Legionellosis Risk Assessment League Table

by Charlie Brain, on 16-11-2017
Find me on:

Legionellosis up close

One question our consultants are continuously asked by clients is “How are we compared to other organisations?”

Over the past few years, the Water Hygiene Centre has carried out thousands of Legionellosis Risk Assessments for a multitude of organisations and properties using our UKAS Accredited method and reports. One of the unique features of our UKAS Accredited method is the ability to produce risk scores for those properties and organisations that have had a risk assessment. Each risk assessment report generated compares properties within an organisation, but also compares risk scores against all other similar organisations that has been assessed by the Water Hygiene Centre.

 

Download your free risk assessment review tool now >

 

As part of the hand-over meeting with all clients, they are presented with a League Table (Table 1), which shows where they are ranked.

This blog aims to interpret and analyse the data which we have collected over the past few years.

Table 1 shows the complete league table of organisations assessed over the last few years, both healthcare and non-healthcare (obviously the names of the organisations have been replaced by a description).

 

Table 1 – Complete League Table

Position

Organisation

Inherent Risk Score %

Actual Risk Score %

% Diff

1

Community Health Trust

84

84

0%

2

College

84

81

-4%

3

Medium Acute Hospital Trust

82

81

-1%

4

Large University

90

79

-12%

5

Small Non-Acute Hospital Trust

81

77

-5%

6

Harbour Buildings

84

75

-11%

7

Medium University

86

76

-12%

8

Mental Health Trust

76

73

-4%

9

Law Enforcement Agency

84

72

-14%

10

Large Acute Hospital Trust

75

71

-5%

11

Schools

85

71

-16%

12

Large Acute Hospital Trust

76

70

-8%

13

Large Acute Hospital Trust

72

70

-3%

14

Education Buildings

88

70

-20%

15

Housing Association

92

67

-27%

16

Council

86

67

-22%

17

Leisure Centres

89

67

-25%

18

Airport

78

67

-14%

19

Community Health Trust

76

66

-13%

20

Large Acute Hospital Trust

74

66

-11%

21

Large Acute Hospital Trust

73

66

-10%

22

Mental Health Trust

74

65

-12%

23

Large Acute Hospital Trust

68

65

-4%

24

Large Acute Hospital Trust

71

64

-10%

25

Large Acute Hospital Trust

68

64

-6%

26

Large Acute Hospital Trust

70

63

-10%

27

Large Acute Hospital Trust

68

63

-7%

28

Large Acute Hospital Trust

66

61

-8%

29

Council Buildings

82

61

-26%

30

Large Acute Hospital Trust

70

60

-14%

31

Large Acute Hospital Trust

70

60

-14%

32

Community Health Trust

77

59

-23%

33

Community Health Trust

80

59

-26%

34

Housing Association

81

56

-31%

35

Large Acute Hospital Trust

69

56

-19%

36

Service/Commercial Buildings

81

55

-32%

37

Large Acute Hospital Trust

55

55

0%

38

Council Buildings

86

53

-38%

39

Sheltered Housing

68

50

-26%

40

Large Acute Hospital Trust

60

50

-17%

41

Care Home

58

47

-19%

42

Automotive Buildings

75

46

-39%

43

Medium Acute Hospital Trust

46

44

-4%

 

Average

76

64

-14%

 

BS 8580 states that “The risk assessor should evaluate risk by appropriately combining factors and comparing the levels of risk with the level acceptable for each circumstance” by using “Risk Appetite” and “ALARP” (As low as reasonably practicable).

Firstly, you will also see a column for “Inherent Risk” and a column for “Actual Risk”. BS 8580 explains how “resources in an organisation are finite, so an understanding of inherent risk might help to ensure that the response is proportionate to the risk.” Inherent risk represents the risk before any action has been taken, it concerns the design and configuration of the system, typically a result of decisions by designers, architects and procurement. Identifying which risks are “inherent” informs Estate Managers/Authorised Persons which risk assessment actions may need more/additional funding and commitment from the purse string holders. By showing an inherent risk score, it shows how good the cards which have been dealt to them are.

Secondly, “Actual Risk” now includes all risk factors of the water systems; Inherent, condition, performance and management. The last three being directly affected by management of those water systems.

