189-1110 / Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers

GOP Information
Organisation sharing the GOP
Related practices from PaSQ database
University Hospital Graz


Clinical risk management
Professional learning program on quality and safety
Implementation of Patient Safety initiatives / Activities
Education in Patient Safety
GOP Description
Implementation level
Clinical settings
Clinical Risk Management was implemented within the entire organisation.
It was foreseen that within a large university hospital, clinical risk managers will be educated to identify in a bottom-up approach the most prominent hazards within health care. Furthermore, clinical risk will then be reduced by implementing certain patient safety tools.
The target population had been health care professionals and administrative employees to create an even safer environment.
“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.”

Text derived from http://link.springer.com/article/10.1007/s00508-014-0620-7

Timeframe implementation
The project started in 2010 and lasted till Nov-2014
Implementation tools available
Tools have been:
1)Corporate governance adaption
2)Risk management (RM) training
3)CRM process designing
4)Information by implementing comprehensive information and communication procedures
5)Involvement through implementing a critical incident reporting system and facilitating the cooperation with educated clinical risk managers
Implementation cost
For 158 trained clinical risk managers direct costs have been appr. € 400.000
Method used to measure the results
Identified risks were grouped by type of top risks. For each top risk appropriate measures were identified and implemented.
“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.”

Text derived from http://link.springer.com/article/10.1007/s00508-014-0620-7

Analysis of the results
For the future we work on reducing identified risks. Furthermore, we produced a patient empowerment movie where most of our findings, results and implemented tools are presented.


Implementation barriers
Did you find implementation barriers?
Please describe implementation barriers
To implement a new project hospital wide is a challenge as our university hospital has more than 7.000 employees and more than 1.500 beds. We care for appr. 90.000 inpatients and 400.000 outpatients per year.
The implementation of clinical risk managers and alongside with them new tools during daily routine is the challenge, however, we were best supported by our top-management.
Describe the strategies used to overcome the barriers (If needed)
To oovercome barriers we identified people who are interested in patient safety and we faclitated a mixture of a top-down approach combined with bottom-up procedures.
Other information
Other information about the GOP that you would like to add (Link or attached document)
To enhance the so called “patient safety culture” time is needed.