Presentation given at the Informa conference in October 2014.

1. Risk Risk…Everywhere!
The Benefits of Utilizing an ERM Framework
to Prioritize Health Leader Decisions
and Actions
Saskatchewan Cancer Agency
October 31st 2014
Jignesh Padia

2. Session Outline
 ERM Framework – What Is It?
 Assessing Risk
 Applying ERM Framework
 Case Study # 1
 Case Study # 2
 Communication and Monitoring
 Summary

3. ERM Framework – What Is It?

4. Does This Look Familiar?
* ISO 31000 Framework and Risk Management Process
*

5. Group Discussion:
How far are you in the roll out of your
organization’s Enterprise Risk Management (ERM)
Program?
What is one thing you are proud of about your
ERM program?
What is one way your ERM program could be
improved?

6. Voting…
We will be using real-time voting
technology to hear from you throughout
the presentation.

7. How Far Are You On Your Risk Management Program
(Framework) Journey Within Your Organization?
AB
CD
We haven’t started yet.
We are working on it.
We have implemented one, but not tested its effectiveness.
We have a fully functional and integrated risk management
program.
0% 0% 0% 0%
A
B
C
D

8. Lets Start Assessing Risk!
Time to make a Decision…

9. Do You See Any Risk?
0% 0% 0% 0% 0%
Bald Tire
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
Negligible
Minor
Moderate
Major
Critical

10. Do You See Any Risk?
Tire Swing (tied to rope)
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
0% 0% 0% 0% 0%
Negligible
Minor
Moderate
Major
Critical

11. Do You See Any Risk To A Child
Using The Swing?
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
0% 0% 0% 0% 0%
Negligible
Minor
Moderate
Major
Critical

12. What Was Your Frame Of Reference?
100
80
60
40
20
0
-20
% identified risk as Major
0 0.5 1 1.5 2 2.5 3 3.5

13. Do You See Any Risk?
Patients on combined cancer treatments (chemo and
radiation therapy) are missing an identifier in the patient
registry system when their treatment plan is decided, which
lets the agency staff know they are on both treatments.
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
Negligible
0% 0% 0% 0% 0%
Minor
Moderate
Major
Critical

14. Do You See Any Risk?
These concurrent therapy patients need to have
their therapies coordinated or their therapies will
have limited effect.
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
Negligible
0% 0% 0% 0% 0%
Minor
Moderate
Major
Critical

15. Do you see any risk?
The missing concurrent therapies identifier is
caught and activated when the patient arrives
for their first visit, before any coordination of
care is necessary.
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
Negligible
0% 0% 0% 0% 0%
Minor
Moderate
Major
Critical

16. What Was Your Frame Of Reference?
100
80
60
40
20
0
-20
% identified risk as Major
0 0.5 1 1.5 2 2.5 3 3.5

17. A Framework To Assess Risk …
* ISO 31000 Framework and Risk Management Process
*

18. Applying an ERM Framework
Case Study # 1

19. Case Study # 1: Background Information
Assume that you are part of a Long Term Care (LTC) Senior Leadership Team
Stats from an organization’s annual and Accreditation reports:
 35% of all Long Term Care (LTC) facilities were audited by the Health
and Wellness Compliance Team in 2008/09
 No jurisdiction received 100% compliance. The combined provincial
compliance rating was 57%
 The common areas of non-compliance are medication management,
infection prevention and control, resident safety and staff education
 Food Safety Inspections – 95,389
 Has 12 independent Health Advisory Councils for various areas of this
province.
Accreditation Survey Result

20. Based on the given information, if this organization were to end up
on the front page of a national or regional newspaper, how severe
would the consequences be?
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
0% 0% 0% 0% 0%
Negligible
Minor
Moderate
Major
Critical

21. What Should Your Response Be?
AB
CDEF
Do nothing
Improve infection control measures
Improve medication management
Improve the use of restraints and aids
Reduce Fire Risks and Install Sprinklers
Other (e.g. Do more audits)
A
0% 0% 0% 0% 0%
B
C
D
E

22. Did You Apply a Framework?
Lets try this again….

23. Supporting Materials…
 Envelop # 1
 Envelop # 2

24. Identification, Analysis and
Evaluation of Risks
 Apply the provided document (framework to identify,
assess and evaluate LTC risks)
 Step # 1 Identify Risks
 How?
 Using the information available in Envelope # 1
 Step # 2 Assess each risk
 How?
 Based on instruction obtained by completing Step # 1
 Step # 3 Evaluate
 How?
 Use the information obtained at the end of the Step # 2 to
complete the template

25. Step 1: Identify Risks
 Ask lots of questions…
 Formulate the right questions and identify
all potential risks
 Use envelope # 1

26. Step 1: Identify Risks
 Use envelope # 1
 Case Study # 1
 Risk Map Template
 Risk Register Template
 Some Laminated Cards
 Objective: To complete the Risk Register
Template – Prioritizing risks using ERM
framework.

