Risk management is a broad term, and its approach depends on the context, stakeholders, and types of business. In hospitals, risk management most often relates to patient safety systems [ 1]. Improving the patient safety system is a significant concern accounting for 3.7-16.6%. Patients admitted to hospitals suffer adverse events, about 50 percent of which are preventable [ 2]. The research in this area inclined rapidly.

Patient safety goal is prioritized in clinical risk management (CRM) to protect against reputational loss for hospitals. CRM performs a vital function in enabling hospitals to identify, assess, and mitigate related to patient safety [ 3]. A study [ 4] concluded that the clinical risk glossary included adverse events, active faults, sentinel events, damages, accidents and so on. Identifying the coverage of clinical risks assists hospitals in managing risks effectively as well as the continuous improvement in quality management function. However, the challenge in hospital risk management perceives that “Does patient safety goal in CRM cover holistic hospital risk management?”.

Managing a hospital in a VUCA (Volatility, Uncertainty, Complexity and Ambiguity) environment is quite difficult. COVID-19 tested the robustness of several hospital systems, such as the readiness of the medical workforce, unique crisis communication, shortage of hospital beds, logistics as well as citizen perspective toward hospitals [ 5, 6]. Even though hospitals generate revenue from vaccination services, this dilemma perceives both risk and opportunity for hospitals. While patient safety is compulsory and perceivable as a hospital foundation, its process covers only a patient risk aspect. Nevertheless, there are still other adverse events related to non-clinical risk, for example, failure in strategic plan implementation, not complying with hospital regulations and laws, declined revenue and so forth. Managing risk in hospitals and healthcare industries should cover the mainstream of corporate strategy. Therefore, the development of an Enterprise Risk Management (ERM) program in hospitals is a mandate.

The American Society for Health Care Risk Management (ASHRM)- a professional membership group of the American Hospital Association (AHA)- promotes effective and innovative risk management beyond the mentioned CRM. These publications address the effective and practical ERM [ 7]. However, some publications revealed that hospitals still suffer from establishing process-orientated ERM and lack of attention and key person expertise [ 8, 9]. Successful implementation of ERM in hospitals is not straightforward for several reasons. First and foremost, the hospital executive team perceives hospital risk as patient safety and neglects the holistic view. Secondly, the complexity of the hospital environment is caused by the several stakeholders as well as the burden culture [ 10]. Well-known international ERM standards such as COSO (Committee of Sponsoring of the Treadway Commission) and ISO 31000, as well as academic articles, agree that culture and leadership perspective in risk are the most influential factors [ 11, 12].

Moreover, ERM nowadays has evolved from the prior paradigm by considering sustainable factors: ESG (Environment, Social and Governance). Climate change adaptation and mitigation failure, environmental degradation, workplace inequality, as well as the compositions of management and Board of Directors are incorporated in the ERM portfolio. Some articles across the industry revealed that ESG has a significant moderating role in increasing the effect of ERM on firm value [ 13-17]. Nonetheless, we hesitate to determine whether hospitals include sustainable factors while implementing risk management Taking this into consideration, our team planned to fix two research questions (1) What are the main focusing areas of hospital risk management globally? (2) According to the main focusing areas in (1), what are the current stage and the implementation gap using public and private Thai hospitals as a case study. The trend data in (1) was analyzed using text analytics toward bibliometric data from several cohort studies in the SCOPUS database. Bibliometric analysis conveys significant information relating to “what is the research trend, who are the productive authors, where are the well-known countries that study this research?” yet it does not answer these questions.

According to the descriptive analysis of publication pattern, co-occurrence of author keywords, clustering, as well as thematic analysis, the major theme of hospital risk management is still patient safety which is the goal of CRM. However, this research profiling has evolved from time to time. We gained insightful, relevant keywords, such as Enterprise Risk Management (ERM), resilience, sustainability, crisis management as well as disaster. Our team concluded past, present and future research themes in hospital risk management: 1) patient safety and CRM, 2) ERM and 3) Sustainable Hospital.

