Medical device risk management specialist implementing ISO

Risk Management Specialist

ISO 14971:2019 risk management implementation throughout the medical device lifecycle.

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Table of Contents

• Risk Management Planning Workflow
• Risk Analysis Workflow
• Risk Evaluation Workflow
• Risk Control Workflow
• Post-Production Risk Management
• Risk Assessment Templates
• Decision Frameworks
• Tools and References

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Risk Management Planning Workflow

Establish risk management process per ISO 14971.

Workflow: Create Risk Management Plan

1. Define scope of risk management activities:
   • Medical device identification
   • Lifecycle stages covered
   • Applicable standards and regulations
2. Establish risk acceptability criteria:
   • Define probability categories (P1-P5)
   • Define severity categories (S1-S5)
   • Create risk matrix with acceptance thresholds
3. Assign responsibilities:
   • Risk management lead
   • Subject matter experts
   • Approval authorities
4. Define verification activities:
   • Methods for control verification
   • Acceptance criteria
5. Plan production and post-production activities:
   • Information sources
   • Review triggers
   • Update procedures
6. Obtain plan approval
7. Establish risk management file
8. Validation: Plan approved; acceptability criteria defined; responsibilities assigned; file established

Risk Management Plan Content

Section	Content	Evidence
Scope	Device and lifecycle coverage	Scope statement
Criteria	Risk acceptability matrix	Risk matrix document
Responsibilities	Roles and authorities	RACI chart
Verification	Methods and acceptance	Verification plan
Production/Post-Production	Monitoring activities	Surveillance plan

Risk Acceptability Matrix (5x5)

Probability \ Severity	Negligible	Minor	Serious	Critical	Catastrophic
Frequent (P5)	Medium	High	High	Unacceptable	Unacceptable
Probable (P4)	Medium	Medium	High	High	Unacceptable
Occasional (P3)	Low	Medium	Medium	High	High
Remote (P2)	Low	Low	Medium	Medium	High
Improbable (P1)	Low	Low	Low	Medium	Medium

Risk Level Actions

Level	Acceptable	Action Required
Low	Yes	Document and accept; still reduce as far as possible (EU MDR)
Medium	After reduction AFAP	Reduce as far as possible; document why further reduction is impossible
High	After reduction AFAP	Reduction required; demonstrate all further options exhausted
Unacceptable	No	Design change mandatory

EU MDR — AFAP, not ALARP: For CE-marked devices, risks must be reduced as far as possible (AFAP) without economic considerations (MDR Annex I, GSPR 1–4; EN ISO 14971:2019/A11:2021 Z-annexes deviation). ALARP ("as low as reasonably practicable"), which permits cost-benefit weighing in acceptability decisions, is not an acceptable criterion under the EU MDR — a notified body will flag it. ISO 14971:2019 itself removed ALARP from the normative text. ALARP may persist in some non-EU jurisdictions (e.g., the UK HSE tradition); if used outside the EU, flag the deviation from EU requirements explicitly.

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Risk Analysis Workflow

Identify hazards and estimate risks systematically.

Workflow: Conduct Risk Analysis

1. Define intended use and reasonably foreseeable misuse:
   • Medical indication
   • Patient population
   • User population
   • Use environment
2. Select analysis method(s):
   • FMEA for component/function analysis
   • FTA for system-level analysis
   • HAZOP for process deviations
   • Use Error Analysis for user interaction
3. Identify hazards by category:
   • Energy hazards (electrical, mechanical, thermal)
   • Biological hazards (bioburden, biocompatibility)
   • Chemical hazards (residues, leachables)
   • Operational hazards (software, use errors)
4. Determine hazardous situations:
   • Sequence of events
   • Foreseeable misuse scenarios
   • Single fault conditions
5. Estimate probability of harm (P1-P5)
6. Estimate severity of harm (S1-S5)
7. Document in hazard analysis worksheet
8. Validation: All hazard categories addressed; all hazards documented; probability and severity assigned

Hazard Categories Checklist

Category	Examples	Analyzed
Electrical	Shock, burns, interference	☐
Mechanical	Crushing, cutting, entrapment	☐
Thermal	Burns, tissue damage	☐
Radiation	Ionizing, non-ionizing	☐
Biological	Infection, biocompatibility	☐
Chemical	Toxicity, irritation	☐
Software	Incorrect output, timing	☐
Use Error	Misuse, perception, cognition	☐
Environment	EMC, mechanical stress	☐

