manajemen risiko perusahaan adalah Suatu Proses yg dilakukan oleh BOD dan manajemen di semua level unit yang dirancang dalam suatu strategi Institusi untuk mengidentifikasi kejadian potensial yang dapat mempengaruhi Institusi dan mengelola risiko tersebut untuk pencapaian tujuan institusi

1. Risk Management Process and
Enterprise Risk Management
(ERM)
Dr Arjaty Daud MARS
Disampaikan pada Kuliah Program Magister Administrasi RS
Univ Esa Unggul
Semsester 2 - 2016

2.  Proses Manajemen risiko
 Definisi Enterprise Risk Management
(ERM)
 Frame work ERM
 Elemen penting dalam ERM
 Domain risiko
 Area untuk di ases
Pembahasan
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3. Risk Management Process
1. Risk Identification and Analysis
2. Risk Treatment
• Risk Control
• Risk Financing
3. Evaluation of Risk Treatment
Strategies
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4. Structure Of The Risk Management Process
LossPrevention(frequency)
NetIncome Liability Personnel
ContractualTransfer
(noninsurance)
Property
Active
Non-insurance
&
Self-insurance
Loss
RiskAnalysis
+LossFrequency:
Howlikely is itthat
aloss willhappen?
+LossSeverity:
Howserious willthe
loss be? Insurer
Acarrier
Passive
Not
recognize
d
Non-Insurer
Hold
harmless
agreements
Risk
Identification
+Identifytheloss
Segregation
LossReduction(severity)
Transfer
RiskFinancing
Retention
TreattheExposureThroughRMTechniques
Identify/AnalyzeExposure
RiskAvoidance
RiskControl
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5. The Five Steps In The Risk
Management Process
1. Identify loss exposures
2. Examine potential risk management
technique(s)
3. Select risk management technique(s)
4. Implement technique(s)
5. Monitor results
(ARM) Arjaty Daud/Esa Unggul 2016 5

6. RISK MANAGEMNT PROCESS
(Standard Australia / New Zealand / AS/NZS)
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7. Arjaty Daud/Esa Unggul 2016 7

8. Why
a centralized approach to risk management?
• globalization of financial and business
markets, / globalisasi keuangan & bisnis
• continued integration of the insurance
industry, /integrasi industri asuransi
• increased regulation, /meningkatnya regulasi
• greater focus on corporate governance. / lebih
fokus pada tata kelola korporasi
• context of clinical governance and patient
safety / clinical governance & keselamatan
pasien
Arjaty Daud/Esa Unggul 2016

9. Definisi Enterprise Risk Management
(ERM) :
Suatu Proses yg dilakukan oleh BOD
dan manajemen di semua level unit
yang dirancang dalam suatu strategi
Institusi untuk mengidentifikasi
kejadian potensial yang dapat
mempengaruhi Institusi dan mengelola
risiko tersebut untuk pencapaian
tujuan institusi
Arjaty Daud/Esa Unggul 2016 9

10. ERM menggunakan pendekatan
fungsi silang untuk ases, evaluasi,
dan mengukur semua risiko
institusi, tidak hanya yang terkait
dengan risiko yang bisa ditransfer
seperti keuangan & risiko hazard
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11. The traditional six-step risk management process :
1. risk identification,
2. risk analysis,
3. development of alternative techniques to treat risks,
4. selection of best risk-treatment techniques,
5. implementation of selected techniques,
6. monitoring and evaluation of effectiveness of the chosen risk
management techniques and strategies.
ERM expands the process to more fully integrate
risk management into the organization’s structure. / lebih
mengintegrasikan manajemen risiko kedalam struktur organisasi
This entails an interactive approach to risk identification,
analysis,and treatment through an entrenchment of risk
management principles into corporate operations and strategic
planning./ pendekatan interaktif untuk identifikasi risiko,
analisa & kelola melalui prinsip manajemen riisko kedalam
operasional korporasi & Renstra
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12. The ERM Framework
KATEGORI
KOMPONENi
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13. Achievement of Objectives
Within the context of an entity’s established mission or vision,
management establishes strategic objectives, selects strategy, and
sets aligned objectives cascading through the enterprise./ Dalam
konteks menetapkan misi atau visi korporasi, manajemen menetapkan
tujuan strategi, memilih strategi, dan menentukan tujuan yang sejalan
dengan korporasi
Framework ERM diarahkan untuk mencapai tujuan
korporasi :
EMPAT KATEGORI
1.Strategic – high-level goals, aligned with and supporting its
mission / tujuan kedepan sesuai dengan misi
1.Operations – effective and efficient use of its resources
2.Reporting – reliability of reporting
3.Compliance – compliance with applicable laws & regulations
.
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14. Components of Enterprise Risk Management
Enterprise risk management consists of eight interrelated
components. These are derived from the way management runs an
enterprise and are integrated with the management process. / ERM
terdiri dari DELAPAN KOMPONEN saling terkait yang diperoleh
dari cara manajemen mengelola korporasi dan integrasikan
dengan proses manajemen
DELAPAN KOMPONEN ERM :
1.Internal Environment – The internal environment encompasses
the tone of an organization, and sets the basis for how risk is
viewed and addressed by an entity’s people, including risk
management philosophy and risk appetite, integrity and ethical
values, and the environment in which they operate. / Lingkungan
internal meliputi “Tone” organisasi, dan menetapkan dasar
bagaimana risiko dipandang dan ditangani oleh orang2 dlm
Institusi, termasuk filosofi manajemen risiko dan risk appetite,
integritas dan nilai2 etika, dan lingkungan di mana mereka bekerja
Arjaty Daud/Esa Unggul 2016 14

