De-risking Your Quality Management Program

Derisking - team putting gears together

Several years ago, the concept of risk assessment was introduced into healthcare. Assessing and managing risk is now a cornerstone to how healthcare organizations need to operate. Have you wondered if there is a way to reduce the risk of not meeting your quality metrics, not achieving accreditation, or not delivering on key internal regulatory initiatives? Have you considered a proven process called ‘de-risking’?


Following your C&A mock survey, you will receive a report that identifies specific areas recommended for improvement, and each of these will have varying degrees of ‘likelihood to harm’ and ‘scope of impact.’  Based on these findings, as you think about internal projects aimed at improving compliance, implementing a facilitated de-risking process can significantly improve your success rate. This process involves:

  • Separating facts from assumptions at the onset.
  • Avoiding unforeseen “landmines” late in the game.
  • Succeeding rapidly, without detours and distractions.
  • Spending funds efficiently on only that which matters.

Effective de-risking will also help in building confidence with your leadership team and the broader organization. Communicating a project plan that incorporates identified risks and mitigation plans will allow everyone to be on the same journey and will enable key decisions to occur more quickly. It will further unify your organization around the common objective of patient, staff, and visitor safety.

The ‘De-Risking’ Process

There are three steps to effective project de-risking:

  • Generate assumptions… possible landmines that could terminate your project.
  • Rate assumptions… for likely impact and certainty on the success of your project.
  • Investigate assumptions… to convert them from uncertainty to certainty.

First the team generates assumptions that must be true for project success.

Generate assumptions: You and your project team should identify project assumptions. Each assumption should complete this sentence, “For our project to succeed, it must be true that ­­­­­________.”

  1. Divide the assumptions into External Factors, Internal Capabilities, and Desired Outcomes. Feel free to generate additional categories if relevant to the project.
  2. Use “triggers” (idea-starters) to generate more assumptions. A process flow model can help to ensure all the key assumptions are identified.

Second, the team rates each assumption for likely impact and certainty.

Rate assumptions: Next the team rates each assumption for its likely impact on project success and its current level of certainty.

  1. Each team member should rate likely impact and certainty on a 1-to-5 anchored scale. This is done individually to avoid ‘group think’ and ensures rich, divergent perspectives.
  2. The entire team reviews histograms of individual responses and settles on its ratings. If there is disagreement, thoughtful project de-risking says the most cautious voice wins… i.e., the highest impact rating and lowest certainty rating.
  3. The team records its Source of Truth. This refers to the need for everyone on the team to make decisions using the same information which should be recorded. As you learn more in the investigation phase, the Sources of Truth can certainly change.

 Third, your goal is to move assumptions from uncertainty to certainty.

 Investigate assumptions: Next the team prepares a Checkpoint plan… a series of tasks to better understand each assumption.

  1. Team members are assigned tasks, e.g., interviewing staff/patients/visitors, conducting observations, running process trials, etc.
  2. Assumptions can move around in the ‘impact vs. certainty’ matrix as additional information is gathered during the investigation.
  3. An assumption that continues to have a higher impact and lower certainty will be referred to as a landmine…something that has high potential to cause project failure. Each landmine should be labelled as: Possible, Probable or Confirmed.

After identifying and agreeing on these landmines, every option should be explored to determine whether the certainty of these assumptions can be improved. These assumptions represent failure points for the project’s success.

The Minesweeper® Software

 The proprietary Minesweeper® Software is designed to assist your de-risking process at every step of the way. In step 1, your assumptions are recorded, organized, and sorted electronically in a sticky note format viewable to everyone. In step 2, the software can collect individual scoring of assumptions followed by a graphical representation of the combined view on a Certainty Matrix with each assumption categorized as safe, caution or danger. In step 3, assumption movement on the Certainty Matrix is tracked based on investigative results and mitigation actions taken. Finally, to assist in sharing progress and results with leadership or broader organization, Minesweeper® provides a de-risking report highlighting the following:

  • Project overview
  • Uncertainty profile
  • Uncertainty timeline
  • Learning path
  • Status
  • Recommendations

Mindsweeper Derisking brainstorm assumptions resourceresourceMindsweeper Derisking rating assumptions resourceMindsweeperDerisking internal and external assumptions


During the recent pandemic, healthcare resources were extremely strained and required organizations to become better at prioritizing, managing workload, and making complex decisions without sacrificing patient care. A de-risking approach to project management aimed at patient care can ensure the continued best use of everyone’s time and the best possible outcome. The outlined approach will ensure everyone is working on the right projects, focused on addressing the most critical aspect of each project, and delivering the highest success rate possible. C&A, together with AIM, can help you get started on this process and incorporate this ‘way of thinking’ into your culture.


Dan Adams, President of Aim Institute, and creator of Minesweeper® project de-risking methodology used to detect and avoid “landmines” in transformational projects.

Contact Us

Would you like to try de-risking a critical project on which you are working? We can provide this support following a mock survey, we can help you on an existing project, or we can conduct training, so you are proficient at using this approach anytime. Contact us at 704-573-4535, send us a message, or request a proposal. We look forward to supporting your organization!

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