Analysis Method Selection

Situation	Recommended Method
Component failures	FMEA
System-level failure	FTA
Process deviations	HAZOP
User interaction	Use Error Analysis
Software behavior	Software FMEA
Early design phase	PHA

Probability Criteria

Level	Name	Description	Frequency
P5	Frequent	Expected to occur	>10⁻³
P4	Probable	Likely to occur	10⁻³ to 10⁻⁴
P3	Occasional	May occur	10⁻⁴ to 10⁻⁵
P2	Remote	Unlikely	10⁻⁵ to 10⁻⁶
P1	Improbable	Very unlikely	<10⁻⁶

Severity Criteria

Level	Name	Description	Harm
S5	Catastrophic	Death	Death
S4	Critical	Permanent impairment	Irreversible injury
S3	Serious	Injury requiring intervention	Reversible injury
S2	Minor	Temporary discomfort	No treatment needed
S1	Negligible	Inconvenience	No injury

See: references/risk-analysis-methods.md

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Risk Evaluation Workflow

Evaluate risks against acceptability criteria.

Workflow: Evaluate Identified Risks

1. Calculate initial risk level from probability × severity
2. Compare to risk acceptability criteria
3. For each risk, determine:
   • Acceptable: Document and accept (EU MDR: still reduce as far as possible)
   • Reduction required (AFAP): Proceed to risk control
   • Unacceptable: Mandatory risk control
4. Document evaluation rationale
5. Identify risks requiring benefit-risk analysis
6. Complete benefit-risk analysis if applicable
7. Compile risk evaluation summary
8. Validation: All risks evaluated; acceptability determined; rationale documented

Risk Evaluation Decision Tree

Risk Estimated
      │
      ▼
Apply Acceptability Criteria
      │
      ├── Low Risk ──────────► Accept and document
      │
      ├── Medium Risk ───────► Reduce as far as possible (AFAP)
      │   │                    Document why further reduction impossible
      │   ▼
      │   Further reduction possible?
      │   │
      │   Yes──► Implement control
      │   No───► Document AFAP rationale (no economic considerations)
      │
      ├── High Risk ─────────► Risk reduction required
      │   │                    Must demonstrate reduction AFAP
      │   ▼
      │   Implement control
      │   Verify residual risk
      │
      └── Unacceptable ──────► Design change mandatory
                               Cannot proceed without control

AFAP Demonstration Requirements (EU MDR)

Criterion	Evidence Required
All control options considered	Analysis of every feasible control per the hierarchy (design, protective measures, information)
Further reduction impossible	Evidence each remaining option is technically infeasible or does not further reduce risk
State of the art	Comparison to similar devices and current standards
Stakeholder input	Clinical/user perspectives

Economic considerations (cost of further risk reduction) must not enter the EU acceptability decision (MDR Annex I GSPR 2; EN ISO 14971:2019/A11:2021). Cost may inform business decisions about whether to market the device — never whether a risk is acceptable.

Benefit-Risk Analysis Triggers

Situation	Benefit-Risk Required
Residual risk remains high	Yes
No feasible risk reduction	Yes
Novel device	Yes
Unacceptable risk with clinical benefit	Yes
All risks low	No

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Risk Control Workflow

Implement and verify risk control measures.

Workflow: Implement Risk Controls

1. Identify risk control options:
   • Inherent safety by design (Priority 1)
   • Protective measures in device (Priority 2)
   • Information for safety (Priority 3)
2. Select optimal control following hierarchy
3. Analyze control for new hazards introduced
4. Document control in design requirements
5. Implement control in design
6. Develop verification protocol
7. Execute verification and document results
8. Evaluate residual risk with control in place
9. Validation: Control implemented; verification passed; residual risk acceptable; no unaddressed new hazards

Risk Control Hierarchy

Priority	Control Type	Examples	Effectiveness
1	Inherent Safety	Eliminate hazard, fail-safe design	Highest
2	Protective Measures	Guards, alarms, automatic shutdown	High
3	Information	Warnings, training, IFU	Lower

Risk Control Option Analysis Template

RISK CONTROL OPTION ANALYSIS

Hazard ID: H-[XXX]
Hazard: [Description]
Initial Risk: P[X] × S[X] = [Level]

OPTIONS CONSIDERED:
| Option | Control Type | New Hazards | Feasibility | Selected |
|--------|--------------|-------------|-------------|----------|
| 1 | [Type] | [Yes/No] | [H/M/L] | [Yes/No] |
| 2 | [Type] | [Yes/No] | [H/M/L] | [Yes/No] |

SELECTED CONTROL: Option [X]
Rationale: [Justification for selection]

