporate
• Information.

• Clinical governance is the management of risk associated with the dispensing process, the sale of medicines and the advice you provide. It also relates to managing the risk associated with community pharmacy services: medicines use reviews, the new medicine service, local commissioned services and any private services you provide. This will incorporate things such as your processes, standard operating procedures, staff training and staffing levels.

• Corporate governance can be thought of as managing financial risk and organisational risk.

Financial risk is related to ensuring that the business remains a going concern. What is the risk of a business moving to new, larger premises? What is the risk of not moving?

Organisational risk will concern the legal, strategic and operational elements of the business.

Legal risks might involve health and safety issues or employment policy.

• Information governance is a newer concept for pharmacy and relates to our duty of care to keep information confidential and secure. This includes access to information, security of storage and access to records held in the pharmacy and accessed online. It also relates to paper-based information. What risk to confidentiality is created by inappropriate disposal of unused dispensing labels in regular paper waste?

These three areas of governance are not distinct entities and failure to manage one can impact on the others. If an unmanaged health and safety risk leads to an accident, it might result in staff being off work, which in itself will lead to a financial risk if their absence is long-term.

There is an organisational risk if the breach of health and safety is serious enough, initially from the potential of the member of staff litigating against you and then the Health and Safety Executive taking action against you. There can also be a clinical risk created by the absence of key members of staff, operating the pharmacy with a lack of trained staff or increased pressure on the staff because of staff shortages.

These areas can also be competing. For example, taking the financial risk of increasing staff levels to manage a risk related to under-resourcing in the dispensary.