The boundaryless hospital through risk management approach: a case study of the A&E unit of a tertiary-care hospital in Malta

Over the years, several scholars and policy makers have attempted to provide solutions to minimize risk in health care, and consequently improve patient safety. Possible solutions are to have parts of the health services better integrated, as well as to optimize resources safely through risk management principles. Twenty years ago, Braithwaite and colleagues discussed the future of the hospital and coined the term boundaryless hospital (Braithwaite et al., Aust NZ J Med 24(5):565-571, 1994). The authors foretell a radical change in the nature of the modern hospital with the advent of state-of-the-art information technology and innovative clinical equipment. Similarly, over the past two decades, risk management principles have been applied to health care (Dey et al., Manag Serv Qual 16(2):203-222, 2006; Liberatore and Nydick, Eur J Oper Res 189(1):194-207, 2008). Health care organizations are being tasked with doing more with less while still striving to safeguard patient safety as well as to operate at lowest levels of risk. The main aim of this research is to improve the quality of care in the accident and emergency (A&E) unit of a Maltese tertiary-level hospital through the assessment of risk and the concept of a boundaryless hospital. This study adopts a risk management framework to identify risk factors that affect the quality of care, analyze their likelihood and impact, and develop responses to mitigate those risks. Through assessment of the risks at the system level, innovative solutions can be applied to reduce boundaries in the patient care pathway.