RBQM implementation requires a shift in mindset and culture, as well as a set of tools and processes, to transition from a traditional to a risk-based approach. The key steps and elements for RBQM implementation include establishing a framework that defines roles and responsibilities, policies and procedures, metrics and indicators. Additionally, it is necessary to conduct a risk assessment to identify potential sources of risk, the likelihood and impact of each risk, and the risk tolerance level for the trial. Developing a risk mitigation plan is also important, which involves determining actions and measures to prevent or reduce risks, triggers and thresholds for intervention, and contingency plans for escalation and resolution. Moreover, implementing a risk monitoring plan helps collect and analyze data to track trial performance and quality, detect any deviations or issues, and evaluate the effectiveness of the risk mitigation plan. Finally, it is essential to review and update the risk management plan based on feedback from data analysis, audits, and inspections.