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Erschienen in: Wiener klinische Wochenschrift 1-2/2015

01.01.2015 | perspective

Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers

verfasst von: PhD Gerald Sendlhofer, MD, PhD Gernot Brunner, MSc Christa Tax, MSc Gebhard Falzberger, MD, PhD Josef Smolle, MSc Karina Leitgeb, BA, MA Brigitte Kober, MD, MSc Lars Peter Kamolz

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 1-2/2015

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Summary

Background

For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach.

Methods

To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified.

Results

Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM.

Conclusion

The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk managers supported the centrally coordinated CRM process. There is a strong commitment among management, academia, clinicians, and administration to foster cooperation. The introduction of CRM led to a visible shift with regard to patient safety culture throughout the entire organization. Still, there is a long way to go to keep people engaged in CRM and work on national and international patient safety initiatives to continuously decrease potential hazards.
Literatur
1.
Zurück zum Zitat Reason J. Managing the risks of organizational accidents. Aldershot: Ashgate; 1997. Reason J. Managing the risks of organizational accidents. Aldershot: Ashgate; 1997.
2.
Zurück zum Zitat Briner M, Kessler O, Pfeiffer Y, et al. Assessing hospitals’ clinical risk management: development of a monitoring instrument. BMC Health Serv Res. 2010;10:337. doi:10.1186/1472-6963-10-337. Briner M, Kessler O, Pfeiffer Y, et al. Assessing hospitals’ clinical risk management: development of a monitoring instrument. BMC Health Serv Res. 2010;10:337. doi:10.1186/1472-6963-10-337.
3.
Zurück zum Zitat Ginsburg LR, Tregunno D, Norton PG, et al. Not another safety culture survey: using the Canadian patient safety climate survey (CAN-PSCS) to measure provider perceptions of PSC across health settings. BMJ Qual Saf. 2014;23(2):162–70. doi:10.1136/bmjqs-2013-002220. Ginsburg LR, Tregunno D, Norton PG, et al. Not another safety culture survey: using the Canadian patient safety climate survey (CAN-PSCS) to measure provider perceptions of PSC across health settings. BMJ Qual Saf. 2014;23(2):162–70. doi:10.1136/bmjqs-2013-002220.
4.
Zurück zum Zitat Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999.
5.
Zurück zum Zitat Battles JB, Lilford RJ. Organizing patient safety research to identify risk and hazards. Qual Saf Health Care. 2003;12(Suppl. 2):ii2–7. PubMedCentralPubMed Battles JB, Lilford RJ. Organizing patient safety research to identify risk and hazards. Qual Saf Health Care. 2003;12(Suppl. 2):ii2–7. PubMedCentralPubMed
7.
Zurück zum Zitat Young PC, Tomski M. An introduction to risk management. Phys Med Rehabil Clin N Am. 2002;13(2):225–46. PubMedCrossRef Young PC, Tomski M. An introduction to risk management. Phys Med Rehabil Clin N Am. 2002;13(2):225–46. PubMedCrossRef
8.
Zurück zum Zitat Miller RH, Bovbjerg RR. Efforts to improve patient safety in large, capitated medical groups: description and conceptual model. J Health Politics Policy Law. 2002;27(3):401–40. CrossRef Miller RH, Bovbjerg RR. Efforts to improve patient safety in large, capitated medical groups: description and conceptual model. J Health Politics Policy Law. 2002;27(3):401–40. CrossRef
9.
Zurück zum Zitat The Council of the European Union. Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections. Off J Eur Union. 2009/C 151/01. The Council of the European Union. Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare associated infections. Off J Eur Union. 2009/C 151/01.
10.
Zurück zum Zitat Federal Ministry for Health. Nationwide patient safety strategy for Austria 2013–2016. Commissioned by the Federal Ministry of Health, Vienna, March 2013. Federal Ministry for Health. Nationwide patient safety strategy for Austria 2013–2016. Commissioned by the Federal Ministry of Health, Vienna, March 2013.
11.
Zurück zum Zitat Eisenberg JM. Medical error is an epidemic. A presentation of the National Summit on medical errors and patient safety research. Washington, DC: The Quality Interagency Coordination Task Force (QuIC); September 2001. Eisenberg JM. Medical error is an epidemic. A presentation of the National Summit on medical errors and patient safety research. Washington, DC: The Quality Interagency Coordination Task Force (QuIC); September 2001.
