The institutional work of hospital risk managers: democratizing and professionalizing risk management

The growing importance of risk management programs and policies in health care organizations has given rise to a new organizational figure, the risk managers. This paper seeks to better understand their role by looking at their risk work as a form of institutional work. From an inductive study of hospital risk managers in the Quebec health care sector, we provide a situated account of the risk work or ‘the effortful pattern of practices’ accomplished by hospital risk managers at the intra- and extra-organizational levels. The results show that they engage in two broader recursive forms of institutional work. At the intra-organizational level, it is by building bridges, autonomizing teams, legitimizing risk work, and pragmatizing interventions that hospital risk managers contribute to democratizing the risk management practices in their organization. At the extra-organizational level, it is by networking with colleagues, hybridizing knowledge, shaping identity, and debating solutions that they contribute to articulating a professionalization project. We argue that the recursive relationship between these two forms of institutional work, namely democratizing and professionalizing risk management, demonstrates how the risk work done at one level facilitates the risk work accomplished at the other. The paper provides three contributions. First, it opens the black box of the hospital risk managers’ roles by showing the complexity of their risk work, instead of formalizing expectations about their role in a normative way, as is generally the case. Second, this research provides evidence about how actors with limited collective power and resources such as hospital risk managers participate in disseminating risk management programs and policies. Third, the paper offers a multi-level understanding of the ways by which hospital risk managers work to institutionalize risk management program and policies. The paper ends by discussing the importance of gaining a better understanding of the risk managers’ role and their institutional work.     

Living in a foreign country: the meaning of place of origin and gender for risk perceptions,experiences, and behaviors

Abstract

Previous research has convincingly proven that perceptions, experience, and exposure to risks vary among certain groups in society. By drawing from a unique combination of Swedish survey data and interviews, this study aims to investigate perceptions and experiences of risks as well as in relation to behavior by analyzing the cleavages related to interactions between place of origin and gender. Theoretically, we see individual risk perception as part of situated hierarchical power relations where an individual’s position (which is an intersection of, for example, gender, race, age, and place of origin) structures action and thought. Findings verify that foreign-born men and women perceive risks to a greater extent than those born in Sweden. However, no direct pattern of ethnicity is apparent in exposure to risks, but since predictors measuring experience of discrimination are shown to be significant, the effect can be mediated by such circumstances. In terms of how risks have affected behavior, women, irrespective of their ethnicity, are affected. Exposure to tragic experiences among those who are foreign born can pose risks that are perceived to a greater extent. Furthermore, more vulnerable material conditions can also affect how risks are perceived, and uncertainty due to a lack of resources and as an inherent ingredient of living in a foreign country seem to enhance perceptions of risk and feelings of unsafety. Last, the sense of discrimination appears to influence exposure to certain risks, which might capture an interaction between racism and violence.     

Managing workplace bullying experiences in nursing: the impact of the work environment

To progress our understanding of good practice in the management of workplace bullying, the authors explored the influence of work environment factors on bullying intervention. Analysis of focus group data from public hospitals in New Zealand revealed factors at multiple levels in the work environment system that influenced intervention. Many of these factors have previously been identified as antecedents to bullying, suggesting that the work environment hypothesis can also be applied to the management of workplace bullying experiences.     

The acerbity of the social: how to include the social in governmental risk assessments

This paper addresses the expansion of risk practices through a case study of a government led project in Sweden purposed to develop a method to include social events in mandatory risk practices. Social heterogeneity was to be transformed into straightforward causality in order to turn the social into a manageable object. In this regard, the project was quite successful. By inviting social scientists into the process, otherwise often marginalized within risk practice, causality and quantifiable risk factors could be established and the model became a rigorous and legitimate scientific model. Although experts were granted significant autonomy and became experts far beyond their own area of expertise, the success of the model lies rather in allowing experts authority within confined boundaries. Grand narratives and critical perspectives are disregarded as too abstract and if social scientists are to infuse aspects of social critique they must adapt to these circumstances: they must become instrumentalists.     

Accessibility of flood risk insurance in the UK: confusion,competition and complacency

Flood risk insurance can be an effective tool in assisting the restoration of damaged property after a flood event and sustaining communities through difficult times. It can also form part of a wider flood risk management strategy. In the light of recent flood events in the UK and in the context of changing property insurance markets, the universal cover previously enjoyed by floodplain residents has been called into question. Conflicting media and industry views leave the floodplain resident and the wider community in confusion. A survey of floodplain residents in England regarding their experience with flooding and flood insurance in England has been undertaken. The results reveal that some floodplain residents do indeed encounter difficulties when seeking insurance for their homes. However, despite the risk‐averse policies of some insurers, availability of insurance is still strong in both at‐risk and previously flooded locations. Success in gaining insurance may lead to complacency among residents who see no advantage in pursuing other, more costly, damage mitigation actions. As a tool in risk management, therefore, the market is prevented from realising its potential by competition, which results in a lack of a consistent approach, rewards homeowners' search strategies and reduces information flow.     

