Objective To compare administration of incidence reporting systems for healthcare risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, and to provide evidence and recommendations for healthcare risk management policy in China. Methods We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews, and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. Results (1) A total of 142 documents were included in this study. The United States had the most relevant documents (68). (2) The type of incidents from reporting systems has expanded from medication errors and hospital-acquired infections to near-misses, and now includes all patient safety incidents. (3) The incidence-reporting systems can be grouped into two models: government-led and legal/regulatory/NGO-collaborative. (4) In two cases, reporting systems were established for specific incident types: One for death or serious injury events (the sentinel events database in Britain, SIRL), and one for healthcare-associated infections (NHSN in America). (5) Compared to the four countries, Taiwan’s system put more emphasis on public welfare, confidentiality, and information sharing. The contents of reporting there covered every aspect of risk management to create a more secure environment. Conclusion (1) Britain’s national reporting and learning system was representative of a government-led model; (2) The United States was the earliest country to have a reporting system, which included a limited range of incident types. Management of incidents became more reliable with increased application of laws, regulations, and guidances; (3) Both the Canadian and the Australian systems drew from the American experience and are still developing; (4) The Taiwanese system was comprehensive and is an instructional case.
This article introduced the structure and features of the medical safety and quality management system of New South Wales (NSW) of Australia. The system was funded by government with overall design, multi-sectors involvement, and explicit roles of government, hospitals, and independent third parties. The system also developed national and state-wide regulations, policies, standards and their certification. The NSW Health Incident Information Management System (IIMS), the guidelines and interventional programs were also established to decrease the medical risk and ensure the healthcare quality. This system will be used for reference to the national medical risk and quality management system of China.
Objective Healthcare risk has become a popular topic in medical research field all over the world. With the increasing of healthcare safety adverse events and medical conflict cases every year, publications about this topic have been rapidly increased in China, but research on the essentials and categories of healthcare risk are still lacked. This paper aims to summarize the essentials and categories of healthcare risk research systematically through analyzing domestic studies in healthcare risk over the past decade, so as to provide decision-making evidences and policy suggenstions on healthcare risk management in China. Methods We searched the China Academic Journal Network Publishing Database of CNKI (1999-2010), in which those papers’ title containing the phrase of healthcare risk had been brought into our research, then we summerized the domestic concepts and contents in healthcare risk by essential analysis and frequency statistics. Results 255 papers were included, including 26 Class B papers (accounting for 10.20%), six Class C papers (accounting for 2.35%) and 223 Class D papers (accounting for 87.45%); but there were only 79 papers (accounting for 35.11% ) which had a clear definition of healthcare risk. From these papers, we found the essentials of healthcare risk included object, consequences, process and causes, and the research category of healthcare risk included prevention and treatment of risk, causes and effects of factors, risk sharing mechanisms, healthcare risk of special diseases, concept and characteristics, education and training, management method, risks of medical appliances, the species and object of healthcare risk, the category of healthcare risk, the research methods of healthcare risk etc. Conclusion At present, the study of healthcare risk focuses on the risk control and how to release risks from the results, besides, systematic studies are lacked, and the unified definition of healthcare risk has not been formed, Therefore, we recommend that systematic study of the healthcare risks should be strengthened, the definition of healthcare risk should be unified, and the early warning, monitoring, evaluating, and identifying methods should be positively developed, providing decision-making evidences to establish healthcare risk management system in China.
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.
Objective To provide information for the establishment of a medical risk monitoring and precaution system in China, by reviewing and analyzing the current status of medical risk management system and preventative measures in New Zealand, Methods We searched EI (1969-2006), SCI and SSCI (1975-2006), EMBASE (1966-2006), SCOPUS (included 100% MEDLINE) (1960-2006), VIP (1989-2006), CNKI (1979-2006) and relevant official and governmental websites. This search was conducted in January 2006 and articles about medical risk management and prevention were collected. Results We included 10 articles involving medical adverse events, patient safety and medical litigation. New Zealand took many measures in order to prevent medical error and improve medical quality, including strengthening medical practice standards, doctor-patient communication, safety awareness and promoting informationization of hospitals. New Zealand also revised “The Health Practitioners Competence Assurance Act” and improved medical litigation to form an appropriate law environment. Conclusions New Zealand has taken many measures and established a medical risk management system to prevent medical risk. Some issues of particular relevance to China include building corresponding medical litigation and relevant laws and regulations.
Objective To analyze experiences of medical risk management in the United Kingdom so as to explore the possible application for the construction of a Chinese medical risk monitoring and early warning system. Methods We searched Engineering Information, SCI and SSCI, EMBASE, SCOPUS with 100% MEDLINE, VIP, CNKI, and government or official websites. This search was conducted in Jan. 2006. We included articles about medical risk, patient safety and medical errors in the UK. Languages of articles were limited either in English or in Chinese. Results Eleven articles were included, of which 9 article are evidence of level B (about 80%) and the other 2 are evidence of level C (about 20%). The report of “An Organization with a Memory” revealed the severity of medical errors and adverse events in the UK in 2000, and subsequently Minister Blair announced a five-year reform program for NHS. Within 7 years of reform, NHS budget has been increased from £33 billion to £674 billion,(check numbers-doesn’t sound correct) the National Patient Safety Agency (NPSA) and the New National System for learning from adverse events and near misses have been established, a series of practicable measures aimed at ensuring patient safety, preventing medical risk and improving healthcare quality have been implemented, all of which have effectively resolved many problems that perplexed the government and public, such as patients waiting time, range of NHS service, the availability of medical facility and mortality induced by high-risk diseases. Conclusion There are both advantages and disadvantages in the present status of the UK medical risk management. Both of them will provide a guide to prevent medical risk, improve healthcare quality and to realize the ultimate goal that everybody could share healthcare sources fairly and safely in our country.
Objective To evaluate evidence from American medical risk monitoring and precaution system (AMRMPS) which may affect the construction of Chinese medical risk monitoring and precaution system (CMRMPS). Methods We searched relevant databases and Internet resources to identify literature on AMRMPS, medical errors, and patient safety. We used the quality evaluation system for medical risk management literature to extract and evaluate data. Results In 1999, a report from the Institute of Medicine (IOM) not only showed the severity and cause of medical errors in America but also gave the solution of it. In 2000, the Quality Interagency Coordination Task Force (QuIC) was appointed to assess the IOM report and take specific steps to improve AMRMPS. After 5 years, a well-developed medical risk management system was established with the improvement in the public awareness of medical errors, patient safety, performance criteria of medical safety, information technology and error reporting system. There was still some weakness of this system in risk precaution and prevention. Conclusion The experience from AMRMPS can be used to establish the CMRMPS. Firstly, we should disseminate and strengthen the awareness of medical risk and patient safety in public. Secondly, we should establish hospital audit system which includes auditing of medical staff and course of medical risk in continuing and academic education. Thirdly, we should develop regulations and guidelines on health care, medical purchase and drug supply which will benefit in management of regular work. Fourthly, we should develop computer information system for hospital which will regulate the management without the disturbance from human. Lastly, we should emphasize outcome evaluations and strive for perfection during the process.