ABSTRACT
BACKGROUND: Cancer care processes represents a number of potential threats to patient safety. A national risk analysis of Norwegian cancer care, entailing diagnosis, treatment, follow-up, palliative care, and terminal care, was conducted. METHODS: Literature review and a retrospective analysis of hazards in different national databases were combined with interviews with key health personnel in an attempt to identify 50 possible hazards. A project team from the Norwegian Board of Health Supervision (NBHS) and 23 other persons participated in the workshop in 2009. RESULTS: In a stepwise, consensus-driven process, the 23 participants discussed the 50 possible hazards and then selected the 16 that they considered most important-clustered into three groups: diagnosis and primary treatment, interactions, and complications. The NBHS distributed the risk analysis report to a variety of stakeholders and asked Norway's hospital trusts to address the hazards. The report generally met a positive reception, albeit with local and interdisciplinary differences in the extent of the perceived applicability of the respective hazards. Two follow-up studies in 2012 and 2013 showed that the hospital trusts lacked the implementation capacity to identify operational solutions to reduce the hazards. At the largest hospital trust in Norway-Oslo University Hospital-the Department of Oncology retested the national risk analysis in in 2011. Four groups, representing different parts of the patient care process. selected 9 of the 16 national hazards and identified 4 new ones. The department has established goals and appropriate activities for 3 of the hazards. CONCLUSIONS: The Ministry of Health and Care determined that hospital trusts must increase their implementation capacity regarding operational solutions to reduce the hazards.
Subject(s)
Cancer Care Facilities/standards , Medical Errors/adverse effects , Neoplasms/complications , Patient Safety , Risk Assessment/methods , Cancer Care Facilities/organization & administration , Databases, Factual , Humans , Interviews as Topic , Medical Errors/statistics & numerical data , Neoplasms/therapy , Norway , Retrospective StudiesABSTRACT
This paper presents results from a case study carried out on an offshore oil and gas production platform with the purpose to apply and test BORA-Release, a method for barrier and operational risk analysis of hydrocarbon releases. A description of the BORA-Release method is given in Part I of the paper. BORA-Release is applied to express the platform specific hydrocarbon release frequencies for three release scenarios for selected systems and activities on the platform. The case study demonstrated that the BORA-Release method is a useful tool for analysing the effect on the release frequency of safety barriers introduced to prevent hydrocarbon releases, and to study the effect on the barrier performance of platform specific conditions of technical, human, operational, and organisational risk influencing factors (RIFs). BORA-Release may also be used to analyse the effect on the release frequency of risk reducing measures.
Subject(s)
Accidents, Occupational , Environmental Pollutants , Hydrocarbons , Risk AssessmentABSTRACT
Investigations of major accidents show that technical, human, operational, as well as organisational factors influence the accident sequences. In spite of these facts, quantitative risk analyses of offshore oil and gas production platforms have focused on technical safety systems. This paper presents a method (called BORA-Release) for qualitative and quantitative risk analysis of the platform specific hydrocarbon release frequency. By using BORA-Release it is possible to analyse the effect of safety barriers introduced to prevent hydrocarbon releases, and how platform specific conditions of technical, human, operational, and organisational risk influencing factors influence the barrier performance. BORA-Release comprises the following main steps: (1) development of a basic risk model including release scenarios, (2) modelling the performance of safety barriers, (3) assignment of industry average probabilities/frequencies and risk quantification based on these probabilities/frequencies, (4) development of risk influence diagrams, (5) scoring of risk influencing factors, (6) weighting of risk influencing factors, (7) adjustment of industry average probabilities/frequencies, and (8) recalculation of the risk in order to determine the platform specific risk related to hydrocarbon release. The various steps in BORA-Release are presented and discussed. Part II of the paper presents results from a case study where BORA-Release is applied.
