title: Performance improvement through proactive risk assessment: Using failure modes and effects analysis.
abstract: BACKGROUND
  Cognizance of any error-prone professional activities has a great impact on the continuity of professional organizations in the competitive atmosphere, particularly in health care industry where every second has critical value in patients' life saving. Considering invaluable functions of medical record department - as legal document and continuity of health care - "failure mode and effects analysis (FMEA)" utilized to identify the ways a process can fail, and how it can be made safer.
  
  
  METHODS
  The structured approach involved assembling a team of experts, employing a trained facilitator, introducing the rating scales and process during team orientation and collectively scoring failure modes. The probability of the failure-effect combination was related to the frequency of occurrence, potential severity, and likelihood of detection before causing any harm to the staff or patients. Frequency, severity and detectability were each given a score from 1 to 10. Risk priority numbers were calculated.
  
  
  RESULTS
  In total 56 failure modes were identified and in subsets of Medical Record Department including admission unit dividing emergency, outpatient and inpatient classes, statististic, health data organizing and data processing and Medical Coding units. Although most failure modes were classified as a high risk group, limited resources were, as an impediment to implement recommended actions at the same time.
  
  
  CONCLUSIONS
  Proactive risk assessment methods, such as FMEA enable health care administrators to identify where and what safeguards are needed to protect against a bad outcome even when an error does occur.
authors.affiliation: Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Yarmohammadian
authors.affiliation: Health Information Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Tahereh Naseri Boori
authors.initials: TN
authors.lastname: Abadi
authors.affiliation: Baghiateallah University of Medical Sciences, Tehran, Iran.
authors.forename: Shahram
authors.initials: S
authors.lastname: Tofighi
authors.affiliation: Department of Medical Information Management, Isfahan University of Medical Sciences, Isfahan, Iran.
authors.forename: Sekine Saghaeiannejad
authors.initials: SS
authors.lastname: Esfahani
keywords: Hospital; medical record department; quality improvement; risk assessment; risk management