Risk assessment techniques in public health administration: A systematic review

Budget shortfalls, pandemic flu, healthcare reform: Public health administrators work in an environment of considerable uncertainty. ISO 31000 (the international standard for risk management) defines risk as “the effect of uncertainty on objectives.” Its supporting standard, ISO 31010, describes 31 risk assessment (RA) techniques to help organizations control risks by systematically identifying, analyzing, and evaluating them. We conducted a systematic literature review to determine which of these methods have been used in public health administration (PHA), and to document the experience of public health administrators in their use. Database: PubMed Search details: “Public Health Administration[Mesh] AND (risk OR risks OR hazard* OR uncertain*) AND X,” where X = the name(s) of the RA technique. Inclusion criteria: English-language, describes the application of the named RA method in a risk management context. Results: 12 studies qualified, representing five RA techniques (structured/semi-structured interviews: 6, cost/benefit analysis: 3, checklists, Delphi method, Monte Carlo simulation: 1 each). None reported the use of the techniques most common in patient safety (root-cause analysis, failure mode and effects analysis, risk matrices, and brainstorming). Three studies on structured/semi-structured interviews described the emergence of new themes/categories during the course of the study, and one study on cost/benefit analysis described the technique as requiring “considerable expertise and investment in time.” No others commented on the use of the RA technique, itself. Discussion: Formal RA techniques appear to be little used in PHA. Experience in other settings suggests that a structured risk management approach modeled on ISO 31000 might benefit the field.