title: Clinical risk management in mental health: a qualitative study of main risks and related organizational management practices.
abstract: BACKGROUND
  A scientific understanding of clinical risk management (CRM) in mental health care is essential for building safer health systems and for improving patient safety. While evidence on patient safety and CRM in physical health care has increased, there is limited research on these issues in mental health care. This qualitative study provides an overview of the most important clinical risks in mental health and related organizational management practices.
  
  
  METHODS
  We conducted in-depth expert interviews with professionals responsible for CRM in psychiatric hospitals. Interviews were transcribed and analyzed applying qualitative content analysis to thematically sort the identified risks.
  
  
  RESULTS
  The main concerns for CRM in mental health are a) violence and self-destructive behavior (i.e. protecting patients and staff from other patients, and patients from themselves), b) treatment errors, especially in the process of therapy, and c) risks associated with mental illnesses (e.g. psychosis or depression). This study identified critical differences to CRM in hospitals for physical disorder and challenges specific to CRM in mental health. Firstly, many psychiatric patients do not believe that they are ill and are therefore in hospital against their will. Secondly, staff safety is a much more prominent theme for CRM in mental health care as it is directly related to the specifics of mental illnesses.
  
  
  CONCLUSIONS
  The current study contributes to the understanding of patient safety and raises awareness for CRM in mental health. The mental health specific overview of central risks and related organizational management practices offers a valuable basis for CRM development in mental health and an addition to CRM in general.
authors: ETH Zurich, Centre for Organizational and Occupational Sciences, Weinbergstrasse 56/58, 8092, Zurich, Switzerland. mbriner@ethz.ch
authors: Matthias
authors: M
authors: Briner
authors: Tanja
authors: T
authors: Manser
mesh_terms: D017144:Focus Groups; D006740:Hospital Administrators; D006778:Hospitals, Psychiatric; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D008603:Mental Health; D061214:Patient Safety; D036301:Qualitative Research; D018570:Risk Assessment; D017751:Safety Management / Q000458:organization & administration*
references: BMJ. 2000 Mar 18;320(7237):726-7
references: 10720336
references: Clin Med (Lond). 2002 Sep-Oct;2(5):452-7
references: 12448595
references: Australas Psychiatry. 2005 Mar;13(1):16-20
references: 15777407
references: BMC Health Serv Res. 2010 Dec 13;10:337
references: 21144039
references: Nervenarzt. 2001 Sep;72(9):693-9
references: 11572102
references: J Clin Psychol. 2006 Feb;62(2):171-84
references: 16342285
references: J Eval Clin Pract. 2013 Apr;19(2):363-9
references: 22409240
references: Jt Comm J Qual Patient Saf. 2005 Feb;31(2):106-13
references: 15791770
references: J Psychiatr Ment Health Nurs. 2006 Apr;13(2):197-204
references: 16608475
references: Clin Chem Lab Med. 2006;44(6):694-8
references: 16729855
references: Acta Psychiatr Scand Suppl. 2002;(412):103-5
references: 12072138
references: Qual Saf Health Care. 2004 Apr;13(2):121-6
references: 15069219
references: J Patient Saf. 2011 Mar;7(1):39-44
references: 21921866
references: Psychiatr Q. 2010 Sep;81(3):197-205
references: 20204514
references: JAMA. 2005 May 18;293(19):2384-90
references: 15900009
references: Br J Psychiatry. 2006 Dec;189:520-6
references: 17139036