Clinical Risk Management Processes Research Articles

Risk Management and Patient Safety in the Artificial Intelligence Era: A Systematic Review.

Healthcare systems represent complex organizations within which multiple factors (physical environment, human factor, technological devices, quality of care) interconnect to form a dense network whose imbalance is potentially able to compromise patient safety. In this scenario, the need for hospitals to expand reactive and proactive clinical risk management programs is easily understood, and artificial intelligence fits well in this context. This systematic review aims to investigate the state of the art regarding the impact of AI on clinical risk management processes. To simplify the analysis of the review outcomes and to motivate future standardized comparisons with any subsequent studies, the findings of the present review will be grouped according to the possibility of applying AI in the prevention of the different incident type groups as defined by the ICPS. On 3 November 2023, a systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was carried out using the SCOPUS and Medline (via PubMed) databases. A total of 297 articles were identified. After the selection process, 36 articles were included in the present systematic review. The studies included in this review allowed for the identification of three main "incident type" domains: clinical process, healthcare-associated infection, and medication. Another relevant application of AI in clinical risk management concerns the topic of incident reporting. This review highlighted that AI can be applied transversely in various clinical contexts to enhance patient safety and facilitate the identification of errors. It appears to be a promising tool to improve clinical risk management, although its use requires human supervision and cannot completely replace human skills. To facilitate the analysis of the present review outcome and to enable comparison with future systematic reviews, it was deemed useful to refer to a pre-existing taxonomy for the identification of adverse events. However, the results of the present study highlighted the usefulness of AI not only for risk prevention in clinical practice, but also in improving the use of an essential risk identification tool, which is incident reporting. For this reason, the taxonomy of the areas of application of AI to clinical risk processes should include an additional class relating to risk identification and analysis tools. For this purpose, it was considered convenient to use ICPS classification.

The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015

Despite the growing recognition of the need to implement systematic approaches for managing the risks associated with healthcare, few studies have investigated the level of implementation for clinical risk management (CRM) at a national level. Therefore, this study aimed to assess the current level of CRM implementation in German hospitals and to explore differences across hospital types. From March to June 2015, persons responsible for CRM in 2,617 hospitals and rehabilitation clinics in Germany were invited to participate in a voluntary online survey assessing the level of implementation for various aspects of CRM: CRM strategy, structures and processes; risk assessment (risk identification, risk analysis, risk evaluation) with a focus on incident reporting systems; risk mitigation measures; and risk monitoring and reporting. 572 hospitals participated in the survey (response rate 22%). Most of these hospitals had a formalised, binding CRM strategy (72%). 66% had a centralised and 34% a decentralised CRM structure. We also found that, despite a broad range of risk assessment methods being applied, there was a lack of integration of risk information from different data sources. Hospitals also reported a high level of implementation of critical incident reporting systems with a strong preference for local (74%) over transorganisational systems. This study provides relevant data to inform targeted interventions concerning CRM implementation at a national level and to consider the specific context of different types of hospitals more carefully in this process. The approach to CRM assessment illustrated in this article could be the basis of a system for monitoring CRM over time and, thus, for evaluating the impact of strategy decisions at the policy level on CRM development.

Implicit, Context Management Systems for Mobile Health Services

Objectives: In this paper data flow and executive model of Mobile Health services risk management by the use of context aware systems are provided. Materials and Methods: Mobile health (M-Health) refers to using portable electronic devices having application for delivering health services and patient’s information management. M-Health can offer various services remotely in prevention, detection, control, and treatment of disease or in the conditions of disaster for a patient or an environment. These services can have more acceptable quality by the help of Context Aware Systems which are defined as the capacity of computing equipment for detection, feeling, interpreting, and replying to user’s local environmental aspects and computing equipment itself. In this paper, executive model is offered for managing services of M-Health based on context aware systems. One of the supplies of developing a context aware system is having a clear and well-defined definition of context and developing appropriate context information provider. In order to deliver high quality and well-managed M-Health services in the form of context aware systems, having clinical risk management plan is necessary. Conclusions: M-Health services need to develop appropriate communication strategies for interacting with stockholders at each stage of clinical risk management process. Risks, which are primarily resides in service providers, communicating channels or service receiver sides, can be well identified and managed using clinical risk management, M-Health and context aware systems. Thereby, these systems can offer qualified and precise services.

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

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. 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. 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. 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.

Patient Safety and the Integration of Graduate Nurses Into Effective Organizational Clinical Risk Management Systems and Processes

This article explores and describes key processes facilitating the integration of neophyte graduate nurses into safe and effective organizational systems and processes as part of a hospital's overall local clinical governance and clinical risk management (CRM) program. This study was undertaken using an exploratory descriptive case study method. Four sample units of analysis were used, notably, 2 cohorts of graduate nurses (n = 11) undertaking a 12-month graduate nurse transition program; key stakeholders (n = 34), that is, nurse unit managers, clinical teachers, preceptors, a quality manager, a librarian, and senior nurse administrators employed by the participating health service; and pertinent literature sources. Data revealed that the cohort of graduate nurses under study became substantively integrated into the hospital's organizational and patient safety system processes within the first 3 to 4 months of their employment. Processes most contributing to this integration included the graduates receiving pertinent information about CRM at the very beginning of their employment (at induction) and thereafter throughout their graduate nurse year. In addition, the graduates needed focused support to assist their efforts to integrate the CRM systems and processes of their employer organization into their "normal working practices." In order for new graduate nurses to become integrated into safe and effective organizational systems and processes as part of a hospital's overall local clinical governance and CRM program, they needed pertinent information on CRM at the beginning of their employment and thereafter be supported throughout their graduate nurse year to develop and translate that information into their "routine" (everyday) practice. Further comparative research involving larger cohorts of graduate nurses is required.

Using clinical risk management processes to develop the national service framework for coronary heart disease

This article discusses the role of clinical risk management in the implementation of the National Service Framework for Coronary Heart Disease (NSFCHD). It considers the practical difficulties faced in meeting NSF standards, and proposes a combined, complementary approach involving primary and secondary care. While the NSF makes no explicit reference to clinical risk management, the risk manager has an important role to play in ensuring that an adverse event reporting system is in place and its role fully accepted by clinicians. From a medico‐legal standpoint, a commitment to auditing outcomes and maintaining good clinician‐patient communication is viewed as essential. It concludes that doctors’ and patients’ interests are best served by clinicians adopting a clinical risk management approach to implementing the NSFCHD.