The ARTS of risk management in rural and remote medicine.

This paper describes an action research process (in which the researchers are active participants throughout the process of development, testing and refinement) to develop a framework for clinical risk assessment and management in the context of rural and remote medicine. The framework is needed to support educational, medicolegal and quality improvement processes in rural and remote medical practice. The research process included identifying a problem and gradually developing a research question, developing a potential model for application in a specific context, refining the tool and piloting the tool in a limited context. The research question and framework were developed during a series of teleconferences under the aegis of the Censorial Panel of the Australian College of Rural and Remote Medicine (ACRRM). After the framework was developed and refined, it was tested at a workshop in conjunction with the ACRRM Scientific Forum in Alice Springs, Australia, in July 2004. Workshop participants were principally but not exclusively rural medical practitioners from across Australia. The main outcome measure was a working framework for risk management broadly applicable in rural and remote medicine. The process clarified differences between safety and quality approaches in metropolitan and rural and remote medical practice, culminating in an appropriate clinical risk management framework. The action research as undertaken resulted in a workable risk management framework that is worthy of further development and that may be a valuable educational tool, both for existing practitioners and for future rural doctors. Further, it has potential as a means of providing legal protection to rural practitioners when actual rural practice is at odds with "best practice" as defined by a metropolitan group of experts