A framework to support risk assessment in hospitals

Abstract Quality problem or issue A number of challenges have been identified with current risk assessment practice in hospitals, including: a lack of consultation with a sufficiently wide group of stakeholders; a lack of consistency and transparency; and insufficient risk assessment guidance. Consequently, risk assessment may not be fully effective as a means to ensure safety. Initial assessment We used a V system developmental model, in conjunction with mixed methods, including interviews and document analysis to identify user needs and requirements. Choice of solution One way to address current challenges is through providing good guidance on the fundamental aspects of risk assessment. We designed a risk assessment framework, comprising: a risk assessment model that depicts the main risk assessment steps; risk assessment explanation cards that provide prompts to help apply each step; and a risk assessment form that helps to systematize the risk assessment and document the findings. Implementation We conducted multiple group discussions to pilot the framework through the use of a representative scenario and used our findings for the user evaluation. Evaluation User evaluation was conducted with 10 participants through interviews and showed promising results. Lessons learned While the framework was recommended for use in practice, it was also proposed that it be adopted as a training tool. With its use in risk assessment, we anticipate that risk assessments would lead to more effective decisions being made and more appropriate actions being taken to minimize risks. Consequently, the quality and safety of care delivered could be improved.

[1]  J. Rossier,et al.  Programme overview , 2018, Narrative Intervention Programme.

[2]  T. Aven,et al.  Risk assessment in critical care medicine: a tool to assess patient safety , 2009 .

[3]  Ward,et al.  Prospective hazard analysis: tailoring prospective methods to a healthcare context , 2010 .

[4]  R. McEachan,et al.  Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systematic review , 2012, BMJ quality & safety.

[5]  D. Ball,et al.  Further Thoughts on the Utility of Risk Matrices , 2013, Risk analysis : an official publication of the Society for Risk Analysis.

[6]  Kevin Grant,et al.  International Journal of Information Management , 2022 .

[7]  Louis Anthony Cox,et al.  What's Wrong with Risk Matrices? , 2008, Risk analysis : an official publication of the Society for Risk Analysis.

[8]  C. Stewart The common safety method for risk evaluation and assessment , 2014 .

[9]  Alan J Card,et al.  Trust-level risk identification guidance in the NHS East of England. , 2015, The International journal of risk & safety in medicine.

[10]  C. Vincent,et al.  Systems analysis of clinical incidents: the London protocol , 2004 .

[11]  Alan J. Card,et al.  Successful risk assessment may not always lead to successful risk control: A systematic literature review of risk control after root cause analysis. , 2012, Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management.

[12]  M. Dixon-Woods,et al.  The problem with root cause analysis , 2016, BMJ Quality & Safety.

[13]  David Drain,et al.  Risk matrix input data biases , 2009, Syst. Eng..

[14]  Kathryn M. Kellogg,et al.  Our current approach to root cause analysis: is it contributing to our failure to improve patient safety? , 2016, BMJ Quality & Safety.

[15]  C. Mangano Risky business. , 2003, The Journal of thoracic and cardiovascular surgery.

[16]  C. Vincent,et al.  Safer Healthcare: Strategies for the Real World , 2016 .

[17]  P. Carayon,et al.  Work system design for patient safety: the SEIPS model , 2006, Quality and Safety in Health Care.

[18]  Peter J Pronovost,et al.  A framework for operationalizing risk: A practical approach to patient safety. , 2018, Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management.

[19]  Alan J. Card,et al.  Generating Options for Active Risk Control (GO‐ARC): Introducing a Novel Technique , 2014, Journal for Healthcare Quality.

[20]  P. Pronovost,et al.  Patient safety incident reporting: a qualitative study of thoughts and perceptions of experts 15 years after ‘To Err is Human’ , 2015, BMJ Quality & Safety.

[21]  Steve Cross,et al.  The development of safety cases for healthcare services: Practical experiences, opportunities and challenges , 2015, Reliab. Eng. Syst. Saf..

[22]  J. Braithwaite,et al.  Learning from incidents in health care: critique from a Safety-II perspective , 2017 .

[23]  L. Hay,et al.  In Practice , 2009, Perspectives in public health.

[24]  Andrew Hale,et al.  Accident models and organisational factors in air transport: The need for multi-method models , 2011 .

[25]  A. Bottle,et al.  Investigating the association of alerts from a national mortality surveillance system with subsequent hospital mortality in England: an interrupted time series analysis , 2018, BMJ Quality & Safety.

[26]  Sallie J. Weaver,et al.  Latent risk assessment tool for health care leaders , 2018, Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management.

[27]  E. Hollnagel,et al.  From Safety-I to Safety-II: A White Paper , 2014 .

[28]  M. Sujan,et al.  Managing the patient safety risks of bottom-up health information technology innovations: Recommendations for healthcare providers , 2018, BMJ Health & Care Informatics.

[29]  Jane Carthey,et al.  Understanding Safety in Healthcare: The System Evolution, Erosion and Enhancement Model , 2013, Journal of public health research.

[30]  Louis Anthony (Tony) Cox,et al.  Some Limitations of Qualitative Risk Rating Systems , 2005, Risk analysis : an official publication of the Society for Risk Analysis.

[31]  P. Pronovost,et al.  Fifteen years after To Err is Human: a success story to learn from , 2015, BMJ Quality & Safety.

[32]  Alan J. Card,et al.  Trust‐Level Risk Evaluation and Risk Control Guidance in the NHS East of England , 2014, Risk analysis : an official publication of the Society for Risk Analysis.

[33]  David D. Walden,et al.  Systems engineering handbook : a guide for system life cycle processes and activities , 2015 .

[34]  Simone Pozzi,et al.  Should healthcare providers do safety cases? Lessons from a cross-industry review of safety case practices , 2016 .

[35]  J. Agnew,et al.  Healthcare Institution Risk Assessments: Concentration on “Process” or “Outcome”? , 2006 .

[36]  Luca Podofillini,et al.  Safety and Reliability of Complex Engineered Systems : ESREL 2015 , 2015 .

[37]  J. Larouzée,et al.  From theory to practice: itinerary of Reasons’ Swiss Cheese Model , 2015 .

[38]  P. Pronovost,et al.  An intervention to decrease catheter-related bloodstream infections in the ICU. , 2006, The New England journal of medicine.

[39]  Kevin Forsberg,et al.  The Relationship of System Engineering to the Project Cycle , 1991 .

[40]  Charles Vincent,et al.  Safety in healthcare is a moving target , 2015, BMJ Quality & Safety.

[41]  Jeffrey O. Grady System Verification : Proving the Design Solution Satisfies the Requirements Ed. 2 , 2016 .

[42]  Simone Pozzi,et al.  How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process , 2017, Reliab. Eng. Syst. Saf..

[43]  James R Ward,et al.  Design for patient safety: a systems-based risk identification framework , 2018, Ergonomics.

[44]  C. Trotter,et al.  Risk assessment in practice , 2016 .

[45]  Sidney Dekker,et al.  A Systems Approach to Analyzing and Preventing Hospital Adverse Events , 2016, Journal of patient safety.