Bibliometrics text analytics precisely shows that the outstanding hospital risk management is from patient safety and CRM. A highly cited paper (Table 2) was published in PLoS one, “Risk Factors for Violence in Psychosis: Systematic Review and Meta-Regression Analysis of 110 Studies” [ 27]. This paper conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar with its aim to identify the reported factors associated with violence in adults diagnosed. There were 405 citations in this paper. Markedly, among the researchers, most citations in hospital risk management until now are patient safety and

Fig. (7). Evolution of author keywords discussion.

CRM. It confirms that patient safety is the main topic in hospital risk management.

However, patient safety and CRM are both operational risk management, while other types of risk should be a concern. Even the majority theme in hospital risk management in our text analytics approach indicated the high attention to clinical risk. The current hotspot theme nowadays accounts for “ERM” (cluster red in Fig. ( 5). Studying non-clinal risk is not new. One of the highly cited articles from an author [ 28], stated the lean system mentioned non-clinical risk management in hospitals; however, ERM in the hospital was not mentioned at that time.

Indeed, from 803 publications, we found 32 articles related to ERM in hospitals. There are two more citations from Etges [ 8, 9] since 2018 and 2019, respectively. Furthermore, Etges has citations in 14 articles. The first article of his team, “Development of an enterprise risk inventory for healthcare,” was published in BMC Health Services Research, 18(1). The aim of this paper was to propose ERM inventory risk to healthcare organizations by using several types of information. Additionally, the second paper was published in the Journal of Risk Research, 22(4), entitled “A proposed enterprise risk management model for health organizations.” The objective of this paper is to propose an ERM model for health organizations using a systematic review of seven case studies in Brazilian hospitals. Importantly, it concluded that studying ERM in hospitals is new and needs to be studied further.

ERM fulfills patient safety and CRM as it allows hospitals to be concerned about other important aspects. For example, inadequate medical staff risk has materialized globally, as well as the COVID situation disrupted hospitals relating to routine operations.

The thematic maps show the emerging theme of sustainability in the hospital sector in recent times. “Sustainable development” was formally established in 1987 with the concept of “the development that meets the needs of the present without compromising the ability of future generations to meet their own needs” [ 29, 30], it is now a starting point in the healthcare and hospital sector. We found only 3 documents related to “sustainable risk in hospitals” in the SCOPUS database [ 31-33].

Studying hospital risk management is not new. However, the analysis of its trend is neglected. We then explored the hospital risk management research landscape from reliable documents in SCOPUS for 43 years using bibliometric analysis. Although we decided not to include Pharmacology, Toxicology and Pharmaceutics, Biochemistry, Genetics and Molecular Biology, Immunology and Microbiology and Earth and Planetary Sciences in order to focus on risk in management view, the research profiling in this field remained “clinical risk management toward patient safety goal.”

The annual growth rate in hospital risk management publications is 7.97% and experiencing an upward trend over time. The peak of publications occurred during the spread of viruses such as SARS and COVID-19. The most productive author and highest citation conducted CRM, while the most productive country was the USA.

The common results from author keywords analysis, such as, co-occurrence and clustering, showed that the majority of hospital risk management is related to CRM aspects such as patient safety, medication error, FMEA, and so forth. However, the research themes in this field have been altered from time to time.

Bibliometric data provided some hidden insights. The main focus area is CRM, after 2020, some relevant themes were found, such as ERM, disaster, resiliency, and sustainability. The thematic analysis further confirms that the emerging theme in this field is “sustainability.”

Conducting research profiling using bibliometric analysis can generate three paradigms of hospital risk management: 1) CRM, 2) ERM and 3) sustainable risk. This article brings about two contributions. Practically, it allows the hospital management team to be concerned about related to risk aspects. In general, the risk manager often identifies risk against patient safety goals while other aspects of risk are neglected. Our bibliometric analysis closes the gap that they need to identify risk at the enterprise level as well as inclusive sustainability. Theoretically, this research initially adopts the bibliometric analysis in the risk context.

Nevertheless, this paper conveyed some limitations. Our key word analysis relied upon our search strategy. All results in this article were based on data extraction by searching. Moreover, studying hospital risk management is more than just 803 documents. There are other relevant sources, such as Web of Science, PubMed and also white papers, that this study neglected. We then proposed future studies incorporating this into their framework.