Standards for risk assessment of standards: how the international community is starting to address the risk of the wrong standards

Technical standards pervade commerce and society and allow the complexity of modern life to operate at all levels, global included. They also provide protection against many risks, whether from food, from dangerous products or from fraud. They are so self-evidently worthy that they are rarely challenged, yet anything as powerful and pervasive as the web of standards needs some element of oversight and quality assurance. There is a danger of over-regulating and the placing of unnecessary constraints on the market and, cumulatively, a constraint on liberties. Technical standards are derived from many sources and for many reasons. The oversight function may need to relate to these reasons, such as the World Trade Organisation controls on damage to trade through protectionist standards. A very common reason for standards is safety, which tends to be treated as an absolute, as an objective technical matter, and there is less oversight or quality assurance of standards set for safety reasons. But safety is a relative term and increases in safety will usually have costs. Judgement needs to be applied in a risk assessment but that raises institutional issues as to who is qualified to apply that judgement. There are also issues of the accountability of those who increase the safety ratchet, which are also related to the institutional issue. This paper explores a case study of one draft standard as an illustration of the need for oversight and then goes on to consider methods of managing the risks inherent in standardisation and technical regulation. It looks in particular at two recent initiatives from within the standards community itself. One is a broad-based proposal for the community to focus on risk management and the other is an instance where a technical regulator has commissioned and designed an impact assessment system in order to provide that quality assurance and accountability.     

A longitudinal study of concern and judged risk: the case of Ebola in the United States, 2014–2015

The goal of the present study was to investigate whether playing a serious game concerning natural and man-made risks leads to increased risk awareness and additional information search. As an experimental task, we developed a serious board game. Fifty-six students participated in the experiment; half of them played the serious game whereas the other half only filled in a questionnaire at pretest and posttest (after two weeks). Participants who had played the game were more aware of risks in their own environment. Furthermore, playing the serious game counterbalanced the decline in self-efficacy as seen in the control condition. In both conditions, participants gathered more information on natural risks. This positive effect in the control condition is probably a side effect of the method used: a reasonably elaborate questionnaire in combination with a delay of two weeks. In all, the results provide a positive basis for further development of the game and to use it on a larger scale to empower citizens to take more responsibility for their own safety.     

Science vs. fear: the Ebola quarantine debate as a case study that reveals how the public perceives risk

This study focuses on newspaper coverage of the Hickox quarantine incident, using it as a case study to examine how the media characterized the spread of disease in an ongoing crisis situation characterized by uncertainty. The study builds on Slovic et al.’s research, who argue that risk perception is comprised of both emotional and analytical aspects. We employed a qualitative approach, first examining articles on Hickox’s story in The New York Times and New York Daily News between October 25 and 31, 2014; and second, readers’ comments in response to these articles. The findings from the newspaper articles show that in their treatment of the quarantine debate, the media did not address the issue of uncertainty, and thus continued the health authorities’ neglect of this issue. Although the media gave expression to various sides of the debate, it emphasized those who objected to the quarantine policy, thus raising the claim that the conflict was between ‘science’ and the public’s ‘irrational fears,’ and that the governors decided on quarantine in response to the public’s panic and fears. From our analysis of readers’ comments, it appears that these claims are unjustified. First, we found that the public did not speak in a single unified voice, but rather, was divided into supporters and opponents of quarantine. Both sides used scientific arguments and resorted to similar terminology, and tended to cite and present studies backing their arguments. As for irrational fears, although quarantine supporters expressed emotions, they indicated mainly concerns, not panic or hysteria.     

The art of risk management: the crucial role of the global art insurance industry in enabling risk and security

This article investigates the under-researched sphere of insurance. It uses empirical research data to focus on one case study, the London art world, to analyse how the global art insurance industry ‘does’ security and how it enables risk and security to be embraced. Examining how the industry plays a crucial role in the security of art and within the art world itself, the article argues that the global art insurance industry’s role is largely beneficial for the art world because by enabling risk to be embraced through insurance, its pre-crime and post-crime responses, and its influence ‘beyond’ insurance, it emboldens and fuels the dynamic, thriving global art world.     

