VHA National Center for Patient Safety
Proactive Risk Assessment
Proactive Risk Assessment (PRA)
A Proactive Risk Assessment (PRA) helps identify and address potential risks in a system or process before any problems happen. It breaks down healthcare processes into smaller parts that can be analyzed one at a time to see if preventive or reactive measures are needed. For the most critical risks, PRAs help create a plan to find likely causes, redesign the process, and test changes to ensure they work.
There are several PRA methods available. The most commonly used in the Veterans Health Administration (VHA) is the Healthcare Failure Modes and Effects Analysis (HFMEA). Other useful methods include Fault Tree Analysis, Event Tree Analysis, Bowtie Analysis, and Hazard Identification. The NCPS Guidebook for Proactive Risk Assessment offers instructions and resources for these methods. The short videos below also provide an overview of these PRA methods.
After completing a PRA, the team will suggest actions or solutions to leadership for implementation. The best actions rely less on human memory, performance, and capability. The Hierarchy of Actions in the NCPS Guidebook for Proactive Risk Assessment can help determine if proposed actions are Stronger, Intermediate, or Weaker.
The VHA uses a Checklist for Proactive Risk Assessment to ensure PRAs follow The Joint Commission’s best practices.
PRA Overview Videos
PRA Resources
- VHA NCPS Guidebook for Proactive Risk Assessment – November 2025
- VHA NCPS Checklist for Proactive Risk Assessment – November 2025
Healthcare Failure Mode and Effects Analysis (HFMEA)
HFMEA was developed by NCPS to create a PRA technique specifically for healthcare. It is designed to be easy for teams of all skill levels to use. HFMEA combines elements of traditional Failure Mode and Effect Analysis (FMEA), Root Cause Analysis (RCA), and other risk assessment tools. It uses both quantitative (risk scoring) and qualitative (decision tree) methods to identify which hazards need to be addressed. HFMEA is ideal for analyzing healthcare processes. You can find a detailed description of the HFMEA process in the VHA NCPS Guidebook for Proactive Risk Assessment.
HFMEA Resources
References
DeRosier, J., Stalhandske, E., Bagian, J.P., & Nudell, T (2002). Using Health Care Failure Mode and Effect Analysis: The VA National Center for Patient Safety's Prospective Risk Analysis System(PDF).The Joint Commission Journal on Quality Improvement, Volume 27 Number 5:248-267, 2002. Posted with permission.