15. 2. Objective Setting – Objectives must exist before
management can identify potential events affecting their
achievement. Enterprise risk management ensures that
management has in place a process to set objectives and that
the chosen objectives support and align with the entity’s
mission and are consistent with its risk appetite. / tujuan
harus ada sebelum manajemen bisa identifikasi event yang
mempengaruhi pencapaian mereka. ERM memastikan
bahwa manajemen berjalan utnuk menentukan tujuan
sejalan dengan misi
3. Event Identification – Internal and external events
affecting achievement of an entity’s objectives must be
identified, distinguishing between risks and opportunities.
Opportunities are channeled back to management’s strategy
or objective-setting processes. / event internal & eksternal
mempengaruhi pencapaian tujuan korporasi harus
diidentifikasi, bedakan antara risiko dan peluang. Peluang
merupakan alat untuk kembali ke strategi atau proses
untuk menentukan tujuan
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16. 4. Risk Assessment – Risks are analyzed, considering
likelihood and impact, as a basis for determining how they
should be managed. Risks are assessed on an inherent
and a residual basis./ Risiko dianalisa, dihitung peluang
dan dampak, sebagai dasar menentukan mengelola risiko
5. Risk Response – Management selects risk responses –
avoiding, accepting, reducing, or sharing risk –
developing a set of actions to align risks with the entity’s
risk tolerances and risk appetite./ manajemen memilih
respon – tolak, terima, reduksi, atau transfer- buat aksi
untuk menangani riisko sesuai toleransi & risk appetite
6. Control Activities – Policies and procedures are
established and implemented to help ensure the risk
responses are effectively carried out./ kebijakan &
prosedur ditetapkan & diimplementasi utnuk memastikan
respon riisko dilaksanakan dengan efektif
Arjaty Daud/Esa Unggul 2016 16

17. 7. Information and Communication – Relevant
information is identified, captured, and communicated in a
form and timeframe that enable people to carry out their
responsibilities. Effective communication also occurs in a
broader sense, flowing down, across, and up the entity./
informasi yang relevan diidentifikasi, dikomunikasikan
dalam bentuk & jnagkawaktu yang membuat individu
melaksanakan tanggungjawabnya. Komunikasi efektif juga
terjadi sangat luas diseluruh korporasi
8. Monitoring – The entirety of enterprise risk management
is monitored and modifications made as necessary.
Monitoring is accomplished through ongoing management
activities, separate evaluations, or both./ ERM dimonitor
& dimodifikasi jika diperlukan. Monitoring dicapai melalui
aktiiftas manajemen yang berjalan, evaluasi yang terpsah,
atau keduanya Arjaty Daud/Esa Unggul 2016 17

18. ERM considers activities at all
levels of the organization:
THREE LEVEL :
1. Enterprise-level
2. Division
3. Subsidiary
4. Business unit processes
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19. Risk Strategy •What is your organization’s
ERM strategy?
•How is the ERM strategy
communicated and executed
throughout the company?
Risk Ownership •How does each division / unit
team contribute to meeting
the goals of the ERM strategy?
•How are teams/individuals
held accountable for success?
Risk Identification • What is your organization’s
definition of risk?
• What are your organization’s
top five risks?
KEY ELEMENTS OF ERM
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20. Risk Ranking •What are the estimated probability,
time to impact and severi
dimensions for the top five risks?
• What are the financial
consequences to you company?
• Which risks are material?
• How should the identified risks be
prioritized?
Risk Treatment •How are these risk currently
managed?
•Is the approach effective?
Risk Solutions •What risk management processes
are appropriate based upon the
findings of the above elements?
•What action plans should be in
place?
• How are risks monitored?
Arjaty Daud/Esa Unggul 2016