12.
Zurück zum Zitat Charles K, McKee L, McCann S. A quest for patient-safe culture: contextual influences on patient safety performance. J Health Serv Res Policy. 2011;16(Suppl. 1):57–64. PubMedCrossRef Charles K, McKee L, McCann S. A quest for patient-safe culture: contextual influences on patient safety performance. J Health Serv Res Policy. 2011;16(Suppl. 1):57–64. PubMedCrossRef
13.
Zurück zum Zitat ONR. Risk management for organizations and systems: terms and basics. ONR 49000. Vienna: Austrian Standards; 2008. ONR. Risk management for organizations and systems: terms and basics. ONR 49000. Vienna: Austrian Standards; 2008.
14.
Zurück zum Zitat ONR. Risk management for organizations and systems: risk management. ONR 49001. Vienna: Austrian Standards; 2008. ONR. Risk management for organizations and systems: risk management. ONR 49001. Vienna: Austrian Standards; 2008.
15.
Zurück zum Zitat ONR. Risk management for organizations and systems: part 1—guideline for embedding the risk management in the management system. ONR 49002-1. Vienna: Austrian Standards; 2008. ONR. Risk management for organizations and systems: part 1—guideline for embedding the risk management in the management system. ONR 49002-1. Vienna: Austrian Standards; 2008.
16.
Zurück zum Zitat ONR. Risk management for organizations and systems: part 2—guideline for methodologies in risk assessment. ONR 49002-2. Vienna: Austrian Standards; 2008. ONR. Risk management for organizations and systems: part 2—guideline for methodologies in risk assessment. ONR 49002-2. Vienna: Austrian Standards; 2008.
17.
Zurück zum Zitat ONR. Risk management for organizations and systems: part 3—guideline for emergency, crisis and business continuity management. ONR 49002-3. Vienna: Austrian Standards; 2008. ONR. Risk management for organizations and systems: part 3—guideline for emergency, crisis and business continuity management. ONR 49002-3. Vienna: Austrian Standards; 2008.
18.
Zurück zum Zitat ONR. Risk management for organizations and systems: requirements for the qualification of the risk manager. ONR 49003. Vienna: Austrian Standards; 2008. ONR. Risk management for organizations and systems: requirements for the qualification of the risk manager. ONR 49003. Vienna: Austrian Standards; 2008.
19.
Zurück zum Zitat European Committee for Standardization. Risk management: principles and guidelines (ISO 13000:2009). European Committee for Standardization; 2009. European Committee for Standardization. Risk management: principles and guidelines (ISO 13000:2009). European Committee for Standardization; 2009.
22.
Zurück zum Zitat Smith KL, Saavedra R, Raeke JL, et al. The journey to creating a campus-wide culture of professionalism. Acad Med. 2007;82(11):1015–21. PubMedCrossRef Smith KL, Saavedra R, Raeke JL, et al. The journey to creating a campus-wide culture of professionalism. Acad Med. 2007;82(11):1015–21. PubMedCrossRef
23.
Zurück zum Zitat Fryer-Edwards K, Van Eaton E, Goldstein EA, et al. Overcoming institutional challenges through continuous professionalism improvement: the University of Washington experience. Acad Med. 2007;82(11):1073–8. PubMedCrossRef Fryer-Edwards K, Van Eaton E, Goldstein EA, et al. Overcoming institutional challenges through continuous professionalism improvement: the University of Washington experience. Acad Med. 2007;82(11):1073–8. PubMedCrossRef
27.
Zurück zum Zitat Ministerio de Sanidad y Consumo. Best practice benchmarking: risk management and clinical governance reorganization policies in the hospital setting. Executive summary. Madrid: Ministerio de Sanidad y Consumo; 2008. Ministerio de Sanidad y Consumo. Best practice benchmarking: risk management and clinical governance reorganization policies in the hospital setting. Executive summary. Madrid: Ministerio de Sanidad y Consumo; 2008.
28.
Zurück zum Zitat Adibi H, Khalesi N, Ravaghi H, et al. Development of an effective risk management system in a teaching hospital. J Diabetes Metab Disord. 2012;11:15. doi:10.1186/2251-6581-11-15. PubMedCentralPubMedCrossRef Adibi H, Khalesi N, Ravaghi H, et al. Development of an effective risk management system in a teaching hospital. J Diabetes Metab Disord. 2012;11:15. doi:10.1186/2251-6581-11-15. PubMedCentralPubMedCrossRef
