Patient safety is an important aspect of the quality of care in hospitals. Patient safety can be defined as the reduction of the risk of unnecessary harm associated with healthcare to an acceptable minimum
. Previous studies have shown that between 2.9% and 16.6% of hospital admissions lead to adverse events
, of which approximately 50% are potentially preventable
. Adverse events can be defined as harm to patients that was not caused by the underlying disease but by medical management, leading to prolonged hospitalization, re-hospitalization, disability or death
. In order to reduce the number of adverse events, safety management systems have been set up in healthcare institutions
[4–6]. Safety management systems aim to prevent undesired outcomes in healthcare by a combination of activities, such as improvement projects, incident reporting and analyses, and risk assessments to identify and assess safety risks in the organizational processes
Risk assessments can be performed retrospectively or prospectively. To date, retrospective risk management has been most common in healthcare
. Several methods for retrospective risk assessments in healthcare are currently used; the key element in all these methods is the analysis of the causes of incidents, near-misses and unsafe situations in order to prevent them from happening again in the future. Examples of these methods are the Prevention and Recovery Information System for Monitoring and Analysis (PRISMA) and Root Cause Analysis (RCA)
[7, 8]. These methods have two disadvantages. First, they require an open incident reporting culture since they rely on reporting by healthcare staff. Second, the analysis can only take place after an unsafe situation has been revealed, with or without consequences
. It therefore makes sense to analyze risks in a prospective manner, complementary to retrospective methods, to prevent unsafe environments that could potentially lead to adverse events
In prospective risk analysis, processes are analyzed for potential risks in order to prevent errors from happening in the first place. Some well-known methods are the Healthcare Failure Mode (HFMEA) and Bow-Tie
[9–13]. Both methods focus on analysis of care processes, and are often organized around a specific disease and therefore bound to one particular medical specialty. In these methods, a group of professionals meets several times to systematically map out the care process that was chosen for the risk analysis. The potential risks and their consequences are determined, and ways of preventing these situations are considered. Although these methods can create awareness about potential risks, they are time-consuming and only focus on one care process at a time.
A complementary method to existing prospective risk analysis methods is Tripod, which takes account of the key organizational processes. Tripod measures latent risk factors categorized into what are termed Basic Risk Factors (BRFs) at the departmental level by means of staff questionnaires. Latent risk factors are risk factors that are present within departments but are not always clearly visible. Tripod uses the individual risk perception of staff to determine the BRFs for an individual department. BRFs are used to determine potential risks in five general organizational domains: Procedures, Training, Communication, Incompatible Goals, and Organization. The method has its origins in the petrochemical sector
[14–16] but could also be applied in the healthcare setting
. Tripod has the potential to be broader and less time-consuming than existing methods. The method can be used as a starting point to obtain a broad picture of the level of control over the organizational processes at the departmental level, and the results allow prioritization of further in-depth prospective risk analyses. The purpose of this study is to investigate whether Tripod is appropriate as a method for prospective risk analysis within hospital departments. This study is based on the adjusted Tripod for prospective risk analysis in healthcare, known as Tripod Delta HC. We will discuss the changes to Tripod to create Tripod Delta HC in more detail in the Methods section. The research questions addressed in this study are:
Can Tripod Delta HC be used as a measurement instrument for prospective risk analysis in hospitals?
Can Tripod Delta HC be used to assess differences in latent risk factors between hospital departments?