Proactive Hazard Analysis and Health Care Policy


Organizations in the private and public sectors have in recent decades devised effective methods to eliminate or minimize hazards in such risk-laden activities as maintaining the health of astronauts in space, manufacturing automobiles, and preventing the transmission of food-borne disease. These methods, called proactive hazard analysis (or proactive risk assessment), could also protect the health and safety of patients and the health care workforce. The Veterans Health Administration (VHA) and the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) have begun to adapt proactive hazard analysis to hospital care.

ECRI and the Milbank Memorial Fund are collaborating to promote discussion about the use of proactive hazard analysis in health care settings. ECRI, a Collaborating Center of the World Health Organization, is a nonprofit medical technology assessment and risk management organization. Its work in proactive hazard analysis, building on more than three decades of analogous experience, is being applied in a variety of patient care settings in the United States and abroad. The Fund is an endowed philanthropic foundation, established in 1905, that works with decision makers in the public and private sectors on significant issues in policy for health care and public health. Fund staff learned about proactive hazard analysis in 2000, when senior policymakers in the U.S. Department of Agriculture requested their assistance in resolving issues that had arisen in the final stages of implementing its use to prevent food-borne illness as a result of the processing of meat, poultry, and eggs.

We convened clinicians, hospital leaders and health researchers, persons experienced in proactive hazard analysis, and representatives of four federal agencies, of state government, and of JCAHO. An earlier draft of this report was a background paper for this meeting. The author, John McDonough, a former legislative leader in Massachusetts, is currently a faculty member at Brandeis University and a program officer of the Fund. He has published books and articles on regulation in the health sector and on politics.

Participants in the meeting addressed the potential value of proactive hazard analysis to prevent pain and suffering among patients and persons who take care of them in hospital and ambulatory settings. We organized the agenda around three compelling issues: the safety of patients experiencing invasive procedures; preventing errors in ambulatory and home care; and reducing illness among patients with sensitive organs and immune systems. These questions received the most attention at the meeting:

  • Should the health sector embrace proactive hazard analysis for patient care?
  • If it should, is the methodology best implemented voluntarily, by regulation, or with some combination of incentives and requirements?
  • Who would incur what costs, and who could receive what benefits, from the widespread adaptation of proactive hazard analysis in health care?

This report summarizes the results of the meeting as well as the history of two approaches to proactive hazard analysis. During the meeting, we heard a consensus develop that either approach could improve the care of patients (though there were advocates of each of them), that it is not yet clear how best to introduce proactive hazard analysis into the health sector, and that because successful use of either approach should reduce reimbursement to treat the results of treatment errors, payers should offer providers financial incentives to introduce it.

We are grateful to the persons who reviewed the report, before and after the meeting. Reviewers who also attended the meeting are listed in the Appendix, other reviewers in the Acknowledgments.

Daniel M. Fox
Milbank Memorial Fund

Jeffrey C. Lerner
President and CEO