IMPLEMENTATION:
- Requirement: [REQ-XXX]
- Design Document: [Reference]

VERIFICATION:
- Method: [Test/Analysis/Review]
- Protocol: [Reference]
- Acceptance Criteria: [Criteria]

Risk Control Verification Methods

Method	When to Use	Evidence
Test	Quantifiable performance	Test report
Inspection	Physical presence	Inspection record
Analysis	Design calculation	Analysis report
Review	Documentation check	Review record

Residual Risk Evaluation

After Control	Action
Acceptable	Document, proceed
Reduced AFAP	Document rationale (no economic considerations), proceed
Still unacceptable	Additional control or design change
New hazard introduced	Analyze and control new hazard

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Post-Production Risk Management

Monitor and update risk management throughout product lifecycle.

Workflow: Post-Production Risk Monitoring

1. Identify information sources:
   • Customer complaints
   • Service reports
   • Vigilance/adverse events
   • Literature monitoring
   • Clinical studies
2. Establish collection procedures
3. Define review triggers:
   • New hazard identified
   • Increased frequency of known hazard
   • Serious incident
   • Regulatory feedback
4. Analyze incoming information for risk relevance
5. Update risk management file as needed
6. Communicate significant findings
7. Conduct periodic risk management review
8. Validation: Information sources monitored; file current; reviews completed per schedule

Information Sources

Source	Information Type	Review Frequency
Complaints	Use issues, failures	Continuous
Service	Field failures, repairs	Monthly
Vigilance	Serious incidents	Immediate
Literature	Similar device issues	Quarterly
Regulatory	Authority feedback	As received
Clinical	PMCF data	Per plan

Risk Management File Update Triggers

Trigger	Response Time	Action
Serious incident	Immediate	Full risk review
New hazard identified	30 days	Risk analysis update
Trend increase	60 days	Trend analysis
Design change	Before implementation	Impact assessment
Standards update	Per transition period	Gap analysis

Periodic Review Requirements

Review Element	Frequency
Risk management file completeness	Annual
Risk control effectiveness	Annual
Post-market information analysis	Quarterly
Risk-benefit conclusions	Annual or on new data

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Risk Assessment Templates

→ See references/risk-assessment-templates.md for details

Decision Frameworks

Risk Control Selection

What is the risk level?
        │
        ├── Unacceptable ──► Can hazard be eliminated?
        │                    │
        │                Yes─┴─No
        │                 │     │
        │                 ▼     ▼
        │            Eliminate  Can protective
        │            hazard     measure reduce?
        │                           │
        │                       Yes─┴─No
        │                        │     │
        │                        ▼     ▼
        │                   Add       Add warning
        │                   protection + training
        │
        └── High/Medium ──► Apply hierarchy
                            starting at Level 1

New Hazard Analysis

Question	If Yes	If No
Does control introduce new hazard?	Analyze new hazard	Proceed
Is new risk higher than original?	Reject control option	Acceptable trade-off
Can new hazard be controlled?	Add control	Reject control option

Risk Acceptability Decision

Condition	Decision
All risks Low	Acceptable
Medium risks reduced AFAP	Acceptable
High risks reduced AFAP, documented	Acceptable if benefits outweigh
Any Unacceptable residual	Not acceptable - redesign

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Tools and References

Scripts

Tool	Purpose	Usage
risk_matrix_calculator.py	Calculate risk levels and FMEA RPN	python risk_matrix_calculator.py --help

Risk Matrix Calculator Features:

• ISO 14971 5x5 risk matrix calculation
• FMEA RPN (Risk Priority Number) calculation
• Interactive mode for guided assessment
• Display risk criteria definitions
• JSON output for integration

References

Document	Content
iso14971-implementation-guide.md	Complete ISO 14971:2019 implementation with templates
risk-analysis-methods.md	FMEA, FTA, HAZOP, Use Error Analysis methods

Quick Reference: ISO 14971 Process

Stage	Key Activities	Output
Planning	Define scope, criteria, responsibilities	Risk Management Plan
Analysis	Identify hazards, estimate risk	Hazard Analysis
Evaluation	Compare to criteria, AFAP assessment (EU)	Risk Evaluation
Control	Implement hierarchy, verify	Risk Control Records
Residual	Overall assessment, benefit-risk	Risk Management Report
Production	Monitor, review, update	Updated RM File

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Related Skills

Skill	Integration Point
quality-manager-qms-iso13485	QMS integration
capa-officer	Risk-based CAPA
regulatory-affairs-head	Regulatory submissions
quality-documentation-manager	Risk file management