Hospital Risk Management Research Articles

Perceptions of surgical never events among interdisciplinary clinicians: Implications of a qualitative study for practice

BackgroundNever Events are serious, preventable, and clearly identifiable medical errors with the potential for causing patients significant morbidity and mortality. Despite extensive efforts to eliminate them, Never Events persist. AimTo assess whether interdisciplinary clinicians (nurses, surgeons, and anaesthesiologists) and risk managers have different mental models about three aspects of the definition of surgical Never Events: incidence, severity, and preventability. MethodsSemi-structured interviews were conducted with 25 operating room clinicians and hospital risk managers in Israel from September to December 2019. Verbatim transcripts were analysed using six-phase inductive thematic analysis. FindingsMental models of Never Events varied by profession. Surgeons described them as rare and nurses saw them as common. While agreeing on their severity, mental models about preventability were mixed, with surgeons and nurses thinking that training and/or safety standards could prevent them, and anaesthesiologists and risk managers considering them to be unpreventable. DiscussionThe common definition of Surgical Never Events characterises them as severe and preventable events. Different mental models characterise interdisciplinary views about the definition. These differences challenge the utility of a single international consensus definition of Never Events. ConclusionGiven differences in mental models among clinicians and risk managers, approaches to eliminating Never Events may benefit from identifying and addressing these differences in order to improve teamwork and implementation of safety protocols.

Personnel solutions for clinical risk management in hospitals: Evidence from the Czech Republic

Clinical risk management (CRM) is a specific form of risk management used in hospitals that focuses directly on clinical processes and indirectly on patient-related processes as well as on individuals, including their potential to make mistakes. The aim of this study was to describe and analyze the central CRM coordination in hospitals using the Czech version of the CRM monitoring tool developed for hospital environments. Quantitative research consisted of collecting and evaluating data using statistical methods. The research set consisted of responses from 53 participating hospitals recorded in the Czech version of the CRM monitoring tool. The results did not identify statistically significant differences among types of hospitals in terms of whether or not a person responsible for the central coordination of clinical risk management activities is designated in them. According to the findings, this fact does not affect the type of hospital or whether it is a public or private hospital. The paper also show that most hospitals have one person responsible for coordinating CRM who is often also employed as the hospital’s quality manager. In faculty hospitals, the person responsible for CRM is often a subordinate to the medical director or the deputy for medical care, etc. In city and other hospitals, they are usually directly subordinate to the director. The study showed that the person responsible for clinical risk management most often holds the quality manager position in hospitals. AcknowledgmentThis contribution was supported by the Faculty of Health and Social Sciences of the University of South Bohemia in České Budějovice as part of an individual internal research project of the ZSF USB entitled “Utilization of Clinical Risk Management in the Environment of Czech Hospitals” funded by the ZSF USB RVO.

Evaluation and prioritization of occupational safety and health risks of Shahid Sadoughi Hospital in Yazd in 2019

Introduction: Today, it is essential to pay attention to the opportunities and threats in health services, especially in hospitals, to identify and evaluate the existing risks and manage them in these centers. Hospital risk management is a program to reduce the occurrence and prevalence of preventable accidents and is of great economic, human and moral importance in the hospital environment. This study aimed to evaluate and prioritize the occupational safety and health risks of the staff of Shahid Sadoughi Hospital in Yazd in 2019
 Methods and material: : The present study is descriptive-cross-sectional. In the first step, the main risks in clinical, laboratory, facilities, radiology, and administrative departments were identified. Based on FMEA logic, three severity, probability, and vulnerability indicators were identified for each risk. Then, prioritization criteria were determined, and ANP prioritized the risks.
 Results: According to infectious disease experts with a risk of 0.86 in the clinical ward, inhalation of Barisek chemical vapor 1.17 in the laboratory, radiation of the device with a risk of 0.64 in imaging, infectious disease with a risk of 0.33 and 1.3 in order of priority The first were in the administrative and facilities department.
 Conclusion: The results showed that the hospital management should adopt special management programs to control infectious diseases with a staff health approach. Control measures should be set with priority risks. The difference in the obtained risk numbers indicated the different priorities of implementing risk management programs in each ward of Shahid Sadoughi Hospital.