Evaluating the sovereign and household credit risk in Singapore: A contingent claims approach

This study evaluates the credit risk of the household and government (sovereign) sectors in Singapore using the contingent claims approach (CCA). The CCA model estimates the default probability of both sectors based on the market value of the assets and liabilities of the sectors. Compared to the traditional credit rating system, this model is able to provide numerical estimates of the exposures and default probabilities. We find that from the year 2000 to 2013, variations in the credit risk measures correspond to the economic growth of Singapore. In addition, we suggest that the main factor affecting the credit risks in the government and household sectors in Singapore is the volatility of the assets held by both sectors, given that the asset-to-distress barrier ratios are relatively stable over the past 14 years for both sectors.     

Measuring systemic risk in the European banking sector: a copula CoVaR approach

We propose a new methodology based on copula functions to estimate CoVaR, the Value-at-Risk (VaR) of the financial system conditional on an institution being under financial distress. Our Copula CoVaR approach provides simple, closed-form expressions for various definitions of CoVaR for a broad range of copula families and allows the CoVaR of an institution to have time-varying exposure to its VaR. We extend this approach to estimate other ‘co-risk’ measures such as Conditional Expected Shortfall (CoES). We focus on a portfolio of large European banks and examine the existence of common market factors triggering systemic risk episodes. Further, we analyse the extent to which bank-specific characteristics such as size, leverage, and equity beta are associated with institutions' contribution to systemic risk and highlight the importance of liquidity risk at the outset of the financial crisis in summer 2007. Finally, we investigate the link between macroeconomy and systemic risk and find that changes in major macroeconomic variables can contribute significantly to systemic risk.     

Systemic risk in the Chinese financial system: A panel Granger causality analysis

In this paper, we investigate China’s changing financial interconnectedness via the presence of Granger-causality between firm level factors (Leverage, Market To Book Value and Returns) and systemic risk measures ($\Delta$CoVaR, MES, and SRISK ). The analysis is based on 161 Chinese financial intermediaries (14 Traditional Banks, 16 Finance Services, 131 Real Estate Finance Developers) continuously listed over the period 2007:1–2021:1. We find that, in addition to traditional banks, finance companies and real estate finance developers pose systemic threats to the Chinese financial system, in particular during the Global Financial Crisis and the 2015 Chinese stock crash. Finally, the outbreak of COVID-19 pandemic has put under strain the Chinese financial system, in particular the finance services.     

Dis-Ag-reement: the construction and negotiation of risk in the Swedish controversy over antibacterial silver

What constitutes a potentially hazardous object is often debated. This article analyses the polemic construction and negotiation of risk in the Swedish controversy over the use of antibacterial silver in health care and consumer products. This debate engages the media, government agencies, parliament and government, non-governmental organizations and companies. Texts and websites from these actors were studied using content analysis. Antibacterial silver is construed by some actors as a risk object with harmful effects on a series of objects at risk: the environment, public health, organisms and sewage treatment. In contrast, other actors deny that antibacterial silver is a risk object, instead construing it as mitigating risk. In such a schema, antibacterial silver is conceived of as managing the risk objects of bacteria and micro-organisms, in turn managing the risk objects of infection, bad smell and washing, and in turn helping the environment and public health (objects at risk). The structure of the debate suggests two basic modes of risk communication. First, antibacterial silver is construed as a risk object, endangering a variety of objects at risk, such as organisms, public health, the environment and sewage treatment. Second, this association between antibacterial silver and objects at risk is obstructed, by denying that antibacterial silver is a risk object or by associating silver with the benefit of mitigating risk.     

Risk perception and risk management in the Middle East market: theory and practice of multinational enterprises in Saudi Arabia

This exploratory study investigates the risk perception and risk management strategies of Western multinational enterprises in the Middle East. A sample of 49 German companies operating in Saudi Arabia provides the empirical setting for this research. The study reveals that cultural risk is assessed as more important in the business environment than political, financial, and economic risk. The most critical risk factors are not sufficiently included in the methodology of country risk measures, which are often used as a source for country‐specific risk information. In terms of risk management strategies, participating firms use mostly informal approaches rather than structured hedging or insurance products. Furthermore, we find that firm size has implications on the perception of some risk factors and for the level of risk management sophistication.     

Displaying expected values in risk elicitation tasks: the effect of information in experimental risk research

We investigate the influence of providing expected lottery results to experiment participants in two common risk attitude elicitation tasks. In a between-subject design, either the Holt and Laury task or the Eckel and Grossman task is carried out by a sample of 208 students. We find no significant effect of shown expected values on the risk attitude measured by the tasks. This result even holds true if we divide the experiment participants into specific sub-groups, i.e. female and male, or lower numeracy and higher numeracy participants. Furthermore, comprehension and processing time are not significantly influenced by presented expected values. Therefore, we conclude that providing information on expected values does not influence decision-making in tasks involving risk. This result indicates the robustness of elicited risk attitudes to variation in common experimental methods, and demonstrates that more information could be provided without creating bias in the results.     

