Integration of prospective and retrospective methods for risk analysis in hospitals

Objective. To explore how hospital management could gain a better picture of risks to support them in setting priorities for patient safety. Methods and Setting. This study deals with the combined application of prospective and retrospective methods for risk analysis on two units of a Dutch general hospital. In the prospective analyses, employees identified and assessed possible risks in selected processes. In the retrospective analyses, incidents were reported by employees and subsequently investigated. The methods were integrated by using information from retrospective incident reports for prospective risk identification and assessment, and by matching their categorization schemes. Two evaluation forms provided insight into the perceived usefulness of the methods and their integration. Results and Conclusions. For both units, the prospective and retrospective analyses resulted in divergent overviews of risks in terms of nature and magnitude, which suggests that one or both methods were subject to biases. Findings from the evaluation forms showed that both methods were perceived as useful and that triangulation provided additional insight into risks. Due to the convergent evidence, triangulation of prospective and retrospective methods can provide hospital management and frontline staff with a more complete and less biased picture of risks. An integrative approach might be advantageous in terms of efficiency of analysis, setting priorities for patient safety and improving the methods themselves.