Open Access Highly Accessed Research article

Assessing hospitals' clinical risk management: Development of a monitoring instrument

Matthias Briner12*, Oliver Kessler2, Yvonne Pfeiffer1, Theo Wehner1 and Tanja Manser3

  • * Corresponding author: Matthias Briner

  • † Equal contributors

Author Affiliations

1 ETH Zurich, Center for Organizational and Occupational Sciences, Kreuzplatz 5, 8032 Zurich, Switzerland

2 Lucerne University of Applied Sciences and Arts, Lucerne School of Business, Zentralstrasse 9, 6002 Lucerne, Switzerland

3 University of Fribourg, Department of Psychology, Rue P.-A. de Faucigny 2, 1700 Fribourg, Switzerland

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BMC Health Services Research 2010, 10:337  doi:10.1186/1472-6963-10-337

Published: 13 December 2010



Clinical risk management (CRM) plays a crucial role in enabling hospitals to identify, contain, and manage risks related to patient safety. So far, no instruments are available to measure and monitor the level of implementation of CRM. Therefore, our objective was to develop an instrument for assessing CRM in hospitals.


The instrument was developed based on a literature review, which identified key elements of CRM. These elements were then discussed with a panel of patient safety experts. A theoretical model was used to describe the level to which CRM elements have been implemented within the organization. Interviews with CRM practitioners and a pilot evaluation were conducted to revise the instrument. The first nationwide application of the instrument (138 participating Swiss hospitals) was complemented by in-depth interviews with 25 CRM practitioners in selected hospitals, for validation purposes.


The monitoring instrument consists of 28 main questions organized in three sections: 1) Implementation and organizational integration of CRM, 2) Strategic objectives and operational implementation of CRM at hospital level, and 3) Overview of CRM in different services. The instrument is available in four languages (English, German, French, and Italian). It allows hospitals to gather comprehensive and systematic data on their CRM practice and to identify areas for further improvement.


We have developed an instrument for assessing development stages of CRM in hospitals that should be feasible for a continuous monitoring of developments in this important area of patient safety.