27. Step 2: Analyze Risks
 Use Envelope # 2
 36 pcs
 It relates to 4 Key risks you identified in Step # 1

28. Step 2: Analyze Risks
 Use Envelope # 2
 36 pcs
 It relates to 4 Key risks you identified in Step # 1
 Put all the pieces together…
 Understand the risk from different angles
 Gather all relevant information which can assist
you in making your assessment.
 Flip each puzzle over

29. Step 3: Evaluate Risks
 Did you flip over your puzzles?
Use this information and Risk
MAP Template Definitions to
complete Severity Rating for
Risk Register
Understand and establish the
context
Identify your
stakeholders
What are some of the
things which make
this risk possible or
more dangerous.
Review any previous
occurrences and factor that into
your consideration for severity,
consequences and likelihood
Identify existing
Risk Controls (+)
&
Gaps (-)
Benchmark your
processes and
controls
Use this information and
Template to identify Risk
Map Category
and Risk Domains
Use this information and Risk
MAP Template Definitions to
complete Likelihood Rating
for Risk Register

30. Step 3: Evaluate Risks
 Did you flip over your puzzles?
 Transcribe the Severity, Likelihood and Consequences
information into the template.
 Complete the template…
 Map the risk on the Heat map
 Document and understand consequences
 Assign relative priority

31. End of Step # 3

32. Based on the Analysis and information, if this organization were to
end up on the front page of a national or regional newspaper, how
severe would the consequences be?
A. Negligible
B. Minor
C. Moderate
D. Major
E. Critical
0% 0% 0% 0% 0%
Negligible
Minor
Moderate
Major
Critical

33. EDMONTON — More than 80 health-care facilities in Alberta, including three rural
hospitals and 10 health centres, are not equipped with fire-suppression sprinklers
and another 50 only have sprinklers in some areas.
Documents obtained from Alberta Health Services under a freedom of information
request reveal a number of facilities aren’t equipped with full fire suppression
systems — from small four-bed rural health centres to 100-plus bed urban mental
and acute-care hospitals.
The province says the cost of renovating the continuing-care facilities is
approximately $60 million.
Health Minister Fred Horne was not available for an interview, but said in a written
statement the Quebec fire showed “that we need to go further” in ensuring fire
safety.

34.  The Herald reported this summer that 455 of the province’s 657 seniors
facilities are not fully equipped with sprinkler systems. It reported at the
time the cost of installing sprinklers in all facilities could top $250 million.
 But Prentice vowed to address the issue if he was selected premier.
 Concern for the safety of Alberta seniors and hospital patients was
heightened last January when a fire swept through a Quebec seniors
residence, killing 32 people.

35. What Should Your Response Be?
AB
CDEF
Do nothing
Improve infection control measures
Improve medication management
Improve the use of restraints and aids
Reduce Fire Risks and Install Sprinklers
Other (e.g. Do more audits)
A
0% 0% 0% 0% 0%
B
C
D
E

36. Applying an ERM Framework
Case Study # 2

37. Case Study # 2: Background Information
 800 patient events reported in the last year.
 350 are related to patient information errors
 170 are related to patient medication errors
 150 are related to radiation treatment errors
 90 are related to scheduling errors
 40 are related to falls
 Money has been made available to purchase
another linear accelerator to reduce wait times
for patients receiving radiation treatments.
 Money has been made available to redevelop the
pediatric treatment area to shorten appointment
times.

38. End of Step #1
Identified Risk(s)

39. Based On The Given Information What Should The Top
Strategic Priority Of The Organization Be For The Next
Year?
AB
CDEF
G
Patient Information Management
Medication Process Improvement
Radiation Treatment Planning
Patient Appointment Management
Patient Falls Prevention
Operationalize a new Linear Accelerator
Redesign the Pediatric Treatment Area
A
0% 0% 0% 0% 0% 0% 0%
B
C
D
E
F
G

40. Let’s Assume We Need To Dig Deeper Before
Deciding…
 Review package #1 at your table…

41. End of Step # 2
Identified Risk(s) Likelihood Severity

42. Based On The Given Information What Should The Top
Strategic Priority Of The Organization Be For The Next
Year?
AB
CDEF
G
Patient Information Management
Medication Process Improvement
Radiation Treatment Planning
Patient Appointment Management
Patient Falls Prevention
Operationalize a new Linear Accelerator
Redesign the Pediatric Treatment Area
A
0% 0% 0% 0% 0% 0% 0%
B
C
D
E
F
G

43. End of Step # 3

44. 3 Months Later…
 Senior leadership comes out with a
strategic plan. Falls prevention is the top
priority.
 Now it is up to the managers at the clinic
to decide how to reduce falls…

45. So What Do We Do To Prevent The Risk…?
 Review package #2 at your table…

46. What Strategy Should We Employ First?
A
B
CD
Redesign falls assessment and patient support processes to
focus on the elderly (at risk) patient population.
Audit facilities for handrails, easements, and other falls related
supports.
Review external environment for risks.
Examine medication reconciliation processes to determine
med related falls risks.
0% 0% 0% 0%
A
B
C
D

47. But Wait… There’s More!
 Luckily the SCA has a risk program that is
good at integrating with planning and
communicating risks and mitigation
opportunities.
 Review the last package (#3) at your
table…

48. What Strategy Should We Employ First?
A
B
CD
Redesign falls assessment and patient support processes to
focus on the elderly (at risk) patient population.
Audit facilities for handrails, easements, and other falls related
supports.
Review external environment for risks.
Examine medication reconciliation processes to determine
med related falls risks.
0% 0% 0% 0%
A
B
C
D

49. Any Guesses What’s Causing The Falls?

50. Does Your Risk Program Provide You With
Timely Decision Support, In Time Of Crisis?
 Determine the overall impact of the incident.
 Make appropriate decisions about the incident.
 Alert the relevant people to handle the incident.

51. Applying an ERM Framework
Communication and Monitoring

52. From Information to Decision Making:
Communication and Monitoring

53. Summary
 Select a relevant and evidence based framework for
ERM
 Identify ALL risks
 Assess ALL risks
 Evaluate ALL risks
 Manage or Mitigate ALL risks
 Make an informed decision

54. Questions?
Jignesh Padia
Jignesh.padia@saskcancer.ca
54