The Joint Commission Journal on Quality and Patient Safety (JQPS) published a study that suggests that reactive risk assessments (RRAs) and proactive risk assessments (PRAs) complement one another and proposes combined proactive risk assessment (CPRA) as an innovative, approachable, scalable, and generalizable technique for identifying vulnerable points in healthcare processes. 

The study “Combined Proactive Risk Assessment: An Approachable Method for Unifying Proactive and Reactive Risk Assessment Techniques in Healthcare” was published in the Joint Commission’s June/July 2022 issue.

Healthcare facilities aim for zero avoidable patient harm. Toward that aim, healthcare organizations continuously identify, assess, and remediate sources of risk. RRAs such as incident reporting and root causes analysis and proactive risk assessments PRAs like failure mode and effects analysis are tools to reduce risk; however, they are generally conducted independently. 

CPRA aligns patient safety reporting data with process steps and failure modes to assess risk. The study used PRAs from several Veterans Health Administration (VHA) facilities and national patient safety data from the VHA National Center for Patient Safety’s database related to outpatient blood draws to develop a comprehensive process flow diagram and list of potential failure modes. 

Aggregating PRAs from multiple facilities identified 220% more failure modes and integrating incident reports into PRA identified 310% more failure modes than the single facility average. Overlaying safety reports onto a comprehensive process flow diagram revealed 86% of events occurred during three of seven process steps. Accuracy of this technique was generally above 85%. 

The study shows that CPRA is promising for increasing the return on investment of safety reporting systems, monitoring risk within key healthcare processes, and proactively directing safety and quality improvement resources based on real data. 

“Bender et al. took a different approach, aggregating all IRs related to a specific healthcare process and categorizing them to create concept sheets,” says an accompanying editorial by Gregory Hagley, PT, DPT, MAS. “This allows all IRs – even descriptions of near misses – to be used to mitigate risks for future patients.”