21. Areas to Assess
Risiko tidak terjadi secara terisolasi (silos)
namun diidentiifkasi secara kelompok dan
dikategorikan dlm Domain Risiko :
1. Operational
2. Financial
3. Human Capital
4. Strategic
5. Legal/Regulatory
6. Technology
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22. DOMAIN RISIKO :
1. Risiko operasional. timbul dari praktik
bisnis utama organisasi. Dalam organisasi
kesehatan, risiko operasional terkait dengan
pelayanan kesehatan.
2. Risiko keuangan. berhubungan dengan
kemampuan organisasi untuk meningkatkan
dan mempertahankan akses ke modal,
masalah kontrak, biaya risiko, dan evaluasi
dukungan pemasok. Domain ini termasuk
risiko memenuhi syarat untuk risiko
pembiayaan, seperti asuransi.
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23. 3. Risiko modal manusia. kemampuan
organisasi untuk memperoleh, mengelola, dan
mempertahankan pekerja. Kompensasi
pekerja, pekerjaan dan lingkungan bahaya,
omset, absensi, kekerasan di tempat kerja,
pelecehan, dan diskriminasi masuk dalam
domain ini
4. Risiko strategis. Risiko yang berdampak
pada pertumbuhan organisasi. Risiko strategis
termasuk merger, akuisisi, usaha patungan,
dan kewajiban iklan. Selain itu, domain risiko
strategis meliputi risiko reputasi yang terkait
dengan hubungan masyarakat dan ekspektasi
kinerja bagi organisasi oleh pasien dan
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24. 5.Hukum dan peraturan risiko. termasuk risiko
yang terkait dengan aturan yang diamanatkan,
peraturan, UU dan standar. Dalam pelayanan
kesehatan, peraturan dan standar2 ini banyak
dan rumit. Contoh akreditasi dan privasi dan
peraturan keamanan.
6. Risiko teknologi. berhubungan dengan
teknologi baru. Ini adalah domain resiko yang
tumbuh dalam pelayanan kesehatan dan
termasuk perangkat biomedis, telemedicine, obat
elektronik, sistem informasi manajemen risiko
dan teknologi informasi lainnya, dan peralatan
usang
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25. Areas to Assess
1. Operational risks
2. Financial
3. Human capital
4. Strategic
5. Legal/regulatory
6. Technology
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26. Enterprise Risk Management
Operational
Human Capital
Financial
Legal/
Regulatory
ASHRM Handbook
Technology
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27. Assessment
Model
PATIENT /
ORGANIZATION
Operational
Human Capital
Legal/Regulatory
Enterprise Risk Management
Assessment
Financial
Strategic
Technology
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28. Areas To Assess:
Operational
 Quality initiatives
 Risk management
 Adverse event management
 Board governance
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29. Areas To Assess:
A Board’s Legal Risks
 Duty to
supervise/manage
 Select competent
physicians
 Conflict of interests
 Provide adequate
facilities and
equipment
 Provide adequate
insurance
 Provide satisfactory
patient care
 Select competent
administrator
 Require competitive
bidding
 Provide safe
environment
 Regulatory and
JCAHO compliance
Arjaty Daud/Esa Unggul 2016 29

30. Areas To Assess:
Operational
 Credentialing and staffing
– Initial appointment
– Reappointment
– Affiliated staff
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31. Areas To Assess:
Operational
● Clinical
– Patient communication
– Patient care records
– Confidentiality
– Informed decision making
– Telephone protocols
– Tracking diagnostic information
– Primary care screening and monitoring
– Supervision
Arjaty Daud/Esa Unggul 2016 31

32. Areas To Assess:
Operational
● Clinical
– Patient satisfaction/complaints
– Referrals and consultations
– Coverage issues
– Infection control
– Medication safety
– Emergency response
– Patient and staff education
Arjaty Daud/Esa Unggul 2016 32

33. Areas To Assess:
Operational
 General Liability Assessment Topics
– Safety program
– Security program
– Facility management
 Parking (lighting, location, security)
– Visitor control procedures
– Valuables
Arjaty Daud/Esa Unggul 2016 33

