Redesigning a nursing risk assessment framework to strengthen frontline nurse engagement in risk prioritization and enterprise governance: A quality improvement initiative in a Singapore tertiary hospital

Enterprise Risk Management (ERM) is increasingly recognized as critical to safety and organizational resilience in healthcare. At Singapore General Hospital, the Nursing Division relied on retrospective clinical incident reports with limited frontline participation, constraining timely detection of emerging risks. This quality improvement initiative redesigned the divisional risk framework to strengthen multisource risk sensing, nurse engagement in prioritization, and sustained monitoring within governance structures. A multidisciplinary team implemented a structured framework across four domains: Robust Risk Screening, Framework Development, Nurse Engagement, and Risk Mitigation, Monitoring and Review, with nurse managers supporting prioritization and monitoring. Key outcomes included expansion to a five-tiered risk intelligence approach, participation of over 500 nurses in risk prioritization, and 11 tracking indicators embedded in quarterly governance reviews. Overall, the redesign operationalized an ERM "bridge" between frontline risk signals and enterprise oversight, strengthening transparency, alignment, and shared accountability. The framework supports planned, periodic risk prioritization and quarterly governance review; immediate patient-safety concerns remained managed through existing clinical escalation and incident-reporting pathways. This reproducible, governance-anchored model offers practical insights for healthcare risk managers and clinical leaders seeking to strengthen internal risk governance.