Risk management and infection control preparedness of Saudi healthcare facilities to overcome the COVID-19 pandemic

ObjectiveTo evaluate the preparedness of Saudi healthcare facilities to handle the coronavirus disease 2019 (COVID-19) pandemic.MethodsBetween April and June 2020, a cross-sectional study was conducted among Saudi hospitals using an online-administered English-language questionnaire by the Saudi Commission for Health Specialties. The questionnaire evaluates all aspects of risk management, infection control and preventative programmes that should be known and practised by all healthcare workers (HCWs). All HCWs in Saudi hospitals designated to accept patients with COVID-19 were involved in the study.ResultsIn total, 161 HCWs responded to the survey. General understanding of hospital risk management plans and infection prevention measures was found to be outstanding (80.4%), with no differences in responses by gender, education or occupation. Some differences in responses were found by age group and years of working experience. Most responses were from hospitals located in the Central Province (72.7%) and governmental hospitals (88%), and most provided family services (68%). Furthermore, the results showed that medical professionals received adequate training, which is recognized as the baseline for effective risk management and infection control and prevention procedures, policies and recommendations.ConclusionsNotwithstanding small differences between HCWs, this study found that all HCWs in Saudi hospitals had excellent knowledge of risk management plans and pandemic sub-plans of infection control and prevention policies, procedures and principles, which has aided the health authorities in Saudi Arabia in mitigating COVID-19 effectively.

Risk identification, assessment and management in the Greek public hospitals: The contribution of the board of directors and internal audit

Research Question: Our study examines the development of a reliable internal audit plan in the Greek public hospitals, focusing on how to identify, assess and evaluate the relevant risks by the Boards of Directors. Data: We use an exceptional database drawing information from a large sample of Greek hospitals based on a structured questionnaire for the period from September 1, 2015 to March 31, 2017. Tools: As our primary source of data we conduct interviews with CAEs of Greek hospitals’, while secondary data sources come from corporate governance codes, COSO framework for ERM, Greek corporate governance laws, regulations, best practices and published articles. Findings: Taking into account the financial crisis of the last ten years in Greece as well as the pathogenesis of the healthcare system, we note the poorly organized risk management in Greek hospitals. The results show that the financial crisis had a direct impact on the way risk management of public hospitals operates. Furthermore, we observe denial of the application and implementation in the form of formal guidelines to the members of the hospitals’ Board of Directors. Contribution: Research findings can have a catalytic effect on hospital management and those who implement public policies.

PENERAPAN MANAJEMEN RISIKO KESELAMATAN DAN KESEHATAN KERJA DI RUMAH SAKIT ISLAM SURABAYA A. YANI

Risk management is a preventive effort for a company, especially those engaged in the service sector, which is very prone to errors and complaints. For this reason, it is necessary to map the risks that occur in accordance with the work unit in it which is expected to minimize the number of accidents or errors in both patients, visitors and employees in the hospital. In the 2019 patient safety incident report data at the Surabaya A. Yani Islamic Hospital, it was found that there were incidents which included near miss 93%, not injured 4%, unexpected events 3% and Sentinel 0%. The purpose of this study was to identify and identify the application of occupational safety and health risk management at the A. Yani Islamic Hospital in Surabaya. This thesis is a qualitative research with a case study method with the aim of fully describing the implementation of K3 risk management at Surabaya A. Yani Hospital based on observation, survey and documentation data on 37 units and hospital workplaces by identifying risks. , analyze and find risk control measures. The results showed that the implementation of K3 risk management in the Islamic Hospital of Surabaya A. Yani based on the results of risk identification obtained as many as 25 risks in the graha building and the old building which were further analyzed by finding 15 moderate risks and 10 high risks. can be done is by repairing damaged infrastructure and improving the existing security system at the A. Yani Islamic Hospital in Surabaya. The conclusion in this study is the implementation of K3 risk management at the Islamic Hospital of Surabaya A. Yani based on the process of risk identification and risk analysis, there are 25 potential risks, of which there are 15 moderate risks and 10 high risks that can potentially cause accidents to employees, visitors and patients. In this case, control efforts are made to minimize the number of incidents and accidents.

