Semi-quantitative Risk Analysis Research Articles

Exposure assessment and semi-quantitative risk analysis of histamine in tuna and tuna-like fish from Indonesia

This study aimed to investigate histamine exposure associated with consumption of fresh tuna and tuna-like species in West Java, and to estimate risk of Scombroid Fish Poisoning (SFP) in Indonesia. A range of species, including tuna (Thunnus spp.), bullet tuna ( Auxis sp.), and skipjack ( Katsuwonus pelamis ) were collected from local markets and fish landing sites. Subsequently, histamine concentrations were determined using NMR analysis and exposure was calculated in mg/day for toddlers, children, and adults. The results showed that skipjack had the highest histamine exposure for all age groups, followed by bullet and regular tuna. The highest EDI for histamine was from skipjack consumption, accounting for 38.67; 37.77 and 20.74 percentage of exposure for toddlers, children and adults, respectively. These values are below the defined thresholds levels (ARfD), indicating no potential risk of acute health effect. Cooked bullet tuna and skipjack were estimated to cause similar illnesses, accounting for 6–7 cases per 100,000 individuals, which was higher than cooked tuna at 1–2 cases per 100,000 individuals. Considering the preparation of raw tuna in restaurants following Good Hygienic Practices (GHP), the predicted annual cases decreased significantly to 4–5 cases per million individuals. This risk estimation only considered histamine levels in fresh fish, without including data from fish preparation. Therefore, further studies were recommended to estimate the risk level in raw/fresh tuna and similar species before consumption.

RISK MANAGEMENT IN MEDICINE: THE PROCESS OF IDENTIFICATION, ASSESSMENT AND CONTROL OF RISKS IN MEDICAL PRACTICE

Risks accompany any activity of a person, company, or country throughout life. The healthcare industry is no exception, given the constant difficult situations that occur with patients, medical personnel, and healthcare facilities in general. All risks in medical practice can be divided into different groups according to the object in the risk zone: general risks (economic, financial, environmental, military, etc.), specific risks aimed at the patient (diagnostic, therapeutic, pharmacotherapeutic, etc.), and specific risks aimed at the healthcare employee (working conditions, contact with hazardous infections, etc.). Risk governance is one of the priorities of healthcare institutions in achieving their goals because there is always a chance that something will go wrong, not as it was planned. In the field of healthcare, as in other industries, to assess and analyze the risks one can use risk matrices. These matrices allow for quantitative, semi-quantitative, and qualitative risk analysis. The latter makes it possible to develop the right strategy for responding to and mitigating those risks. This study aims to conduct comprehensive research of the risk stages in medical practice, as well as to provide detailed recommendations for risk analysis and emphasize the importance of corporate risk governance in healthcare activities. The authors analyzed the data collected since 2013. It has been found that the study of the overall risk level assigned to each incident helps to determine the urgency and degree of control measures required.

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Risks accompany any activity of a person, company, or country throughout life. The healthcare industry is no exception, given the constant difficult situations that occur with patients, medical personnel, and healthcare facilities in general. All risks in medical practice can be divided into different groups according to the object in the risk zone: general risks (economic, financial, environmental, military, etc.), specific risks aimed at the patient (diagnostic, therapeutic, pharmacotherapeutic, etc.), and specific risks aimed at the healthcare employee (working conditions, contact with hazardous infections, etc.). Risk governance is one of the prio rities of healthcare institutions in achieving their goals because there is always a chance that something will go wrong, not as it was planned. In the field of healthcare, as in other industries, to assess and analyze the risks one can use risk matrices. These matrices allow for quantitative, semi-quantitative, and qualitative risk analysis. The latter makes it possible to develop the right strategy for responding to and mitigating those risks. This study aims to conduct comprehensive research of the risk stages in medical practice, as well as to provide detailed recommendations for risk analysis and emphasize the importance of corporate risk governance in healthcare activities. The authors analyzed the data collected since 2013. It has been found that the study of the overall risk level assigned to each incident helps to determine the urgency and degree of control measures required.

