Managing clinical risk retrospectively and prospectively with a risk management framework in an acute care hospital in Singapore

Objective: To expound on the implementation of the clinical risk management framework in an acute care hospital to minimise clinical risks and improve patient safety on account of systemic and human risk factors and patterns.Methods: The clinical risk management framework involves a 2-pronged approach through retrospective and prospective methods. The 5 stages of the retrospective approach include data collection, data aggregation, risk assessment and prioritisation, risk mitigation, and lastly, risk monitoring. The prospective approach entails horizon scanning which aims to detect risks early and ensure controls are swiftly implemented to prevent harm from arising. When combined, the framework seeks to be responsive to reduce the possibility and severity of patient harm. The number of incidents and risk scores for top clinical risks from 2016 to 2019 were monitored and studied to assess the effectiveness of the newly implemented clinical risk management framework.Results: When the clinical risk management framework was implemented in 2017, the number of incidents as well as corresponding risk scores for many of the identified clinical incident types and root causes decreased over the years. Most notably, two top clinical risks, results not being reviewed or delayed, and staff inadequate skills and knowledge, saw major improvements in risk scores.Conclusions: The systematic workflow of the 2-pronged clinical risk management framework allows the campus to manage risks comprehensively and efficiently. While retrospective risk analysis examines and reacts to reported clinical incidents, amidst volatile circumstances and advancements of technology exposing unprecedented risks in healthcare, prospective risk analysis conducted through horizon scanning is useful in anticipating and acting before harm arises, ultimately resulting in improved patient safety.