Staffing and patient-related factors affecting inpatient falls in a psychiatric hospital: a 5-year retrospective matched case\u2013control study

BackgroundThe frequency and severity of falls of psychiatric inpatients in Thailand have not been previously reported. Also, the risk factors of falls have been numerous and complicated. This study aimed to investigate the staffing factors and patient-related factors that increase the likelihood of falls among psychiatric inpatients.MethodsA five-year retrospective matched case–control study was conducted that selected cases of inpatients who fell and which were reported to the hospital risk management system. Subjects were compared to two control patients from the same hospital (1:2) by age (± 5 years), sex, and admission the same year. The total sample consisted of 240 patients. Univariate and multivariate conditional logistic regression was used to analyze the data.ResultsOf the eighty falls, 86.3% resulted in temporary harm and required intervention. The multivariate model showed that three patient-related factors were associated with increased inpatient falls: (1) having an acute psychotic condition (adjusted odds ratio (AOR) = 4.34; 95% CI 1.45, 13.05; p < 0.05), (2) polypharmacy with more than four types of medicines (AOR = 3.06; 95% CI 1.59, 5.88; p < 0.05), and (3) taking atypical psychiatric drugs (AOR = 2.74; 95% CI 1.35, 5.58; p < 0.05). Staffing for 26–50 patients in the wards was more protective for falls than with 25 or fewer patients (AOR = .17; 95% CI 0.04, 0.72; p < 0.05).ConclusionsThe risk factors found may help assess fall risk and manage the number of patients in psychiatric units. Drug dosage and drug interaction of antipsychotic drugs and cardiovascular agents with other medications and drug administration timing before falls are recommended for further investigation. Also, staff ratio per patient and the proportion of staff mix in psychiatric units need further study to establish adequate levels of surveillance to prevent inpatient falls.

Further Development of Maturity Levels of Quality and Risk Management System at the University Hospital Schleswig-Holstein

Following upon our publication "Maturity Levels of Quality and Risk Management at the University Hospital Schleswig-Holstein" in 2018, we present the further development of the maturity model. Quality and risk management in hospitals is not only required by law but also plays a significant role in an optimized patient- and process-oriented health care. A questionnaire-based self-assessment was carried out by 46 clinical units of the UKSH (location Kiel and Lübeck) for the analysis of nine quality criteria overall. Four of these criteria (quality assurance (QS), critical incident reporting system (CIRS), complaint management (BM) and process management (PM)) were already analysed in 2016 and were extended to the five new aspects, namely audits and on-site inspections, responsibilities, morbidity and mortality conferences, hygiene training and surgical safety checklist. Every quality item was graded into four categories from "A" (fully implemented) to "D" (not implemented at all). The comparison of the results for quality criteria QS, CIRS, BM, PM and the overall maturity level between 2016 and 2020 demonstrated statistically significant improvements in 2020 concerning the criteria QS (p=0.013), CIRS (p=0.026), PM (p=0.000) and the overall maturity levels (p=0.019). The criteria BM did not show any statistically significant improvement. The five newly added quality criteria demonstrated maturity levels "A" (fully implemented) and "B" (largely implemented) the following: audits and on-site inspections (100%), responsibilities (95.6%), morbidity and mortality conferences (65.2%), hygiene training (95.6%), and surgical safety checklist (100%). An integrated quality and risk management has already been a firm element of UKSH for years. Nevertheless, review of effectiveness of the initiated targeted measures is still a challenge. This is the reason why it is necessary to develop effective and resource-saving approaches for the evaluation of measures and the identification of potential for improvement. The recognised potential for improvement should be risk-prioritized and completely exploited using sustainable measures. Following this principle, we designed a qualitative model of maturity levels for the evaluation of our quality and risk management system at the UKSH in 2016, whose further development we demonstrate here.

Benchmarking between two different hospitals on health risk management in the covid-19 emergency

