A risk matrix can help hospital leaders and staff identify issues most likely to happen and to cause the most harm. The matrix can be used for individual problems or systemic issues.

  • The matrix helped pinpoint the cause of readmissions.
  • The hospital also revamped its safety huddles.
  • Traditional safety huddles are followed by a more in-depth informational meeting.

As part of an overall project to improve quality and patient safety at Madison Memorial Hospital in Rexburg, ID, Director of Risk Management and Compliance Nolan Bybee, RRT, wanted to find a way to be more proactive and not wait for adverse event reports. He found solutions that accomplished that goal and draw staff into the decision-making that goes on every day in a hospital, encouraging them to take more responsibility.

In the first solution, Bybee and his colleagues developed a risk matrix that focuses on quality, patient safety, and financial issues that could lead to an unwanted result, including a malpractice lawsuit or an employee or patient injury. By using the risk matrix, staff can determine how to prioritize tasks and resources, focusing on those issues that are most likely to cause the most damage.

The matrix is an improvement over how the hospital previously tracked incidents, essentially waiting for someone to report an injury or concern and then tracking down what caused it, Bybee says. Madison Memorial implemented the new matrix in September 2015.

“The matrix helps us determine the worst possible consequence of a set of facts and the likelihood of that happening,” Bybee says.

The matrix also is used to address systemic problems in the hospital. Bybee used it recently to address readmission rates. Prior to the matrix, hospital leaders waited until the readmission rates became problematic and then investigated, looking for a solution.

“With the matrix, we stepped back and identified that there are only a few reasons why patients are being readmitted,” Bybee says. “One was a situation in which we discharge them to a home health agency and the agency doesn’t get there until the next day, so for a long amount of time they’ve missed getting their meds and the care they were getting here. Once we recognized that problem, we started using a select few home health agencies, nursing homes, and medical supply companies as preferred providers, and we coordinate with them to avoid that kind of problem.”

The hospital established patient care navigators that communicate with counterparts at each of the preferred providers to monitor the patient’s progress.

“The risk matrix helped us identify that we have to monitor the progress of these patients quite closely for 30 to 60 days after they leave, at least, rather than saying they’re out of our door and not our problem,” Bybee says. “We were able to drill down and identify the potential for harm and the barriers to better care.”

Improved Safety Huddles

Madison Memorial also revamped its safety huddles. Like many hospitals, Madison Memorial holds a morning safety huddle that includes representatives from many departments, leadership, and anyone else who wants to attend. Bybee and other leaders realized that the safety huddles, while useful, weren’t providing enough information to address the root problems of safety concerns.

Now, immediately following that huddle, Bybee, the department representatives, and administrators hold a second meeting to report in more detail about any issues that the whole hospital should be aware of, Bybee says.

“Med-surg might report that they have 15 patients on the floor and three are in isolation. That’s not specifically a safety issue, but it can be if the staff is overwhelmed. People might realize that med-surg is really slammed, so maybe today isn’t the best day to hound them about that new project,” Bybee says. “That way, the whole hospital knows what’s going on in a more in-depth way than just the direct safety concerns that are mentioned in the huddle. This isn’t intended as a way to fix problems; it’s a chance to say this is what’s going on, so people can get that back to their departments.”

Bybee encourages risk managers to work closely with quality assurance on improvement projects like these. Many projects originating with the quality department will benefit risk management as well, he says, but only if they work cooperatively.

“As risk managers, sometimes we’re quick to say ‘No, we can’t do that,’ when actually it might be in the best interest of the patient to say yes. We just need to figure out a safe way to do it,” Bybee says. “We have to be open to improvement and change.”


  • Nolan Bybee, RRT, Director of Risk Management and Compliance, Madison Memorial Hospital, Rexburg, ID. Telephone: (208) 359-6900. Email: nolan.bybee@mmhnet.org.