Comparative Analyses on Methods and Tools for Medical Risk Management and Assessment in the United Kingdom, the United States, Canada, Australia and Taiwan Region_Chinese Journal of Evidence-Based Medicine

Authors：

CHENG Lan ¹ , SUN Niuyun ² , WANG Li ¹ , LIANG Minghui ² ,  LI Youping ¹ , YUAN Qiang ¹ , CUI Xiaohua ¹ , LI Xiao ¹

1. Chinese Evidence-Based Medicine Center, West China Hospital, Sichuan University, Chengdu 610041, China2. Clinical Safety and Risk Management Center, National Institute of Hospital Administration, Beijing 100083, China;

Corresponding author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Medical risk; Risk management; Risk assessment

DOI：

10.7507/1672-2531.20110209

Video：

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Objective 　To comprehensively compare the methods and tools for medical risk management and assessment in the United Kingdom, the United States, Canada, Australia and Taiwan region (hereafter shortened as “four countries and one region”), so as to provide evidence and recommendations for medical risk management policy in China.
Methods 　The official websites of the healthcare risk management agencies in these four countries and one region were searched to collect materials concerning healthcare risk management and monitoring, such as laws, regulatory documents, research reports, reviews and evaluation forms, then the descriptive comparative analysis was performed on the methods and tools for risk management.
Results　 a) A total of 146 documents were included in this study, including 2 laws, 17 regulatory documents, 41 guidelines, 37 reviews and 49 documents about general information; b) The United Kingdom applied the integrated risk management; Australia and Taiwan adopted the classical risk management process, including risk identification, risk analysis, risk evaluation and risk control, while the United States and Canada mainly chose the prospective failure mode and effects analysis (FMEA) for clinical risk management; c) The severity of clinical risk was divided into five grades in the United Kingdom and Australia, and six in Taiwan, respectively. The frequency of medical risk was divided into five grades with four grade responses in above two countries and one region; and d) There were almost the same processes and tools about Root Cause Analysis (RCA), but a little difference in the objects of analysis in these four countries and one region.
Conclusion ?There are three models of risk management with the same assessment tools in these four countries and one region: the prospective risk assessment, the retrospective assessment based on occurred incidents and the integrated risk management. Although the grading of risk is similar, the definition of grading is different in the United Kingdom, Australia and Taiwan. The methods and processes of analyses on the adverse events are almost the same in these four countries and one region.

Citation： CHENG Lan,SUN Niuyun,WANG Li,LIANG Minghui,LI Youping,YUAN Qiang,CUI Xiaohua,LI Xiao. Comparative Analyses on Methods and Tools for Medical Risk Management and Assessment in the United Kingdom, the United States, Canada, Australia and Taiwan Region. Chinese Journal of Evidence-Based Medicine, 2011, 11(11): 1240-1246. doi: 10.7507/1672-2531.20110209 Copy

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5.	Department of Health. Government of West Australia. Clinical Risk Management Guidelines for the Western Australian Health System. [2010-10-5]Available from: URL: http://www.safetyandquality.health.wa.gov.au/docs/clinical_risk_man/Clinical_risk_man_guidelines_wa.pdf.
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15.	NPSA. Reducing Venous Thromboembolism Root Cause Analysis Tools (25 November 2010) [2010-12-22] Available from: URL: http://www.nrls.npsa.nhs.uk/ resources/?entryid45=75355.
16.	Lawrence Faltz, John Morley, Ellen Flink. The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures. [2010-12-24] Available from: URL:http://www.ahrq.gov/downloads/ pub/advances2/ vol1/Advances-Faltz_56.pdf.
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19.	刘碧瑶, 沈毅. “失效模式和效果分析”降低医院医疗风险的研究进展. 国外医学（卫生经济学分册）, 2005, 22(2): 73-77.
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22.	罗云, 樊延晓, 马晓春, 编著. 风险分析与安全评价. 北京: 化学工业出版社, 2004: 100-109, 158, 178-179.

