Healthcare institutions face high levels of risk on a daily basis. Efforts have been made to address these risks and turn this complex environment into a safer environment for patients, staff, and visitors. However, healthcare institutions need more advanced risk management tools to achieve the safety levels currently seen in other industries. One of these potential tools is occurrence investigation systems. In order to be investigated, occurrences must be detected and selected for investigation, since not all institutions have enough resources to investigate all occurrences. A survey was conducted in healthcare institutions in Canada and Brazil to evaluate currently used risk management tools, the difficulties faced, and the possibilities for improvement. The findings include detectability difficulties, lack of resources, lack of support, and insufficient staff involvement.