Industrial and Environmental Disaster Risk Assessment for Hazardous Materials in Balikpapan City, East Kalimantan, Indonesia

Industrial disasters may cause massive public health problems, as they create large environmental damage and major loss of life. Balikpapan City has experienced a large oil spill which caused an industrial and environmental disaster: five fishermen died, various public health problems arose, and damage to environmental wildlife and ecosystems occurred. The objective of this study was to evaluate the industrial and environmental disaster risk related to hazardous material (hazmat) in Balikpapan. The research method involved the use of a semi-quantitative risk analysis with an originally organized checklist, a risk matrix, and a Geographic Information System (GIS) analysis. The results suggested that the risk score in Balikpapan’s City is 32 (MEDIUM; the dominant types of hazmat were flammables and corrosives). The major sectors contributing to the risk appeared to be the mining, energy, and oil and gas industries, with a medium risk (average risk score 33), while one clean water industry showed a low risk (risk score 24) using the checklist and risk matrix. According to the results from the GIS mapping, the areas t the highest risks appeared to be located within Balikpapan City coastal regions. The industries and the government of Balikpapan must be prepared for industrial and environmental disasters by educating competent major hazmat responders and ensuring a large spills response equipment, extensive environmental monitoring and measurement, procedures to deal with major fire and explosions and adequate disaster communication and coordination.

Data use and data needs in critical infrastructure risk analysis

This paper provides an overview and mapping of needs and use of data related to formal risk analysis within the context of critical infrastructures, including activities of risk assessments and risk modelling as a part of preventive work against major accidents and crises. The aim is to contribute to a greater understanding of the type of data that is actually used in published sources where different risk assessment or risk analysis methods are applied for critical infrastructure protection. The study focuses specifically on the presentation of applications of quantitative or semi-quantitative risk analysis in the scientific literature within the domain of societally important services and critical infrastructures. The survey was delimited to peer reviewed research papers between the years 2010 and 2020 and resulted in a total number of 183 papers subject for evaluation. The results provide insights into the type of data that is used, missing or difficult to obtain for an application of the identified methods. To obtain a comprehensive critical infrastructure risk analysis data needs are related to three different data dimensions; geospatial topology data, socio-economic data, and infrastructure data. However, no databases are currently available with the explicit purpose to support critical infrastructure risk analysis. Even though this is not viewed as a problem in the examined papers, collecting that data is resource intensive which is a barrier for a more systematic use of formal risk analysis methods.

A calculation method of pipeline reliability based on risk identification

In the process of calculating the reliability of longdistance pipelines, a calculation method of pipeline section reliability, based on the semi-quantitative risk analysis widely used in the industry, is established to cope with the problems of low calculation efficiency of mathematical analysis and limited consideration of model failure factors. Based on this approach, the calculation efficiency is evidently improved by adopting some data of risk assessment results to carry out subsequent calculations. Moreover, the consideration scope of failure factors is enlarged with better practicality and easier calculation.

Risk Management Activities in a Lung Cancer Multidisciplinary Team at a Comprehensive Cancer Center: Results of a Prospective Analysis.

The objective of the study was to highlight sources of harm that could negatively affect the lung cancer multidisciplinary team (MDT) activities to reduce the level of risk of each factor. A modified Delphi approach was used by a board of multi-health care professionals of the lung cancer MDT to identify the main processes, subprocesses, and risk factors of the multidisciplinary pathway of patients with lung cancer. A semiquantitative matrix was built with a five-point scale for probability of harm (likelihood) and severity of harm (consequences) according to the international risk management standards (ISO 31000-2018). The risk level was calculated by multiplying likelihood × consequences. Mitigation strategies have been identified and applied by the MDT to reduce risks to acceptable levels. Three main processes (outpatient specialist visit, MDT discussion, and MDT program implementation), eight related subprocesses, and 16 risk factors were identified. Four risk factors (25%) were related to outpatient specialist visit, seven (43.75%) to case discussion, and five (31.25%) to program implementation. Overall, two risk factors were assigned a low-risk level (12.5%), 11 a moderate-risk level (68.75%), one (6.25%) a high-risk level, and two (12.5%) a very high-risk level. After the implementation of mitigation measures, the new semiquantitative risk analysis showed a reduction in almost all hazardous situations: two risk factors (12.5%) were given a very low level, six (37.5%) a low level, seven (43.75%) a moderate level, and one (6.25%) a very high level. An interdisciplinary risk assessment analysis is applicable to MDT activities by using an ad hoc risk matrix: if the hazard is identified and monitored, the risk could be reduced and managed in a short time.

