ORIGINAL ARTICLE

Assessing patient safety risk before the injury occurs: an introduction to sociotechnical probabilistic risk modelling in health care

D A Marx¹ and A D Slonim²

¹ President, Outcome Engineering LLC, Dallas, TX, USA
² Children’s National Medical Center, The George Washington University School of Medicine, Washington, DC, USA

Correspondence to:
Correspondence to:
Mr D A Marx
President, Outcome Engineering LLC, Dallas, TX, USA; dmarx{at}outcome-eng.com

Since 1 July 2001 the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has required each accredited hospital to conduct at least one proactive risk assessment annually. Failure modes and effects analysis (FMEA) was recommended as one tool for conducting this task. This paper examines the limitations of FMEA and introduces a second tool used by the aviation and nuclear industries to examine low frequency, high impact events in complex systems. The adapted tool, known as sociotechnical probabilistic risk assessment (ST-PRA), provides an alternative for proactively identifying, prioritizing, and mitigating patient safety risk. The uniqueness of ST-PRA is its ability to model combinations of equipment failures, human error, at risk behavioral norms, and recovery opportunities through the use of fault trees. While ST-PRA is a complex, high end risk modelling tool, it provides an opportunity to visualize system risk in a manner that is not possible through FMEA.

Keywords: patient safety; sociotechnical probabilistic risk assessment (ST-PRA); root cause analysis; quality improvement; risk management

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Runciman, W., Hibbert, P., Thomson, R., Van Der Schaaf, T., Sherman, H., Lewalle, P. (2009). Towards an International Classification for Patient Safety: key concepts and terms. Int J Qual Health Care 21: 18-26 [Abstract] [Full Text]  
• Hofoss, D., Deilkas, E. (2008). Roadmap for patient safety research: approaches and roadforks. Scand J Public Health 36: 812-817 [Abstract]  
• Koppel, R., Wetterneck, T., Telles, J. L., Karsh, B.-T. (2008). Workarounds to Barcode Medication Administration Systems: Their Occurrences, Causes, and Threats to Patient Safety. J. Am. Med. Inform. Assoc. 15: 408-423 [Abstract] [Full Text]  
• Brown, C, Hofer, T, Johal, A, Thomson, R, Nicholl, J, Franklin, B D, Lilford, R J (2008). An epistemology of patient safety research: a framework for study design and interpretation. Part 1. Conceptualising and developing interventions. Qual Saf Health Care 17: 158-162 [Abstract] [Full Text]  
• Lau, D. T., Scandrett, K. G., Jarzebowski, M., Holman, K., Emanuel, L. (2007). Health-Related Safety: A Framework to Address Barriers to Aging in Place. Gerontologist 47: 830-837 [Abstract] [Full Text]  
• Runciman, W B, Williamson, J A H, Deakin, A, Benveniste, K A, Bannon, K, Hibbert, P D (2006). An integrated framework for safety, quality and risk management: an information and incident management system based on a universal patient safety classification. Qual Saf Health Care 15: i82-i90 [Abstract] [Full Text]  
• Bonnabry, P, Cingria, L, Sadeghipour, F, Ing, H, Fonzo-Christe, C, Pfister, R E (2005). Use of a systematic risk analysis method to improve safety in the production of paediatric parenteral nutrition solutions. Qual Saf Health Care 14: 93-98 [Abstract] [Full Text]