title: Clinical risk management in hospitals: strategy, central coordination and dialogue as key enablers.
abstract: OBJECTIVE
  The study aims to identify key enablers fostering clinical risk management (CRM) in hospitals to guide health care in this vital area of patient safety.
  
  
  METHODS
  A cross-sectional survey was conducted at the national level in 324 Swiss hospitals in 2007-2008 to assess the relationship between key elements and systematic CRM. Therefore, a comprehensive monitoring instrument for CRM was used for the first time. Organizational factors (e.g. strategy, coordination, resources) and structural conditions (e.g. hospital size) were tested as key elements. CRM was assessed by evaluating its maturity (i.e. the level of CRM development) by 12 theoretically derived indices joining together essential aspects of CRM at the hospital level and the service level. Chi-square measures were used to analyse the relationships between organizational factors or structural conditions and maturity of CRM.
  
  
  RESULTS
  Participation in this voluntary survey was good, with CRM experts of 138 out of 324 hospitals responding (response rate 43%). Three key enablers for CRM were identified: implementing a function for central CRM coordination, assuring dialogue with and between the different hospital services, and developing strategic CRM objectives.
  
  
  CONCLUSIONS
  This study offers, for the first time, an assessment of the maturity of hospitals' CRM and identifies key enablers related to CRM. This is a feasible first step in guiding hospitals to shape their CRM and presents a basis for future studies, for example, linking CRM to outcome data.
authors.affiliation: ETH Zurich, Center for Organizational and Occupational Sciences, Zurich, Switzerland. mbriner@ethz.ch
authors.forename: Matthias
authors.initials: M
authors.lastname: Briner
authors.forename: Tanja
authors.initials: T
authors.lastname: Manser
authors.forename: Oliver
authors.initials: O
authors.lastname: Kessler
mesh_terms: D003430:Cross-Sectional Studies; D006302:Health Services Research; D006761:Hospitals; D006801:Humans; D061214:Patient Safety; D012308:Risk Management / Q000458:organization & administration*; D013557:Switzerland