Enhancing clinical and non-clinical risk management: A case study using ELECTRE Tri-nC

Adverse events in healthcare continue to challenge hospital management practices, often resulting in avoidable patient harm and substantial financial costs. Despite technological progress and the availability of risk management tools, healthcare institutions still struggle to systematically monitor and evaluate risk dynamics over time. This study proposes a multi-criteria decision analysis framework based on the ELECTRE Tri-nC method to assess the evolution of clinical and non-clinical risks at Hospital da Luz Lisboa, a private Portuguese hospital. A panel of risk management experts evaluated twelve criteria across five years (2018-2022), enabling the classification of each quarter into one of five predefined risk categories. The model accommodates the non-compensatory nature of risk indicators and integrates expert-defined thresholds. Results reveal critical periods of heightened risk, underscoring the importance of analysing risk trends over time rather than focusing on isolated incidents. A stability analysis confirms the robustness of the weight structure and highlights the model's sensitivity to changes in the credibility threshold. Overall, the proposed approach provides healthcare decision-makers with a transparent and structured framework for retrospective risk analysis and supports the design of timely, targeted mitigation strategies. The methodology is adaptable to other hospital settings.