IusseThe strategies adopted during COVID19 emergencies by two different hospitals in the Lazio Region are presented: S. Maria Goretti Hospital (SMGH) directly managed by the ASL Latina, hub and centre of the Emergency Department, and Cristo Re Classified Hospital (CRH), accredited in the territory of the ASL Roma1.Description of the problemSMGH has been identified as COVID19 Intervention Hospital. CRH initially was a No-COVID support structure, then included in the COVID19 network. During the COVID19 emergency, the directors of both hospitals had to simultaneously ensure activity as usual, COVID19 recovery and risk management.ResultsSMGH, while continuing the emergency, oncological, pregnancy, paediatrics and outpatient activities, COVID19 patients was isolated on 7 different floors/areas. Moreover was defined: chain of command; clinical admission criteria; COVID19 multi-professional and support teams, roles, skills and specific training; health surveillance; environmental hygiene, safety paths/procedures, vaccinal center and much more. CRH, while continuing minimum programmed activities to reduce waiting lists, in the first epidemic phase was created 4 tensile structures for Pre-triage and COVID pathways, respiratory isolation area for supsected patient; transfer admission for emergency networks, clean-dirty pathway. Moreover in the second phase, was activated beds of COVID19 network and 4 technical beds OBI; the ‘Walk-in' for antigenic testing, with molecular confirmation <24h and infectious counselling; multi-disciplinary and specialist support teams, training courses, health surveillance, vaccinal center and much more.LessonsDuring COVID19 pandemic, risk management skills linked to the technical-organisational strategy of hospital directors, making it possible to reprogramme their structure in a short period of time with flexibility and resilience of the whole organization.Key messages Specific skills and roles, both hygienic and organizational, are essential to risk management in hospitals during epidemic emergencies.The multidisciplinarity, flexibility and modularity of the hospital structure are the organizational bases in cases of pandemics.

The Role of Information System for Risk Management in Hospital: A Narrative Review

The Role of Information System for Risk Management in Hospital: A Narrative Review

IMPLEMENTATION OF OCCUPATIONAL SAFETY AND HEALTH RISK MANAGEMENT IN ISLAMIC HOSPITAL SURABAYA A. YANI

Background: Risk management is a preventive effort for a company, especially those engaged in the service sector, which is very prone to errors and complaints. For this reason, it is necessary to map the risks that occur in accordance with the work unit in it which is expected to minimize the number of accidents or errors in both patients, visitors and employees in the hospital. In the 2019 patient safety incident report data at the Surabaya A. Yani Islamic Hospital, it was found that there were incidents which included near miss 93%, not injured 4%, unexpected events 3% and Sentinel 0%. The purpose of this study was to identify and identify the application of occupational safety and health risk management at the A. Yani Islamic Hospital in Surabaya. Methods: This thesis is a qualitative research with a case study method with the aim of fully describing the implementation of K3 risk management at Surabaya A. Yani Hospital based on observation, survey and documentation data on 37 units and hospital workplaces by identifying risks. , analyze and find risk control measures. Results: The results showed that the implementation of K3 risk management in the Islamic Hospital of Surabaya A. Yani based on the results of risk identification obtained as many as 25 risks in the graha building and the old building which were further analyzed by finding 15 moderate risks and 10 high risks. can be done is by repairing damaged infrastructure and improving the existing security system at the A. Yani Islamic Hospital in Surabaya. Conclusion: The conclusion in this study is the implementation of K3 risk management at the Islamic Hospital of Surabaya A. Yani based on the process of risk identification and risk analysis, there are 25 potential risks, of which there are 15 moderate risks and 10 high risks that can potentially cause accidents to employees, visitors and patients. In this case, control efforts are made to minimize the number of incidents and accidents.

Assessment of Occupational Health and Safety Awareness among Healthcare Workers at the Pediatric Hospital in Benghazi City

Occupational health and safety (OHS) is an essential area concerned with the protection, health, and safety plus the welfare of individuals involved in any kind of occupation. This study aimed at assessing the occupational health and safety awareness and practices among the healthcare workers in the pediatric hospital in Benghazi city, Libya. The study adopted descriptive survey research in the Benghazi pediatric hospital. The study randomly selected 246 healthcare workers and the response rate was 96%. A questionnaire was used as the main data collection instrument. The data were coded and analyzed using descriptive statistics; frequencies and percentages and inferential analysis of correlation. Around 50% of the participants reported a lower level of awareness regarding occupational health and safety (OHS). The study proposes that the ministry of health should conduct specialist training in occupational health and safety for their staff, they also should confirm provisions of this policy and technical guidelines apply to all health institutions and administrative units within the health sector. Further hospital risk management should put in place a regular monitoring team who will certify that workers notice in firm terms safety measures put in place to avoid any accidents/injuries. Lastly, the study recommends that further research on the factors determining the implementation of occupational health and safety awareness and practices at public health care facilities in Libya.

Hospital risk management at the time of Covid-19: An analysis of the Lombardy Region

Covid-19 has imposed a rethinking of risk management systems in the healthcare sector. The aim of this paper is to investigate how the risk has been and is managed by the healthcare organizations, on the basis of regional directives. The analysis focuses on the health system of the Lombardy Region. In particular, the authors focused on the resolutions adopted by the Lombardy Region in the acute phase of the pandemic (2 March 2020-12 May 2020) with the aim of rebuilding the system put in place by the Region for risk prevention and management. Thanks to the resolutions, the Lombardy Region has established a risk management system, consisting of a surveillance system and an emergency management system that seems to have led to positive consequences.

