Volume 2020 Number 3
  • ISSN: 1999-7086
  • EISSN: 1999-7094


Over the years, the fragmented traditional risk management approach was replaced by a holistic view that is commonly identified by the literature as enterprise risk management. The comprehensive and integrative characteristic of this approach requires good communication through a reliable risk management information system to improve performance as well as provide an overall cost reduction by automating routine tasks and synchronising risk management efforts across the entire organisation. So far in healthcare, no risk analysis tool has been developed to proactively analyse and visualise risks in a comprehensive way1. The suitability of the bowtie method in healthcare risk analysis, control, follow up, and communication was assessed using a qualitative literature review process. Based on the fault tree and event tree analyses, and the Swiss cheese model, the bowtie method was developed as a proactive barrier-based risk management tool (Figure 1) to be used for visual risk assessment of critical events related to the core operations in many high-reliability industries1,2. Bowties were used to support medication errors investigation and analysis, provide a standard for audit, improve surgical operations and intensive care unit safety, and minimise surgical instrument retention risks. Acquiring a risk management platform has the capacity to improve performance through integrated and reliable systems1,2. The development and appropriate use of the bowtie method have the potential to improve process safety and achieve operational excellence, and communicate in a clear and accessible manner the best practice for a holistic risk management approach1,3. The bowtie simplifies the complexity of daily risks to a manageable size without losing the context. A bowtie platform is a value adding advancement to create an overview of an organisation's risks and how they are managed and communicated on all levels of the operational phase to cover the whole spectrum of enterprise risk management domains2.


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  1. Elamir H. Enterprise risk management and bow ties: going beyond patient safety. BPMJ. 2019;26(3):770–785 .
  2. CGE Risk. Bowtie Methodology Manual [internet]. Revision 15. CGE Risk Management Solutions B.V; 2015. Available from: https://www.icao.int/safety/SafetyManagement/SMI/Documents/BowTieXP%20Methodology%20Manual%20v15.pdf .
  3. Turner C, Hamilton WI, Ramsden M. Bowtie diagrams: A user-friendly risk communication tool. Proceedings of the Institution of Mechanical Engineers, Part F: Journal of Rail and Rapid Transit. 2017;231(10):1088–97 .

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  • Article Type: Conference Abstract
Keyword(s): Bowtie diagramcommunicationprocess and risk analysis
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