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Enterprise risk management and bow ties: going beyond patient safety

Hossam Elamir (Ministry of Health, Al-Asma, Kuwait) (CGE Risk Management Solutions, Leidschendam, The Netherlands)

Business Process Management Journal

ISSN: 1463-7154

Article publication date: 15 August 2019

Issue publication date: 17 June 2020



The growing importance of risk management programmes and practices in different industries has given rise to a new risk management approach, i.e. enterprise risk management. The purpose of this paper is to better understand the necessity, benefit, approaches and methodologies of managing risks in healthcare. It compares and contrasts between the traditional and enterprise risk management approaches within the healthcare context. In addition, it introduces bow tie methodology, a prospective risk assessment tool proposed by the American Society for Healthcare Risk Management as a visual risk management tool used in enterprise risk management.


This is a critical review of published literature on the topics of governance, patient safety, risk management, enterprise risk management and bow tie, which aims to draw a link between them and find the benefits behind their adoption.


Enterprise risk management is a generic holistic approach that extends the benefits of risk management programme beyond the traditional insurable hazards and/or losses. In addition, the bow tie methodology is a barrier-based risk analysis and management tool used in enterprise risk management for critical events related to the relevant day-to-day operations. It is a visual risk assessment tool which is used in many higher reliability industries. Nevertheless, enterprise risk management and bow ties are reported with limited use in healthcare.


The paper suggests the applicability and usefulness of enterprise risk management to healthcare, and proposes the bow tie methodology as a proactive barrier-based risk management tool valid for enterprise risk management implementation in healthcare.



The author would also like to acknowledge the contribution of Jumana Al-Amir in proofreading this paper.


Elamir, H. (2020), "Enterprise risk management and bow ties: going beyond patient safety", Business Process Management Journal, Vol. 26 No. 3, pp. 770-785.



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