The costs of risk and fear: a qualitative study of risk conceptualisations in allied health resource allocation decision-making

Abstract

Over the past several decades, the paradigm of risk has become increasingly salient for understanding how health care is provided. In more recent years, we have seen an expanding body of literature raising concerns of possible harms that a focus on risk may carry. Despite considerable research interest in risk, relatively little is known about the construction of risk in contexts of allied health resource allocation decision-making. This article reports on qualitative research exploring how allied health leaders construct the concept of risk and how this influences resource allocation decision-making. Data are drawn from forums held in August and September 2014, with a total of 59 participants who occupied leadership roles in allied health in Australia. The findings highlight three domains of risk: resource, patient and organisational risk. Some domains of risk received more attention from participants and exerted greater influence on decision-making than others. Relative to the other domains, patient risk was not a core focus. Risk had a distinct emotive element and some domains of risk led participants to focus on catastrophic outcomes. Patient risk did not evoke emotive responses, whereas both resource and organisational risk did. It appears that perceived risk may be costly for health organisations, as it can be a primary driver underpinning resource allocation decisions. We explore the relative lack of attention to patient risk, the role of fear and anxiety in decision-making, and discuss implications of the impact of a focus on risk in wider society.