Health risks of solid waste management practices in rural Ghana: A semi-quantitative approach toward a solid waste safety plan

Inadequate solid waste management (SWM) can lead to environmental contamination and human health risks. The health risks from poor SWM can vary based on specific practices and exposure pathways. Thus, it is necessary to adequately understand the local context. This information, however, is rarely available in low-resource settings, particularly in rural areas. A solid waste safety plan could be helpful in these settings for gathering necessary data to assess and minimize health risks. As a step in developing such a tool, a semi-quantitative health risk analysis of SWM practices in nine Ghanaian rural villages was undertaken. Data on SWM in each village were collected through qualitative field observations and semi-structured interviews with local stakeholders. SWM-related health risks were assessed using the collected data, similar case studies in the scientific literature and dialogue among an assembled team of experts. The analysis identified context-specific practices and exposure pathways that may present the most substantial health risks as well as targeted solutions for mitigation risks. A risk assessment matrix was developed to quantify SWM risks as low, medium, high, or very high based on the likelihood and severity of identified hazards. The highest SWM risks were identified from dumpsites and uncontrolled burying of solid waste. More specifically, a very high or high risk of infectious and vector-borne diseases from SWM in the villages was identified, both in the disposal of solid waste in dumpsites and uncontrolled burying of solid waste. Additionally, a very high or high risk of inhalation, ingestion or dermal contact with contaminants was found in the disposal of solid waste in dumpsites, open burning of waste and reuse of waste from dumpsites as compost. The results demonstrate the potential value of a solid waste safety plan and a parsimonious approach to collect key local data to inform its contents.

Spatio-temporal and trade export risk analysis of bluetongue disease in France: A case study of China.

Bluetongue disease (BT) is a viral disease that can be introduced through imported animals and animal products, affecting local animal husbandry. In this study, the spatial and temporal patterns of BT outbreaks (outbreak: a BT infection in cattle, sheep, or goats on a farm, involving at least one infected animal) in France were analyzed and the risk of introducing bluetongue virus (BTV) into countries through trade was assessed. A spatiotemporal analysis of BT reported during the study period (2015-2018) showed that there were clustered outbreaks of BT in France in 2016 and 2017, with outbreaks concentrated from August to December. The outbreak moved eastward from the center of mainland France to surrounding countries. A semi-quantitative risk analysis framework was established by combining the likelihood assessment and consequence analysis of introducing BTV into trading countries through trade. Exemplified by China, the research showed that in the analysis of the likelihood of BTV from France being introduced into trading countries through live cattle trade, China imports a large number of live cattle, bringing high risks. The likelihood of introducing bovine semen into trading countries was similar to that of live cattle, but the harm caused by the trade in live cattle was higher than that caused by the trade in bovine semen. This risk analysis framework can provide a reference for other countries to quickly assess the risk of bluetongue transmission in import and export trade.

Semi-quantitative risk assessment of adjacent track accidents on shared-use rail corridors

There are several safety questions associated with operating passenger trains and freight trains on shared-use rail corridors (SRCs). Among them are adjacent track accidents (ATA) in which derailed railroad equipment intrudes upon (“fouls”) adjacent tracks and is struck by another train on adjacent tracks. ATAs can occur in any multiple track territory, but they become more complex and potentially more hazardous on SRCs. ATAs can be broken down into three principal events: the initial derailment, an intrusion, and a train present on an adjacent track. Previous research established a foundation for addressing intrusion risk by qualitatively identifying the risk and potential mitigation measures and conducting preliminary quantitative intrusion probability analysis; however, a gap remains between current research on intrusion risk and a comprehensive risk assessment model for ATAs. This paper presents an index-based, semi-quantitative risk analysis framework to evaluate probability and consequence of ATAs. A new risk index system was developed to evaluate ATA risk by assigning levels of probability to the three principal events and the overall ATA consequence level to different track segments, thereby enabling comparison of relative ATA risk among these track segments. The levels of ATA probability and consequence are determined by various infrastructure, rolling stock, and operational factors identified in this research where each factor contributes risk scores that can be summed and converted to levels of probability and consequence. The magnitude of risk due to each factor is determined by their effect, i.e., whether it increases or decreases the probability and/or consequence. A case study based on a 320-km, modified real-world SRC is presented to demonstrate and validate the model. Higher operating speed, lack of containment or barriers, and higher initial derailment rate all significantly affect ATA risk. The model enables comparisons of the relative ATA risks among different track segments at a resolution not previously achieved. It can also be used to locate high-risk locations (risk hotspots) on a railroad corridor where ATA risk is high. This model also provides information pertinent to future improvements in quantification of ATA risk and research on mitigation measures.

