The Importance of the Complex Approach towards Patient Safety and Risk Management in Healthcare Organizations

Laimutis Paškevičius


Patients have a right to safe and high-quality health care. However, research in the field of patient safety shows that adverse events in healthcare have significant moral, social and financial costs for societies, healthcare sectors and institutions. Global changes are stimulating healthcare sector and its organizations to pay more attention to the safety and quality of health care services, introduce patient safety and risk management systems.
However, due to the lack of complex and systematic approach to the patient safety and risk management, patient safety interventions at the national (country) and local (institutional) levels are often inefficient.
The aim of the article is to highlight the importance of the complex approach toward patient safety and risk management in healthcare institutions.
Therefore, in the article the complex approach towards patient safety and risk management is presented and its importance is stressed in planning and implementing patient safety and risk management systems and instruments for health care organizations.


patient safety; risk management; adverse event; complex approach; sociotechnical system

Full Text:

PDF (Lithuanian)


An organization with a memory. Report of an Expert Group on Learning from Adverse Events in the NHS Chaired by the Chief Medical Officer. London.The Stationary Office, 2000.

Analizė apie galimybę sukurti nepageidaujamų įvykių ir gydymo klaidų registracijos sistemą. Galutinė sutarties vykdymo ataskaita [interaktyvus]. Vilnius. 2013. [žiūrėta 2012-12-05] .

Baker GR, Norton PG, Flintolf V, et al. 2004. The Canadian Adverse events Study: the incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal, 179(11): 1678 - 1686.

Bar-Yam, S., et al. 2012. A Complex Systems Science Approach to Healthcare Costs and Quality. New England Complex Systems Institute. USA.

Battles, J.B., et al. 2006. Sensemaking of patient safety risks and hazards. Health Services Research, 41: 1555-1575.

Battles, J.B.; Lilford, R. J. 2003. Organizing patient safety research to identify risks and hazards. Quality and Safety in Health Care, 12 (Suppl.2): ii2-ii7.

Bonnabry, P., et al. 2006. Use of prospective risk analysis method to improve the safety of the cancer chemotherapy process. International Journal for Quality in Health Care, 18:9-16.

Building a safer NHS for patients. Implementing an Organization with a memory. 2002.

Canadian Incident Analysis Framework. 2012. Canadian Patient Safety Institute [interaktyvus]. 2012, [žiūrėta 2013-12-21]..

Chantler, C. 1999. The role and education of doctors in the delivery of health care, Lancet, Vol 353: p. 1181.

Davis, P., et al. Adverse events in New Zealand public hospitals: occurrence and impact. New Zealand Medical Journal, 2002, 115 (1167):U271.

ES Tarybos 2009 m. birželio 9 d. Rekomendacija dėl pacientų saugos ir su sveikatos priežiūra susijusių infekcijų prevencijos ir kontrolės; 2009/C 151/01. [interaktyvus]. 2009. [žiūrėta 2013-12-09] .

Governments and patient safety in Australia, the United Kingdom and the United States. A review of policies, institutional and funding frameworks, and current initiatives. Report prepared for the Advisory Committee on Health Services by Working group on Quality of Health Care Services. 2002.

HealthGrades Quality study. Second Annual. Patient Safety in American Hospital Report. 2005.

Heinrich, H.W., et al. 1980. Industrial Accident Prevention. New York: McGraw-Hill.

Hobbs, A., et al. 2008. Three principles of human-system integration. Proceedings of the 8th Australian Aviation Psychology Symposium. Sydney, Australia.

Hogan, H., et al. 2008. What can we learn about patient safety from information sources within an acute hospital: A step on the ladder of integrated risk management? Quality and Safety in Health Care, 17: 209-215.

Hollnager, E. Risk + barriers = safety? Safety Science, 46: 221-229.

Institute of Medicine. Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. Washington, DC: National academy Press, 2003.

Janušonis, V. 2005. Rizikos valdymas sveikatos priežiūros organizacijose. Klaipėda: S. Jokužio leidykla-spaustuvė.

Johnson, C. W.; Holloway, C. M. 2007. A Longitudinal Analysis of the Causal Factors in Major Maritime Accidents in the USA and Canada (1996-2006). Proceedings of the 15th Safety-Critical Systems Symposium. Bristol, UK. The Safety of Systems: 85-94.

Lee, R. C.; Donaldson, C.; Cook, L. S. 2003. The need for evolution in healthcare decision modeling. Medical Care, 41(9): 1024-1033.

Nelson, E.C., et al. 2008. Clinical microsystems, part 1. The building blocks of health systems. Joint Commission Journal on Quality and Patient Safety, 34(7): 367-378.

Nepageidaujami įvykiai ir jų priežastys sveikatos priežiūros specialistų ir pacientų požiūriu. 2008. Higienos institutas.

Patient safety: towards sustainable improvement. Fourth report to the Australian Health Ministers’ Conference. Australian council for safety and quality in health care. Commonwealth of Australia 2003.

Plsek, P. E.; Greenhalgh, T. 2001. Complexity science: The challenge of complexity in health care. BMJ, Vol. 323: 625-628.

Plsek, P.E.; Wilson, T. 2001. Coplexity science. Complexity, leadership, and management in healthcare organizations. BMJ, Vol.323:746-749.

Qureshi Z.H. 2008. A Review of Accident Modeling Approaches for Complex Critical Sociotechnical Systems. Technical Report.

Rasmussen, J. 1997. Risk Management in a Dynamic Society: A Modeling Problem. Safety Science, 27:183-212.

Reason J. 2000. Human error: models and management. BMJ, 320:768-770.

Reason, J. 1997. Managing the Risks of Organizational Accidents. Aldershot, Hants, Ashgate.

Sharpe, V.A.; Faden, A.I. 1998. Medical Harm. Historical, Conceptual and Ethical Dimensions of Iatrogenic Illness. Cambridge University Press. Cambridge.

Smits, M. et al. 2010. Exploring the causes of adverse events in hospitals and potential prevention strategies. Quality and Safety in Health Care, 19(5): e5.

Standing Committee of the Hospitals of the EU. 2000. The quality of health care/hospital activities: Report by the Working Party on quality care in hospitals of the subcommittee on coordination.

Stolzer, A.J.; Halford, C.D.; Goglia, J.J. 2013. Safety Management Systems in Aviation. Ashgate Studies in Human Factors for Flight Operations. Burlington: Ashgate Publishing Company.

Takayanagi, K.; Hagihara, Y. 2007. Revised sunflower - SHELL model - an analysis tool to ensure averse events‘ factor analysis and followed by patient safety strategy. Jpn Hosp. Jan (25): 11-8.

Thomas, E.J., et al. 2000. Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care, 38:261-71;

Vincent, C.A. 2004. Analysis of clinical incidents: a window on the system not a search for root causes. Qual Saf Health Care, 13: 242-243.

Wheatley, M. 2005. Finding Our Way: Leadership for an Uncertain Time. Berrett-Koehler Publishers. San Francisco, CA.


Article Metrics

Metrics Loading ...

Metrics powered by PLOS ALM


  • There are currently no refbacks.

"Health Policy and Management" ISSN online 2029-9001 / ISSN print 2029-3569