Risk management is an important tool to decrease medical errors and to improve overall quality of care in US hospitals. To gain insight into current practices in US hospitals, survey methods were used to explore the extent to which risk management systems in hospitals have the tools, resources and staffing appropriate to handle and improve risk management. It was clear from both a voluminous literature on this topic and the survey that hospitals still have many challenges with regard to implementing risk management systems. Most hospitals had only one or a few risk management personnel who had little ongoing training and background preparation in risk management methodology. They performed a large variety of tasks and were faced with a large range of risks. Although the framework used for this study was primarily oriented to assessing performance, results suggested that hospital culture and behaviors often seemed to contribute to key concerns, such as the willingness to hire individuals with little background in formal risk management and to accept as standard practice the use of only very risk management tools.