29.
Zurück zum Zitat Pronovost PJ, Faden RR. Setting priorities for patient safety: ethics accountability, and public engagement. JAMA. 2009;302:890–1. PubMedCrossRef Pronovost PJ, Faden RR. Setting priorities for patient safety: ethics accountability, and public engagement. JAMA. 2009;302:890–1. PubMedCrossRef
33.
Zurück zum Zitat Crema M, Verbano C. Guidelines for overcoming hospital managerial challenges: a systematic literature review. Ther Clin Risk Manag. 2013;9:427–41. doi:10.2147/TCRM.S54178. Crema M, Verbano C. Guidelines for overcoming hospital managerial challenges: a systematic literature review. Ther Clin Risk Manag. 2013;9:427–41. doi:10.2147/TCRM.S54178.
34.
Zurück zum Zitat Berger MS, Wachter RM, Greysen SR, et al. Changing our culture to advance patient safety. J Neurosurg. 2013;119(6):1359–69. PubMedCrossRef Berger MS, Wachter RM, Greysen SR, et al. Changing our culture to advance patient safety. J Neurosurg. 2013;119(6):1359–69. PubMedCrossRef
36.
Zurück zum Zitat International Atomic Energy Agency. Basic safety principles for nuclear power plants. Safety series no. 75-INSAG-3. Vienna: International Atomic Energy Agency; 1999. International Atomic Energy Agency. Basic safety principles for nuclear power plants. Safety series no. 75-INSAG-3. Vienna: International Atomic Energy Agency; 1999.
37.
Zurück zum Zitat Wachter RM. Patient safety at ten: unmistakable progress, troubling gaps. Health Aff (Millwood). 2010;29(1):165–73. doi:10.1377/hlthaff.2009.0785. Wachter RM. Patient safety at ten: unmistakable progress, troubling gaps. Health Aff (Millwood). 2010;29(1):165–73. doi:10.1377/hlthaff.2009.0785.
38.
Zurück zum Zitat Dixon-Woods M, Baker R, Charles K, et al. Culture and behaiviour in the English National Health Services: overview of lessons from a large multimethod study. BMJ Qual Saf. 2014;23(2):106–15. doi:10.1136/bmjqs-2013-001947. Dixon-Woods M, Baker R, Charles K, et al. Culture and behaiviour in the English National Health Services: overview of lessons from a large multimethod study. BMJ Qual Saf. 2014;23(2):106–15. doi:10.1136/bmjqs-2013-001947.
39.
Zurück zum Zitat Lawton R, McEachan RR, Giles SJ, et al. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systemic review. BMJ Qual Saf. 2012;21(5):369–80. doi:10.1136/bmjqs-2011-000443. Lawton R, McEachan RR, Giles SJ, et al. Development of an evidence-based framework of factors contributing to patient safety incidents in hospital settings: a systemic review. BMJ Qual Saf. 2012;21(5):369–80. doi:10.1136/bmjqs-2011-000443.
41.
Zurück zum Zitat Conley DM, Singer SJ, Edmondson L, et al. Effective surgical safety checklist implementation. J Am Coll Surg. 2011;212(5):873–9. PubMedCrossRef Conley DM, Singer SJ, Edmondson L, et al. Effective surgical safety checklist implementation. J Am Coll Surg. 2011;212(5):873–9. PubMedCrossRef
42.
Zurück zum Zitat Vincent C, Taylor-Adams S, Chapman EJ, et al. How to investigate and analyse clinical incidents: clinical risk unit and association of litigation and risk management protocol. BMJ. 2000;320:777–81. PubMedCentralPubMedCrossRef Vincent C, Taylor-Adams S, Chapman EJ, et al. How to investigate and analyse clinical incidents: clinical risk unit and association of litigation and risk management protocol. BMJ. 2000;320:777–81. PubMedCentralPubMedCrossRef
43.
Zurück zum Zitat Kessels-Habraken M, Van der Schaaf T, De Jonge J, et al. Integration of prospective and retrospective methods for risk analysis in hospitals. Int J Qual Health Care. 2009;21:427–32. PubMedCrossRef Kessels-Habraken M, Van der Schaaf T, De Jonge J, et al. Integration of prospective and retrospective methods for risk analysis in hospitals. Int J Qual Health Care. 2009;21:427–32. PubMedCrossRef
44.
Metadaten
Titel
Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers
verfasst von
PhD Gerald Sendlhofer
MD, PhD Gernot Brunner
MSc Christa Tax
MSc Gebhard Falzberger
MD, PhD Josef Smolle
MSc Karina Leitgeb
BA, MA Brigitte Kober
MD, MSc Lars Peter Kamolz
Publikationsdatum
01.01.2015
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 1-2/2015
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-014-0620-7