The Role of the Risk Manager in Patient Safety: The Delphi Method Volume 60- Issue 2

Alberto Firenze¹*, Luciana Bevilacqua², Francesco Armetta³, Alessandra Allegro⁴, Letizia Cascio⁵, Maria Lampasona⁴, Omar Enzo Santangelo⁶, Salvatore Calagna⁷, Francesco Di Piazza⁷, Silvana Castaldi⁸, Alessandra De Palma⁹, Antonio Capodicasa¹⁰, Serafino Nucera¹¹, Salvatore Gabriele Sardo¹¹, Riccardo Tartaglia¹², Manfredi Rizzo¹³ and Francesco Leonforte¹⁴

• ¹Direttore Scuola di Specializzazione Medicina del lavoro, Università degli Studi di Palermo, Direttore Sanitario Azienda Ospedaliera Universitaria Policlinico P. Giaccone Palermo, Presidente Nazionale Associazione Scientifica Hospital and Clinical Risk Managers- HCRM, Italy
• ²Medico Chirurgo specializzata in Neurologia ed Igiene e medicina preventiva, Clinical Risk Manager Fondazione Don Gnocchi, componente consiglio direttivo Associazione Scientifica Hospital and Clinical Risk Managers- HCRM
• ³Dirigente Medico di Direzione Sanitaria di Presidio Azienda Ospedaliera Universitaria Policlinico P. Giaccone
• ⁴Dirigente Medico di Direzione Sanitaria, Ospedali Riuniti Villa Sofia- Cervello
• ⁵Dottoressa magistrale in giurisprudenza, esperto in organizzazione sanitaria e risk management, bioeticista clinico, Segretario Nazionale Associazione Scientifica Hospital and Clinical Risk Managers - HCRM
• ⁶Dirigente medico presso l’Azienda Socio Sanitaria Territoriale di Lodi · SC Vaccinazioni e Sorveglianza Malattie Infettive
• ⁷Medico Chirurgo, Specializzando in Medicina del Lavoro, Universita degli Studi di Palermo
• ⁸Professore Associato - Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano.
• ⁹Dirigente Medico - Direttore della struttura complessa di Medicina Legale e Gestione Integrata del Rischio - Area Sicurezza delle Cure, IRCCS Azienda Ospedaliera Universitaria di Bologna - Policlinico di Sant’Orsola
• ¹0Medico Chirurgo Infettivologo, Clinical Risk Manager Aziendale, componente consiglio direttivo Associazione Scientifica Hospital and Clinical Risk Managers-HCRM
• ¹¹Medico in formazione specialistica in medicina del lavoro, Università degli studi di Palermo
• ¹²Dirigente Medico di Il livello (disciplina medicina del lavoro), Direttore SODc Laboratorio GRC Azienda Ospedaliero Universitaria di Careggi, Direttore Centro Gestione Rischio Clinico e Sicurezza del Paziente della Regione Toscana
• ¹³Professore Ordinario (MEDS-08/A), Umiversità degli studi di Palermo, Dipartimento Promozione della Salute, Materno Infantile, di Medicina Interna e Specialistica di Eccellenza G. D’Alessandro
• ¹⁴Dirigente Medico di Direzione Sanitaria di Presidio Azienda Ospedaliera Universitaria Policlinico G.Rodolico-San Marco, scuola di specializzazione in Igiene e medicina preventiva Unict, Catania, Italy

Received: December 10, 2024; Published: January 30, 2025

*Corresponding author: Alberto Firenze, Direttore Scuola di Specializzazione Medicina del lavoro, Università degli Studi di Palermo, Direttore Sanitario Azienda Ospedaliera Universitaria Policlinico P. Giaccone Palermo, Presidente Nazionale Associazione Scientifica Hospital and Clinical Risk Managers- HCRM, Italy

DOI: 10.26717/BJSTR.2025.60.009418

Abstract PDF

Dear Director,

With great admiration and trust in the columns of your journal, | would like to bring to your kind attention the initiative that the Scientific Association Hospital & Clinical Risk Managers - HCRM, an association registered in the AgeNaS National Observatory of Good Practices on Health Safety, in the first months of 2022, together with the Lombard Academy of Public Health, it questioned the role of Risk Managers in Patient Safety by applying the Delphi methodology. The purpose of this investigation was to turn the spotlight on the role of the Risk Manager since, during the bloodiest phases of the Covid-19 pandemic, more importance was given to the role of the RSPP - Head of the Prevention and Protection Service ( in compliance with the provisions of Legislative Decree 891/2008 Consolidated Text on Worker Safety) to protect safety in the workplace, emphasizing an inequality between the safety of operators and that of patients, not valuing the role of the Risk Manager equally.

This condition is aggravated by the fact that despite the fact that the Gelli-Bianco Law (n. 24/2017) provides for the function of Risk Manager in all health and social health structures, the responsibilities, functions, competence, training of this professional figure. This scenario has led to a state of confusion as it has not been possible to exploit the means that were already available, such as the use of a common glossary, the correct management and identification of adverse events/sentinel events, thus operating in line with what provides for the Gelli Bianco law 24/2017 which in art. 1 establishes “ Safety of treatment is a constitutive part of the right to health and is pursued in the interest of the individual and the community”. The survey was approached according to the Delphi model, a typical methodology of social research, which allows for the interview of a selected group (panel) of experts, called to express, anonymously, their opinions and opinions on a given issue, at the the aim of validating some of them through mutual comparison and progressive sharing.

The Rand Corporation Delphi Method was developed by Olaf Helmar, Norman Dalkey and Nicholas Rescher at the beginning of the Cold War to be able to guide political decision-makers in strategic/ technological choices, and is used in the healthcare world to collect opinions on phenomena, to express a convergence of opinions and to put together common knowledge in order to solve or deal with situations of uncertainty.

The experts selected on the basis of experience and expertise who made up the Panel is representative of Risk Managers, General Managers (non-medical), Medical Directors, DMPO, DITRA, Pharmacists, Medical xaminers, Lawyers, RSPP, Clinical Engineers, Doctors of the work, journalists/opinionists, voluntary associations and scientific societies.

The sample involved in the survey consisted of 300 experts who expressed their views on an anonymous online questionnaire on 6 macro-subjects, defined by the “Statement” methodology, and concerned Training- Competence, Role and Functions, Resources and scopes of action, Institutions, Claims and Insurance Management, Healthcare Related Infections, Institutions, Relations and Committees. The outcome of the survey reveals that all the Statements, with the exception of Institutions, reports and committees which reported a substantial disagreement, achieved a consensus of judgments greater than 75%.

The results obtained form the basis for drafting a document that opens up discussions with institutions for a better and more precise definition of the roles and responsibilities of the Risk Manager figure in Patient Safety.