A comparison between risk types reveal that on average there is a 14% increase in risk from Inherent to Actual. Indeed it is only the organisation sitting pretty in Position 1 that can boast that their risk management is as good as the water systems themselves.

From our data captured during the legionella risk assessment, we can see how many of the risks at a site (be it from interview, inspection of records or physical asset assessment), meet or exceed their target (ALARP). One of the first interpretations to make from Table 1 is that there are more non-healthcare organisations near the top, whereas large acute hospitals are more lower-mid table. This is because a non-healthcare organisation has a higher “Risk Appetite”, therefore will accept and tolerate more risk, decreasing their ALARP target. Non-healthcare organisations who house people generally with a lower susceptibility have the lower inherent risk systems (mains water & point-of-use water heaters), whereas the buildings in organisation serving the “immuno-compromised” population tend to have more complex water systems. Table 2 confirms this, non-healthcare organisations have the lower risk water systems (83% versus 71% inherent risk scores).

 

Table 2 – Healthcare v Non-Healthcare

Organisation

Inherent Risk Score %

Actual Risk Score %

% diff

Healthcare Organisations

71

64

-10

Non-Healthcare Organisations

83

65

-22

 

However, it is not a surprise that this is the case. Actual risk includes aspects that can change very quickly i.e. temperature and condition, and also requires more continuous, everyday human interaction. Table 2 shows that Healthcare organisations do make up for more complex water systems by managing them more rigorously than non-healthcare organisations (10% difference compared to 22%).

To look into the stats more deeply, Healthcare Estate Managers/Responsible Persons/Authorised Persons reading this may want to know more about their type of organisation.

 

Table 3 – Hospital Types Comparison

Organisation

Inherent Risk Score %

Actual Risk Score %

% diff

Small non-acute Hospital

81

77

-5

Non-Acute Hospitals

78

69

-12

 

Table 3 shows how non-acute healthcare buildings have a much better Inherent Risk score, this is not surprising as these buildings include Health Centres, Clinics and cottage hospitals that do not require more complex water systems, for example, cold water storage tanks and air conditioning not being required.

What may be surprising is that the difference between Inherent and Actual Risk is greater in non-acute hospitals. This suggests that management in Acute Hospitals is better, which we all hope would be the case!

 

Table 4 – Hospital Size Comparison

Organisation

Inherent Risk Score %

Actual Risk Score %

% Diff

Single Site Organisations

69

65

-7

Multiple Site Organisations

73

64

-12

 

Table 4 shows the difference between hospital organisations that manage a single site compared to those managing multiple sites. What is interesting here is that the difference between Inherent and Actual Risks in multiple site healthcare organisations compared to single site organisations is greater. Does this highlight the fact that those organisations with many properties are harder to manage? We only tend to deal with problems in front of us? With organisations such as community Trusts that have multiple small sites, it may be understandable that gathering and managing records/ppms can become difficult. Hospitals that are managed centrally, may receive more attention that its “satellites”.

 

Conclusion 

Of course, the data captured is only as accurate as the assessor and represents a snapshot in time, it is also using the Water Hygiene Centres’ risk assessment method (albeit UKAS accredited). However, when the consultants and assessors look at the League Table, there is general approval of where organisations stand in relation to others. There are also elements that cannot be disputed, for example, the organisations that have high Inherent Risk scores are those with simpler water systems (non-healthcare) and those that have a higher “ALARP” target (Acute Hospitals) have a much harder task getting to the top.

However, the League Table is a great way of showing where your organisation is compared to others. It also, in some cases, can be shown with pride to your Water Safety Group.

If you would like to enter the League Table to see where you feature, please contact us.

Editors Note: The information provided in this blog is correct at date of original publication - November 2017. 

© Water Hygiene Centre 2019

water safety for healthcare

About the author

Charlie Brain

Charlie started the Water Hygiene Centre as a trainee risk assessor back in 2010, since then he has developed professionally from risk assessor, project manager and is now a Senior Consultant. During this time he has taken ownership of our risk assessment method and development of our bespoke reporting platform and has been key in our UKAS accreditation to 17020.

Share your thoughts

    Subscribe to our weekly email updates

    New call-to-action

    Most Popular Blog Posts