Semi-quantitative risk analysis of high concrete face rockfill dams under seismic action

A dam failures cause immeasurable losses, but more concrete face rockfill dams (CFRDs) are being built in areas where earthquakes occur frequently. If the risk level of CFRDs under seismic action can be identified promptly and corresponding measures taken in advance, dam failure risks can be mitigated to protect life and property. However, no study has been conducted on the seismic risk analysis of CFRDs. This study aimed to meet public security needs; hence, the risk matrix approach was used for analyzing the semi-quantitative risk of CFRDs under seismic action. Considering the seismic failure modes of dam deformation and dam slope instability, we also proposed a calculation technique of seismic failure possibility for high CFRDs. According to the worst-case scenario, the linear weighted sum method was used to assess the comprehensive seismic risk loss of CFRDs in terms of life loss,and economic loss, and socio-environmental impact. The risk levels of CFRDs under seismic action were accurately evaluated, and corresponding risk management measures were proposed according to the “As Low As Reasonably Practicable” principle. The results of this work fill the gap in the risk analysis of CFRDs under seismic action. Additionally, the results provide a theoretical basis and technical support for future seismic designs, seismic risk assessments, and risk decision-making for high CFRDs and similar projects in strong seismic areas.

Climate change risk assessment of heritage tourism sites within South African national parks

Climate change and variability are among the most critical threats facing heritage sites across the world. However, despite the threats posed by climate change and variability on heritage tourism sites, there are limited research and management interventions to help build the resilience of threatened sites. South African national parks are home to numerous heritage sites, including unique ecosystems, prehistoric ruins and rock art, which are still undocumented. This research assesses the risks imposed by climate change and variability on heritage sites within selected South African national parks. Assessing and prioritising risk is important to designing effective conservation and preservation strategies. The participatory Climate Vulnerability Index was used to assess climate vulnerability on three heritage sites within Kruger, Mapungubwe and Table Mountain national parks. The research developed and used a seven scale semi-quantitative risk analysis tool to rank and prioritise the identified climate related threats. Survey questionnaires were administered to park visitors to assess their perceptions of climate change impacts on heritage sites. Discussions with key informants were also done using in-depth interviews and focus groups. The results show that the vulnerability of heritage sites to climate change was high at all sites. Warming temperatures, drought and flooding intense rainfall are the main climatic stressors. A SMART (Specific, Measurable, Achievable, Realistic, and Timely) action list for the identified critical climate related risks was developed. To build future resilience, the paper recommends changes in how threatened tourism heritage sites are presented to visitors, improved funding for the documentation of the impacts of climate change on the heritage sites and developing anticipatory action to manage potential impacts.

Heavy Metal Accumulation in Soil and Water in Pilot Scale Rice Field Treated with Sewage Sludge

Widespread use of chemical fertilizers in agricultural activities poses a high risk of multi-micro metal contamination in soils and potentially causes health issues through consumption of contaminated foods. Bio-organic fertilizers from sewage sludge have been regarded as a suitable substitute for chemical fertilizer for rice farming. In this study, we investigated accumulation of heavy metals (Cu and Zn) in soil, water and rice plant in three pilot-scale rice paddy fields treated with different fertilization schemes. The control field was treated with conventional chemical fertilizers while the soil of two treatment fields was mixed with biological sewage sludge obtained from a local wastewater treatment system in Vietnam at different ratios (1% and 3%). Initial results showed that heavy metals accumulated in the soil, water, and rice plant at varying levels and most of the Cu and Zn contents found in soils, water and rice products exceeded permissible Vietnamese standards (QCVN 03: 2008) and US EPA 503. Notably, the rice field whose soil was treated with sludge at 3% ratio showed a significantly lower accumulation of heavy metals in soil, water and in rice plant. However, treatment of sludge at this level seemed to cause higher heavy metal retention in soil after one harvest. Semi-quantitative risk analysis revealed that the risk of metal contamination in soil and water of the control field ranged from medium (RQ index between 0.1 and 1) to high risk (RQ index higher than 1) and that fertilization methods would also affect the level of risk to the environment.