34. Assessment
Model
PATIENT /
ORGANIZATION
Operational
Human Capital
Legal/Regulatory
Enterprise Risk Management
Assessment
Financial
Strategic
Technology
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35. Areas To Assess:
Financial
 Risk Financing Treatments
– Insurance
– Self-insurance
 Ability to raise capital
 Reimbursement
 Billing and collection
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36. Areas To Assess:
Financial
 Contract Administration
– Scope of service and method of payment /
ruanglingkup layanan dan metode pembayaran
– Professional services provided / layanan profesional
– Quality expectations / ekspektasi mutu
– Contractual terms
– Termination provisions
– Risk-sharing agreements
– Apparent agency liability
– Hold harmless and indemnity agreements
– Remedies for breach
Arjaty Daud/Esa Unggul 2016 36

37. Assessment
Model
PATIENT /
ORGANIZATION
Operational
Human Capital
Legal/Regulatory
Enterprise Risk Management
Assessment
Financial
Strategic
Technology
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38. Areas To Assess:
Human Capital
 Employment Practices/ Human
Resources Topics
– Workers’ compensation
– Harassment
– Negligent firing
– Discrimination
– Testing
– Background checks
– Grievance procedures
– Confidentiality
Arjaty Daud/Esa Unggul 2016 38

39. Areas To Assess:
Human Capital
 Employment Practices/Human Resources Topics
– Education
 orientation
 continuing education
 CPR
– Employee health
 exposures
– Employee assistance programs (EAPs)
– Benefits
– Staff rights and staff competency
Arjaty Daud/Esa Unggul 2016 39

40. Areas To Assess:
Human Capital
 Environmental issues related to
employees
– Safety
– Security
– Occupational hazards
– Environmental hazards
Arjaty Daud/Esa Unggul 2016 40

41. Assessment
Model
PATIENT /
ORGANIZATION
Operational
Human Capital
Legal/Regulatory
Enterprise Risk Management
Assessment
Financial
Strategic
Technology
Arjaty Daud/Esa Unggul 2016
41

42. Areas To Assess:
Strategic
 Strategic plan and mission
– Immediate goals vs. long range goals
 Business ventures
– Mergers
– Acquisitions and divestitures
– Joint ventures
 Competition’s status
 Advertising liability
 Reputational risks
– Patient and community relations
– Media relations
– Marketing and sales
Arjaty Daud/Esa Unggul 2016
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43. Areas To Assess:
Strategic
 New Projects and Services Topics
– “Fit” with existing organization structure
– Identification of insurance needs
– Staff requirements
– Contract needs
– Competitive impacts
– Process development
 Policies/procedures
– Implementation schedules
Arjaty Daud/Esa Unggul 2016 43

44. Areas To Assess:
Strategic
 Construction/Renovation
–Licenses/permits
–Contracts
–Disruption of services
–Hazards
 Air quality
 Interim and design safety
–Communication issues
–Approvals
Arjaty Daud/Esa Unggul 2016 44

45. Assessment
Model
PATIENT /
ORGANIZATION
Operational
Human Capital
Legal/Regulatory
Enterprise Risk Management
Assessment
Financial
Strategic
Technology
Arjaty Daud/Esa Unggul 2016
45

46. Areas To Assess:
Legal and Regulatory
 Statutes, standards and regulations
– Federal, state and local impacts
 Licensure
 Accreditation
Arjaty Daud/Esa Unggul 2016 46

47. Areas To Assess:
Legal and Regulatory
 Corporate Compliance Program/Interface
– Identification of related compliance factors
/ identifikasi faktor terkait kepatuhan
– Compliance assessment results / hasil
asesmen kepatuhan
– Program components - education,
reporting, data maintenance, review,
monitoring
– Relationships
Arjaty Daud/Esa Unggul 2016 47

48. Assessment
Model
PATIENT /
ORGANIZATION
Operational
Human Capital
Legal/Regulatory
Enterprise Risk Management
Assessment
Financial
Strategic
Technology
Arjaty Daud/Esa Unggul 2016
48

49. Areas To Assess:
Technology
 Information systems
 Telemedicine
 Equipment
 New technologies
 Inventory control
Arjaty Daud/Esa Unggul 2016 49

50. Areas To Assess
 Setting priorities for program development /
buat prioritas untuk pengembangan program
– Utilize information from external and
internal assessment sources / gunakan
informasi dari sumber ekstrenal & internal
– Goals should be:
 Flexible
 Short and long term
– Priorities should be:
 Politically correct
 Financially correct
 Ethically correct
Arjaty Daud/Esa Unggul 2016 50