title: A risk analysis of cancer care in Norway: the top 16 patient safety hazards.
abstract: BACKGROUND
  Cancer care processes represents a number of potential threats to patient safety. A national risk analysis of Norwegian cancer care, entailing diagnosis, treatment, follow-up, palliative care, and terminal care, was conducted.
  
  
  METHODS
  Literature review and a retrospective analysis of hazards in different national databases were combined with interviews with key health personnel in an attempt to identify 50 possible hazards. A project team from the Norwegian Board of Health Supervision (NBHS) and 23 other persons participated in the workshop in 2009.
  
  
  RESULTS
  In a stepwise, consensus-driven process, the 23 participants discussed the 50 possible hazards and then selected the 16 that they considered most important-clustered into three groups: diagnosis and primary treatment, interactions, and complications. The NBHS distributed the risk analysis report to a variety of stakeholders and asked Norway's hospital trusts to address the hazards. The report generally met a positive reception, albeit with local and interdisciplinary differences in the extent of the perceived applicability of the respective hazards. Two follow-up studies in 2012 and 2013 showed that the hospital trusts lacked the implementation capacity to identify operational solutions to reduce the hazards. At the largest hospital trust in Norway-Oslo University Hospital-the Department of Oncology retested the national risk analysis in in 2011. Four groups, representing different parts of the patient care process. selected 9 of the 16 national hazards and identified 4 new ones. The department has established goals and appropriate activities for 3 of the hazards.
  
  
  CONCLUSIONS
  The Ministry of Health and Care determined that hospital trusts must increase their implementation capacity regarding operational solutions to reduce the hazards.
authors.affiliation: Department of Oncology, Akershus University Hospital, Lørenskog, Norway. einh@ahus.no
authors.forename: Einar
authors.initials: E
authors.lastname: Hannisdal
authors.forename: Helga
authors.initials: H
authors.lastname: Arianson
authors.forename: Geir Sverre
authors.initials: GS
authors.lastname: Braut
authors.forename: Ellen
authors.initials: E
authors.lastname: Schlichting
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Vinnem
mesh_terms: D002173:Cancer Care Facilities / Q000458:organization & administration / Q000592:standards*; D016208:Databases, Factual; D006801:Humans; D007407:Interviews as Topic; D019300:Medical Errors / Q000009:adverse effects* / Q000706:statistics & numerical data; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D009664:Norway; D061214:Patient Safety; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*