On risk-based maintenance: A comprehensive review of three approaches to track the impact of consequence modelling for predicting maintenance actions

Since gas plants are progressively increasing near urban areas, a comprehensive tool to plan maintenance and reduce the risk arising from their operations is required. To this end, a comparison of three Risk-Based Maintenance methodologies able to point out maintenance priorities for the most critical components, is presented in this paper. Moreover, while the literature is mostly focused on probabilistic analysis, a particular attention is directed towards consequence analysis throughout this study. The first developed technique is characterized by a Hierarchical Bayesian Network to perform the occurrence analysis and a Failure Modes, Effects and Criticality Analysis to assess the magnitude of the adverse outcomes. The second approach is a Quantitative Risk Analysis carried out via a software named Safeti. Finally, another software called Synergi Plant is adopted for the third methodology, which provides a Risk-Based Inspection plan, through a semiquantitative risk analysis. The proposed study can assist asset manager in adopting the most appropriate methodology to their context, while highlighting priority components. To demonstrate the applicability of the approaches and compare their rankings, a Natural Gas Regulating and Measuring Station is considered as case study. The results showed that the most suited method strongly depends on the available data.

The Risk Assessment on Bamboo Weaving Craftsmen in Rajapolah District Tasikmalaya Regency

Introduction: Tasikmalaya Regency is one of the areas in West Java that has a large industrial potential, especially small and handicraft industries. Every workplace, both formal and informal, has various potential hazards that can affect the health of workers or can cause occupational diseases. As bamboo is sharp, the craftsmen must be very careful in treating bamboo as a woven materialbecause the risk of accidents such as cutting off hands, being punctured by bamboo slats, and the risk of other potential mechanical hazards can occur. The purpose of this study is to analyze the occupational health and safety risks of woven craftsmen in the Rajapolah District, Tasikmalaya Regency. Methods: This study was a descriptive study. 5 Bamboo weaving craftsmen were the subjects of this study. Meanwhile, the objects of this study were the work process and workplace environment. Data collection was carried out by observation and interviews. Data analysis was performed using a semi-quantitative risk analysis method according to AS/NZS 4360: 2004 standard. Results: 23 potential hazards are identified from all stages of the bamboo process, and 23 health and safety risks are identified from all potential hazards, with 1 risk at a lowrisk level, 15 risks at a medium risk level, and7 risks at a highrisk level. Conclusion: There are 7 risks at the high-risk level that must be prioritized for control, originating from the potential hazards of ergonomics and chemicals.

A Concept Model to Scale the Impact of Safety Risk in a Construction Project Using a Semi Quantitative Method

The success of a construction project is influenced by variables including time, cost, quality, scope, safety and the environment. These variables all have associated risks. These risks can be managed through the stages of risk identification, risk analysis to determine priority, the risk response itself and risk control. Qualitative and quantitative methods are generally used in the risk analysis stage. A probability-impact (P-I) risk matrix is used for qualitative risk analysis. The weakness of a qualitative risk analysis is that it is not able to provide integrated information on the impact of risks on the project variables, whereas semi-quantitative analysis can alternatively be conducted. The current semi-quantitative description and measurement scale is limited to the P-probability and I-impact for variable cost, quality, time and the scope of the project. The integration of the project constraint variables found is usually a triple constraint which integrates the cost, quality and time variables. The accommodation of global issues in the safety aspects of the project then allows for the development of a diamond model that integrates the variables of cost, quality, time and safety. The development of a semi-quantitative risk analysis is limited by integrating the triple constraint variable where the diamond constraint variable has not been found. This is due to the unavailability of a semi-quantitative safety impact scale. This paper specifically formulates the impact of risk on the safety aspects in a semi-quantitative manner. A descriptive methodology was used for this research. The variance in the safety impact scale was identified from a literature review and the expert judgment method was analyzed through brainstorming with experts. The results of the analysis for the formulation of the safety risk impact scale model using the semi-quantitative method were obtained through the use of a hybrid formulation between the Project Management Body of Knowledge (PMBOK) guidelines and the Standard Australian / Standard New Zealand (AS / NZS) 4360 with a scale of 1 to 5 and a description of the impact starting from very low through to low, moderate, high and very high. It has numeric values of 0.05, 0.1, 0.2, 0.4 and 0.8 adopted from the PMBOK while the detailed descriptions were adopted from the AS / AZS 4360 guidelines. This obtained safety scale can be used in integrated risk analysis with semi-quantitative methods and a constraint diamond model with the variables of cost, quality, time and safety.

