• Accreditation
• Anaesthesia
• Attitudes

In this issue, Redley and Raggatt1 report on the use of risk assessment tools in the care of older people in Victoria, Australia. Concern with healthcare quality and safety has precipitated widespread use of a range of such seemingly simple interventions. Checklists, pathways, algorithms are a tempting way for organisations and healthcare professionals to signal to the outside world that they are making a good faith effort to ensure service quality. Yet the popularity of these everyday tools has not been matched by their systematic and critical analysis, leading to concern about the potential impact of a growing epidemic of ‘polyformacy’ on healthcare systems. Redley and Raggatt draw into view specific insights about risk management in older people, but their research highlights issues of wider relevance about the use of everyday technologies for healthcare quality and safety that merit further reflection.

A key finding from the study was the sheer volume of tools identified in the 11 health services—52 in total—and the associated burdens for staff and patients. Healthcare work has always involved charts and documents of one kind or another, but over the last three decades the patient record has been transformed from a loosely structured narrative description produced for educational purposes2 to a highly complex account of any aspect of treatment that has official status.3 In a context in which trust in professionals has been replaced by trust in auditable systems, documentation has become important evidence of organisational and professional performance.4 Far from serving as a straightforward catalogue of care, the …