Raising the Bar for Risk Assessment

In today’s complex health care environment, preventing harm requires more than reviewing past events; it requires identifying risks before they lead to safety incidents or malpractice claims.

At Candello’s 2025 Summit session, Raising the Bar for Risk Assessments, three subject matter experts examined the evolution of CRICO and Candello’s Risk Assessment Program and shared strategies to strengthen safety culture across organizations. They outlined two primary assessment models—the Risk Appraisal Process (RAP), which evaluates entire organizations, and the Service Line Risk Assessment (SLRA), which targets specific clinical areas such as surgery, obstetrics, or emergency medicine. Both rely on a structured, multi-phase approach that includes preparation, interviews, analysis, and long-term follow-up, offering institutions a proactive roadmap for uncovering vulnerabilities and driving meaningful change.

What Risk Assessments Offer

Christine Ringler, Patient Safety and Risk Program Director at Candello, opened the session with an overview of the risk assessment process, emphasizing its role in fostering a proactive safety culture. Risk assessments, she explained, aren’t just checklists, but rather structured opportunities to uncover hidden vulnerabilities in communication, leadership, and clinical processes.

“Risk assessments identify ’upstream’ issues not seen directly in the MPL data,” Ringler explained. Although the three-phase process requires time and commitment, its true value lies in surfacing risks before they escalate into harm or litigation. By intervening early, organizations can shift from a reactive to a preventive approach.

Findings from assessments conducted between 2019 and 2024 reveal consistent patterns, with several key recommendations emerging as top priorities across diverse health care organizations.

Ringler highlighted the importance of closing the loop when incidents occur by ensuring feedback reaches frontline staff. This reinforces transparency, builds trust, and creates a learning environment where reporting leads to action.

Program Improvements

Julie Higden, Senior Patient Safety Program Director for Operations & Development at CRICO, highlighted several recent enhancements to the Risk Assessment Program aimed at making recommendations more actionable and measurable. Pre-assessment evaluations now sharpen the focus of each review, while a benchmarking tool and scorecard provide leaders with a clear picture of safety culture across 24 focus areas, organized into three domains: Culture, Structure, and Leadership. These tools allow organizations to compare their performance against both Academic Medical Centers and Community averages, helping them prioritize efforts where gaps are most significant.

Beyond identifying risks, the program emphasizes accountability and follow-through. The Risk Assessment tracker not only records recommendations but also pairs them with practical resources, with CRICO staff providing structured check-ins at six, 12, and 18 months to ensure progress stays on track.

Higden also underscored the value of collaboration across institutions. By connecting organizations facing similar challenges, CRICO helps them learn from one another’s successes and avoid common pitfalls. A strong example of this peer-to-peer learning is the TeamBirth program, a structured communication initiative in obstetrics.

Lessons from Dana-Farber Cancer Institute

Sarah Kadish, Vice President of Quality and Safety at Dana-Farber Cancer Institute, shared a powerful case study from her organization. Their risk assessment generated a myriad of recommendations and best practices, ranging from communication improvements to system redesigns. Dana-Farber prioritized high-impact items and aligned them with institutional goals to ensure resources were directed strategically.

Kadish provided an example of a project to improve real-time communication among clinical care teams, which involved agreeing on terminology, communication methods, and shared expectations. She then emphasized that risk assessments are most effective when treated as ongoing collaborations, not one-off reports. Dana-Farber’s experience reinforced that buy-in from every level, from board members and executives to frontline staff, is essential for lasting change.

Broader Lessons

The session underscored several key themes:

• Look upstream: Risk assessments uncover vulnerabilities not always visible in malpractice data, yet offer vital signals to patient safety.
• Measurement and follow through: New risk assessment tools allow organizations to assess their current state and benchmark against peers. Structured follow-ups at six, 12, and 18 months help ensure accountability and progress.
• Leverage the network: By connecting institutions facing similar challenges—such as communication breakdowns in obstetrics—risk assessments can foster peer-to-peer learning and accelerates adoption of best practices among CRICO subscribers and Candello clients.

By raising the bar for risk assessments, CRICO, Candello, and members of their national community continue to push health care toward a future where safety is proactive, collaborative, and sustainable.