Process Safety Analysis of Hydrogen Fluoride Production Unit Based on HAZOP-LOPA

In order to improve the accuracy of the risk analysis of the hydrogen fluoride industrial production process, the HAZOP and LOAP methods were combined to conduct a semi-quantitative risk analysis of the rotary reactor in the hydrogen fluoride production unit to study the danger during the reaction. Firstly, HAZOP is used to analyze the possible consequences of the six deviations and propose corresponding safety measures. One hazardous scenarios is selected from the HAZOP analysis and LOPA analysis is performed. The LOPA calculation is used to compare the quantitative values with the risk tolerance values. By taking security measures to reduce the risk of dangerous scenarios that exceed the risk tolerance to an acceptable level. The results show that HAZOP-LOPA analysis can accurately identify potential safety hazards and improve the safety management level of enterprises.

Semiquantitative Risk Analysis.An EPSC Working Group

Semiquantitative Risk Analysis (SQRA) tools like e.g. LOPA were developed for the assessment of scenarios which have previously been identified with Process Hazard Analysis (PHA) tools like e.g. HAZOP. These SQRA tools represent a scenario as chain of events with barriers preventing the propagation of the chain of events towards the final accident. Orders of magnitude are used to express frequencies, failure rates and consequences.The risk acceptance criteria are a central element of each SQRA tool and are typically represented in a matrix having an axis for frequency and one for severity. These risk matrices are defined individually by each company as part of its SQRA tool.Though some countries have defined risk acceptance criteria for individual or societal risk as part of Quantitative Risk Analysis (QRA), there is no generally accepted standard for SQRA applied to single cause a single consequence scenarios. The focus of the working group was therefore a comparison of the risk matrices of the participating companies with their individual risk acceptance criteria and application rules. These application rules a e.g. the use of modifiers or the assumed frequencies for initial events a have a significant influence on the risk level obtained by use of a risk matrix.Key results of the discussion and comparison within the working group are:Risk acceptance criteria for 1 fatality as reference scenario differ only by one order of magnitudeCompanies using or not using modifiers are equally representedCriteria used for ALARP are similar for most companiesIn some cases differences in use of modifiers and risk acceptance criteria compensate resulting in a comparable risk levelApplication of company-specific risk matrices to an example case gave the same results for most participants, thus demonstrating that most risk matrices of working group members will arrive at a comparable risk levelWhile individual companies will often not share their risk matrix in public, the results of the working group can be shared, as the comparisons have been anonymized.The matrices discussed in this study were submitted by major European companies from the chemical and oil & gas industries. As these companies are the leaders in their industries, the study will be of interest to others to compare and assess their practice.

Semi-quantitative risk analysis of a normally unmanned installation facility

Risk assessments of industrial facilities, especially offshore oil and gas companies, are required to consider safety, environmental, financial, and company reputation risks. Risk assessments of normally unmanned installation (NUI) facilities usually do not accommodate personnel or employees. Therefore, a risk value cannot be applied when there is a plan to deploy personnel at an NUI. Hence, this study aimed to determine the inherent risk value when security personnel are deployed at an NUI. The NUI to be assessed has two types of platforms with different conditions. Risk values were obtained using a semi-quantitative risk analysis method by determining the likelihood and consequence criteria, whose values ranged from 1 to 5 according to the 5 times 5 risk-matrix scale used. The risk-assessment results demonstrate that NUI is at a “low risk” and is broadly acceptable.

Resilience engineering for socio-technical risk analysis: Application in neuro-surgery

Healthcare practitioners are generally forced to adapt their actions to cope with the complexity of daily conditions, taking advantage of their inherent potential for resilient performance. Following the principles of Resilience Engineering, this article details the application of the Functional Resonance Analysis Method (FRAM), for a semi-quantitative risk analysis of patient's pathway. The analysis adopts a holistic perspective on the complexity of everyday work in order to manage emergent behaviours, mainly related to iatrogenic disease associated with neuro-anesthesia treatment.Enhancing the traditional FRAM approach, the paper presents a structured systemic analysis for a case study in the neurosurgery peri‑operative patient's pathway. A multi-layer semi-quantitative framework is used as a basis for a novel decision support tool: the Variability Impact Matrix (VIM). The VIM aids to prioritize corrective measures and the need for functional performance indicators. A combination of social and technical perspectives is confirmed being necessary to cope with complex work environments, such as healthcare practices.