The concept of a safety management system (SMS) to control the risks of operational activities has already been introduced in high-risk industries some decades ago. Nevertheless, such an SMS is often criticized as burdensome and complex. Through its requirement to formalise all main activities, the SMS is perceived as bureaucratic and as a vehicle for pure compliance, exemplary for the old view on safety management. Furthermore, the SMS is often perceived as detached from an organisation’s core and operational activities, and as incompatible with local practice. It is questioned whether it can deliver the expected safe performance....

To tackle increasing health care costs and increase quality of health care the prevention of unnecessary admission by direct referral for elderly with a social indication from the hospital to other care institutes is perceived successful by stakeholders. No method to assess the effectiveness was present in literature. A six-step assessment method is designed based on literature and tested and reflected by an application to the Zorgtransferium-process of the Albert Schweitzer Hospital. The six steps are the the Description of the object of study, the Stakeholder selection, the Indicator collection, the Indicator selection, the Data collection and the Data analysis. The Zorgtransferium-process is effective on 'Availability of hospital beds' (374 occupant days/year), 'Referral Distance'(average:8.7 km, min: 0 km, max: 19 km) and 'Referral Time' (average: 22.6 hours, min: 2 hours, max: 78 hours). The assessment method creates overarching insight for the stakeholders on the process and makes future assessment of effectiveness possible. In the future more research is needed to create a benchmark or generally accepted norms to place the results on effectiveness in broader context, the process should be expanded to other patient groups and the evidence-based management approach used in this research should be applied to other pilot projects in hospitals.