Clinical Assessment of Risk Management: an INtegrated Approach (CARMINA)

Pierfrancesco Tricarico, Stefano Tardivo, Giovanni Sotgiu, Francesca Moretti, Piera Poletti, Alberto Fiore, Massimo Monturano, Ida Mura, Gaetano Privitera, Silvio Brusaferro

Research output: Contribution to journalReview articlepeer-review


Purpose – The European Union recommendations for patient safety calls for shared clinical risk management (CRM) safety standards able to guide organizations in CRM implementation. The purpose of this paper is to develop a self-evaluation tool to measure healthcare organization performance on CRM and guide improvements over time. Design/methodology/approach – A multi-step approach was implemented including: a systematic literature review; consensus meetings with an expert panel from eight Italian leader organizations to get to an agreement on the first version; field testing to test instrument feasibility and flexibility; Delphi strategy with a second expert panel for content validation and balanced scoring system development. Findings – The self-assessment tool – Clinical Assessment of Risk Management: an INtegrated Approach includes seven areas (governance, communication, knowledge and skills, safe environment, care processes, adverse event management, learning from experience) and 52 standards. Each standard is evaluated according to four performance levels: minimum; monitoring; outcomes; and improvement actions, which resulted in a feasible, flexible and valid instrument to be used throughout different organizations. Practical implications – This tool allows practitioners to assess their CRM activities compared to minimum levels, monitor performance, benchmarking with other institutions and spreading results to different stakeholders. Originality/value – The multi-step approach allowed us to identify core minimum CRM levels in a field where no consensus has been reached. Most standards may be easily adopted in other countries.

Original languageEnglish
Pages (from-to)744-758
Number of pages15
JournalInternational Journal of Health Care Quality Assurance
Issue number7
Publication statusPublished - Aug 8 2016


  • Benchmarking
  • Clinical governance
  • Clinical risk management
  • Patient safety
  • Risk management
  • Self-assessment

ASJC Scopus subject areas

  • Health Policy


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