1. 1 Sun NY, Wang L, Zhou J, et al . International comparative analyses of healthcare risk management. Journal of Evidence-Based Medicine , 2011, 4(1): 22-31.
2. 22 Duwe B, Fuchs BD, Hansen-Flaschen J. Failure mode and effects analysis application to critical care medicine. Crit Care Clin , 2005, 21(1): 21-30.
3. NPSA. Healthcare risk assessment made easy. [2010-10-22]. Available from: URL: http://www.nrls.npsa.nhs.uk/resources/collections/root-cause-analysis/.
4. ACT Insurance Authority. Guide to risk management. [2010-10-4] Available from: URL: http://www.treasury.act.gov.au/actia.
5. Department of Health. Government of West Australia. Clinical Risk Management Guidelines for the Western Australian Health System. [2010-10-5]Available from: URL: http://www.safetyandquality.health.wa.gov.au/docs/clinical_risk_man/Clinical_risk_man_guidelines_wa.pdf.
6. HHS. Office of inspector general. Risk management at health centers. [2010-11-3] Available from: URL: http://oig.hhs.gov/oei/reports/oei-01-03-00050.pdf.
7. HHS. Guidance on risk analysis requirements under the hipaa security rule.[2010-12-5] Available from: URL: http://www.hhs.gov/ocr/privacy/hipaa/administrative/ securityrule/ securityrulepdf.pdf.
8. ISMP Canada. Failure Modes and Failure Modes and Effects Analysis. [2010-10-15]Available from: URL:http://www.ismp-canada.org/download/ISMP_Canada_FMEA_presentation.pdf.
9. ISMP. Canadian Failure Mode and Effects Analysis Framework. [2010-10-15] Available from: URL: http://www.ismp-canada.org/fmea.htm.
10. NPSA. A risk matrix for risk managers. [2010-12-24] Available from: URL: http://www.npsa.nhs.uk/nrls/improvingpatientsafety/patient-safety-tools-and-guidance/risk-assessment-guides/risk-matrix-for-risk-managers/?locale=en.
11. West Austrlia Department of Health. Clinical risk analysis tables and evaluation criteria. [2010-12-25] www.safetyandquality.health.wa.gov.au/ clinical_risk/Clinical_Risk_Analysis_Tables_Evaluation_Criteria.pdf.
12. 台湾行政院卫生署.根本原因分析法学员版手册. [2010-10-6] Available from: URL: http://60.248.196.52/FrontStage/page.aspx?ID=5BAB09FB-BD56-403F-990A-E5CCDAFB2198.
13. The NPSA. Seven steps to patient safety. The full reference guide.[2010-5-12] Available from: URL: http://www.nrls.npsa.nhs.uk/resources/collections/ seven-steps-to-patient-safety/.
14. NPSA. Glossary - Root Cause Analysis.[2010-12-22] Available from: URL: Http://its-services.org.uk/npsa-guide-to-root-cause-analysis-glossary.doc.
15. NPSA. Reducing Venous Thromboembolism Root Cause Analysis Tools (25 November 2010) [2010-12-22] Available from: URL: http://www.nrls.npsa.nhs.uk/ resources/?entryid45=75355.
16. Lawrence Faltz, John Morley, Ellen Flink. The New York Model: Root Cause Analysis Driving Patient Safety Initiative to Ensure Correct Surgical and Invasive Procedures. [2010-12-24] Available from: URL:http://www.ahrq.gov/downloads/ pub/advances2/ vol1/Advances-Faltz_56.pdf.
17. Canadian Patient Safety Institute. Canadian root cause analysis framework. A tool for identifying and addressing the root causes of critical incidents in healthcar[2010-12-24] http://www.patientsafetyinstitute.ca/English/ toolsResources/rca/Documents/March%202006%20RCA%20Workbook.pdf.
18. Julie Greenall and David U. Root Cause Analysis: A patient safety tool. [2010-12-24] Available from: URL:http://www.ismp-canada.org/download/hnews/HNews0512.pdf.
19. 刘碧瑶, 沈毅. “失效模式和效果分析”降低医院医疗风险的研究进展. 国外医学（卫生经济学分册）, 2005, 22(2): 73-77.
20. American Hospital Association. Strategies and Tips for Maximizing Failure Mode Effect Analysis in Your Organization. [2010-7-16] Available from: URL: www. ASHRM.org.
21. NPSA. Risk assessment programme overview. November 2006. [2010-12-25] Available from: URL:www.npsa.nhs.uk.
22. 罗云, 樊延晓, 马晓春, 编著. 风险分析与安全评价. 北京: 化学工业出版社, 2004: 100-109, 158, 178-179.

Chinese Journal of Evidence-Based Medicine

Comparative Analyses on Methods and Tools for Medical Risk Management and Assessment in the United Kingdom, the United States, Canada, Australia and Taiwan Region

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