Level of Knowledge of Medical Staff on the Basis of the Survey in Terms of Risk Management, Associated with Clostridioides difficile Infections.

Infections caused by the toxigenic strains of Clostridioides difficile in the hospital environment pose a serious public health problem. The progressive increase in hospital infections in Poland indicates that risk management is a tool that is not used in an effective way and significantly differs from the goals set by the Leading Authorities, the Ministry of Health and its subordinate units. Systematic education of medical personnel constitutes the basic element of rational risk management aimed at reducing the number of infections as it allows for the transfer of knowledge, development of appropriate organizational procedures, and improves internal communication. This paper presents the results of a survey conducted in hospital facilities throughout Poland. The study dealt with what medical personnel know about channels of transmission and prevention of Clostridioides difficile infections in the hospital setting, professional training and risk management in terms of reducing the number of infections. The survey reveals that Clostridioides difficile continues to be a serious problem in the inpatient care system. Procedures and management strategies implemented by hospitals in order to limit the spread of the pathogen are predominantly focused on short-term action, which does not lead to a real improvement in terms of hospitalized patients’ safety. The infection risk management system was assessed at a fairly low level. The obtained research results confirmed the research hypotheses that had been formulated.

Turbulent Airflow Costume Compromises Occupational Safety and Infection Control: A Hospital Risk Management Case Report

Objectives: To inform hospital infection control, risk management, hospital administrators, and healthcare workers about a new and surprising threat to infection control: air-powered costumes.Backg...

Risk management and surveillance systems: A Model proposed for the provincial public hospital (CHP)

During the Covid-19 pandemic, the provincial hospitals (CHP) of Morocco have demonstrated a remarkable capacity for reactivity. They were able to reorganize themselves to ensure the response to the pandemic and maintain basic functions. However, this reactivity alone does not prove their resilience in the face of new infections and possible disasters. The CHP must plan its responsiveness well in advance by building an intra-hospital health vigilance system that meets basic provincial requirements and that communicates with its internal and external environments. A qualitative analysis, using the focus group method, on Ifrane hospital risk management system revealed that, the systems for notification and declaration of adverse events are set up under the responsibility of multiple actors and using multiple notification forms. The processes and procedures are not clear with an overlap between the activities of quality assurance, risk management and complaints treatment system. A lot of information does not arrive at its destination on time, which impacts decision-making. This work proposes a hospital risk management model with two systems, one for safety of care and the other for risk management, taking into account the missions of the CHP and the different sources of information.

Best leadership practices of nurses in hospital risk management: case study.

To highlight the best leadership practices of nurses who contribute to hospital risk management. Single case study with two integrated units of analysis, with a qualitative approach. Data collected from April to November 2018, through focused interviews with nurse managers, non-participant observation and documentary research. Analysis using the analytical technique to the explanation construction. Three thematic categories were evidenced, demonstrating that the best leadership practices involve technical and non-technical competencies anchored in behavioral development, scientific knowledge, guidelines for quality and patient safety and participatory management of the health team. The best leadership practices of nurses who contribute to hospital risk management pervade technical skills and/or formal positions, valuing each team professional in a unique way and emphasizing the importance of scientific knowledge and the professional reference model that the nurse exercises in hospitals.

Determinants of the implementation of hospital risk management: Case of the Provincial Hospital Center of El Jadida Morocco

Determinants of the implementation of hospital risk management: Case of the Provincial Hospital Center of El Jadida Morocco

SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities.

Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.

How Hospital Leaders and Risk Managers Can Nurture Ethics-Driven Lawyering

How hospital lawyers assess legal risk in clinically and ethically complex cases can shape risk management operations, influence clinicians' morale, and affect the care patients receive. This article suggests that many disagreements, particularly those involving key ethical and legal questions arising from a patient's care, should launch a process that might include family meetings, early palliative care integration, and ethics consultation or committee review of clinical teams' and surrogates' reasons and perspectives. This article also explains why exploration of these perspectives can motivate fuller understanding of the sources of clinical and ethical disagreements and inform the approach to legal advice that hospital executives and risk managers should foster.