Effective risk communication and CCS: the road to success in Europe

Over the past ten years or so, there have been multiple attempts to site and build carbon capture and storage (CCS) facilities in Europe, North America and elsewhere. To date, most of those attempts have not been successful. In Europe, for example, there are currently no commercial CCS facilities in operation. There are a number of reasons for this, ranging from lack of political will, the collapsing price of CO₂, lack of commercial drivers to capture and store CO₂, and public opposition to the proposed facilities. There have been several case studies examining the communication challenges associated with the siting of CCS facilities. Up till now, most of this research has been carried out by climate change or carbon policy experts as well as social researchers rather than scientists representing the wider risk communication community, aside from some notable exceptions. This study does the opposite by examining CCS from a broader risk communication perspective. It provides a brief overview of risk communication theory in order to situate some of the findings of the CCS communication research, and then, it makes some recommendations on how the siting of CCS facilities could be improved including the importance of trust, proactive communication and early stakeholder involvement. In conclusion, this study notes that if the science associated with the technology is communicated in the correct manner and if the key risk communication recommendations are adhered to, then the siting of future CCS facilities should be successful.     

From objective to constituted risk: an alternative approach to safety in strategic technological innovation in the European Union

Safety is a legitimate means of limiting technological innovation in our societies. However, the potential socio-economic impact of curtailing techno-industrial progress on the grounds of safety means that risk governance policies tend to restrict the range of legitimate approaches to safety on the principle that it can only be discussed in the frame of an allegedly objective scientific representation of risk. In European risk governance, socio-economic factors such as the underlying innovation rationales and goals are not openly considered to be related to the constitution of safety, but tend largely to be treated as factors of subjective reaction towards risk and technology. This paper seeks to overcome that approach by proposing a ‘constitutive’ understanding of how risk and socio-economic factors and dynamics relate, focusing in particular on the ‘safe and responsible’ development of nanotechnology in the European Union (EU). I argue that risk is constituted according to socio-economic considerations, and that the controllability of the environmental and health risks of nanotechnology in the EU is assumed on principle in the very strong institutional commitment to the industrial exploitation of nanotechnology R&D. Using a constitutive approach, we may legitimately conceive a broader set of potential safety scenarios, while at the same time highlighting major obstacles to implementing more critical constitutions of techno-industrial risk in the framework of a highly competitive knowledge-based global economy.     

Self-determination and risk: the role of life goals and causality orientation in domain-specific risk propensity

A growing body of risk research shows that risk is content specific. Accordingly, various studies have highlighted some factors that could explain why people’s risk propensity may arise in certain domains of risk (e.g. the financial domain) but not in other domains (e.g. the recreational domain). Until now, no research has examined motivation as a possible correlate of domain-specific risk propensity. On the basis of self-determination theory (SDT), we examined the role of both extrinsic life goals (i.e. superficial goal striving, including fame, money, and physical attraction) and control-orientated personality style (i.e. feeling that one’s behaviors are governed by external contingencies) in the propensity to take risks in various domains (social, ethical, recreational, financial, and health/safety). A community sample of 197 participants completed measures scaled to assess extrinsic life goals, controlled orientation, and domain-specific propensity (DOSPERT). The results showed that pursuing extrinsic goals and being control oriented increased the propensity to take ethical, recreational, financial, and health/safety risks but decreased the propensity to take social risks. In addition, to corroborate that risk propensity is domain specific, these results indicate that superficial life aspiration and sensitivity to social pressures are highly predictive of instrumental risks (e.g. ethical and financial), moderately predictive of health risks, and negatively predictive of ego-threatening risks (e.g. social risk). The results are discussed in light of the domain-specific risk literature and in the perspective of interventions based on SDT.     

Risk selection in the London political risk insurance market: the role of tacit knowledge,trust and heuristics

This study demonstrates that the basis of decision-making and risk selection in the London Political Risk Insurance (PRI) market is a combination of Art and Science with such factors as trust and reputation playing an important role. The study breaks new ground by uncovering and examining different methods and strategies of political risk underwriting employed in the insurance market, which does not rely on statistical tools as seen in more traditional insurance types. Adopting a grounded theory approach, the data was generated through 14 semi-structured and unstructured interviews conducted with PRI experts from five PRI companies and two leading political risk broking houses. The data also included documentation reviews and observations.