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

Systematische Einführung vom Klinischen Risikomanagement in einem Universitätsklinikum: Bedeutung von Risikomanagern

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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.

Zusammenfassung

Ziel

Das Thema Patientensicherheit hat in den letzten Jahren im Gesundheitswesen zunehmend an Bedeutung gewonnen. Nationale und internationale Strategien wurden entwickelt, um die häufigsten Risiken, die während des Behandlungsprozesses auftreten können, bestmöglich zu vermeiden. In diesem Kontext nimmt das Klinische Risikomanagement (KR) eine wichtige Rolle ein, um Risiken zu identifizieren, zu analysieren und zu bearbeiten. Die Implementierung des KR in bestehende Routineprozesse innerhalb eines komplex organisierten Krankenhauses ist jedoch eine Herausforderung, da organisatorische Veränderungen mit einem Top-down Ansatz in der Vergangenheit oft nicht funktionierten. Unser Ziel war es daher, eine gewisse Anzahl an Risikomanagern auszubilden, um das Thema KR im Bottom-up Ansatz aufzubauen.

Methodik

Um das primäre Ziel der Implementierung des KR zu erreichen, wurden fünf Stoßrichtungen entwickelt und konsequent verfolgt: Unternehmensführung, Risikomanagement-Training, Prozess KR, Information und Beteiligung. Einen großen Anteil am Prozess KR nahm die Ausbildung von Risikomanagern in jeder Organisationseinheit ein. Die Größe des Krankenhauses berücksichtigend, war die Ausbildung von zumindest 1 % der Mitarbeiter im KR vorgesehen, um das Thema wie auch die Verbesserungsmaßnahmen in Bezug auf Qualität und Sicherheit angemessen zu verbreiten. Gemäß Roll-out-Plan wurde das KR in jeder Organisationseinheit eingeführt und Risiken wurden identifiziert.

Ergebnisse

Neben Änderungen in der Unternehmensführung wurde ein krankenhausweiter KR-Prozess mit insgesamt 158 ausgebildeten Risikomanagern eingeführt, dies entspricht 2,0 % der Mitarbeiter. Risikomanager sind auf allen Organisationseinheiten vorhanden und identifizierten insgesamt 360 operative Risiken. Davon wurden 176 Risiken als strategische Risiken bewertet und zu Top-Risiken gruppiert. Zusätzlich wurden neue Meeting-Strukturen und Möglichkeiten zum Informationsaustausch eingeführt. Bislang wurden 31 Organisationseinheiten im KR extern auditiert.

Schlussfolgerung

Der eingeführte KR-Prozess ist einzigartig in seiner Ausprägung, Mitarbeiter aus allen Berufsgruppen wurden ausgebildet und identifizierten potentielle Risiken. Ein Netzwerk von Risikomanagern unterstützt den zentral gesteuerten KR-Prozess. Die kollegiale Führung, die Medizinische Universität, die Mitarbeiter der Kliniken und das Management unterstützen das KR. Im Krankenhaus führte der KR-Prozess zu spürbaren Veränderungen hinsichtlich der Patientensicherheitskultur. In den kommenden Jahren konzentrieren wir uns darauf, die Mitarbeiter auch weiterhin im KR einzubinden, um nationale und internationale Patientensicherheitsinitiativen umzusetzen.

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Authors and Affiliations

  1. Department of Quality and Risk Management, University Hospital Graz, Auenbruggerplatz 1, 8036, Graz, Styria, Austria

    Gerald Sendlhofer PhD, Karina Leitgeb MSc & Brigitte Kober BA, MA

  2. Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Styria, Austria

    Gerald Sendlhofer PhD & Lars Peter Kamolz MD, MSc

  3. University Hospital Graz, Graz, Styria, Austria

    Gernot Brunner MD, PhD, Christa Tax MSc & Gebhard Falzberger MSc

  4. Institute for Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Styria, Austria

    Josef Smolle MD, PhD

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  1. Gerald Sendlhofer PhD
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Correspondence to Gerald Sendlhofer PhD.

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Sendlhofer, G., Brunner, G., Tax, C. et al. Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers. Wien Klin Wochenschr 127, 1–11 (2015). https://doi.org/10.1007/s00508-014-0620-7

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