RJ
Uploaded byReynaldo Joson
PPTX, PDF1,783 views

Risk Management in Hospitals - ROJoson - 2018 - Surabaya, Indonesia

This document provides an overview of risk management in healthcare institutions from a lecture given by Reynaldo O. Joson. It discusses key concepts of risk and hospital risk management, including defining risk and describing the importance of managing risks in hospitals. It also outlines the basic framework and processes involved in hospital risk management programs, such as establishing policies and procedures, assessing risk maturity, and ensuring multisectoral coordination.

Healthcare◦
Related topics:
Risk-Management•

Embed presentation

Downloaded 66 times
1 / 141
2 / 141
Most read
3 / 141
4 / 141
5 / 141
6 / 141
7 / 141
8 / 141
9 / 141
10 / 141
11 / 141
12 / 141
13 / 141
14 / 141
15 / 141
16 / 141
17 / 141
18 / 141
19 / 141
20 / 141
21 / 141
22 / 141
23 / 141
24 / 141
25 / 141
26 / 141
27 / 141
28 / 141
29 / 141
30 / 141
31 / 141
32 / 141
33 / 141
34 / 141
35 / 141
36 / 141
37 / 141
38 / 141
39 / 141
40 / 141
41 / 141
42 / 141
43 / 141
44 / 141
45 / 141
46 / 141
47 / 141
48 / 141
49 / 141
50 / 141
51 / 141
52 / 141
53 / 141
54 / 141
55 / 141
56 / 141
57 / 141
58 / 141
59 / 141
60 / 141
61 / 141
62 / 141
63 / 141
64 / 141
65 / 141
66 / 141
67 / 141
68 / 141
69 / 141
70 / 141
71 / 141
72 / 141
73 / 141
74 / 141
75 / 141
76 / 141
77 / 141
78 / 141
79 / 141
80 / 141
81 / 141
82 / 141
83 / 141
84 / 141
85 / 141
86 / 141
87 / 141
88 / 141
89 / 141
90 / 141
91 / 141
92 / 141
93 / 141
94 / 141
95 / 141
96 / 141
97 / 141
98 / 141
99 / 141
100 / 141
101 / 141
102 / 141
103 / 141
104 / 141
105 / 141
106 / 141
107 / 141
108 / 141
109 / 141
110 / 141
111 / 141
112 / 141
113 / 141
114 / 141
115 / 141
116 / 141
117 / 141
118 / 141
119 / 141
120 / 141
121 / 141
122 / 141
123 / 141
124 / 141
125 / 141
126 / 141
127 / 141
128 / 141
129 / 141
130 / 141
131 / 141
132 / 141
133 / 141
134 / 141
135 / 141
136 / 141
137 / 141
138 / 141
139 / 141
140 / 141
141 / 141
Risk Management in Healthcare Institution Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg Darya-Varia Laboratoria Multidiscipline Scientific Forum Surabaya, Indonesia February 10, 2017
Thank You Terima Kasih Salamat Po Darya-Varia Laboratoria
2017 - Yogyakarta Value-based Healthcare Service in National Health Care
Risk Management in Healthcare Institution For Hospital Administrators Risk Management in Hospitals Hospital Risk Management (HRM) Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg Darya-Varia Laboratoria Multidiscipline Scientific Forum Surabaya, Indonesia February 10, 2017 (45-minute lecture and 15-minute discussion)
Risk Management in Hospitals Hospital Risk Management (HRM) HUGE TOPIC! Given (45-minute lecture and 15-minute discussion) OVERVIEW SOME IMPORTANT EXAMPLES AND TIPS ON PROCESSES Thoughts, Perceptions, Opinions and Recommendations (TPORs)
Survey on Risk Maturity of Sample of Indonesian Hospitals – 2018 – Surabaya Guide in ROJoson’s Lecture Self-assessment of Hospital Owners and Administrators
Self-assessment on Risk Maturity important and first step in developing and continually improving a risk maturity program of hospitals / organizations! IDENTIFY GAPS ACTION PLANS
Hospital Risk Maturity – ROJ’s TPORs Concepts of Hospital Risk Maturity What is Hospital Risk Maturity? Level of development of the Risk Management Program / Capability of a hospital
Hospital Risk Maturity – ROJ’s TPORs Concepts of Hospital Risk Maturity What is importance of Hospital Risk Maturity Assessment? To know the current status or level of development of the Risk Management Program / Capability of a hospital and then to move forward or improve.
Hospital Risk Maturity – ROJ’s TPORs Concepts of Hospital Risk Maturity How is the Hospital Risk Maturity Assessment done? Self-assessment Checklists - Questionnaire Observation Critical Incident Reports External assessment Checklists-Questionnaire Observation Evaluation of Critical Incident Reports
Hospital Risk Maturity – ROJ’s TPORs Concepts of Hospital Risk Maturity Questionnaires on Hospital Risk Maturity Assessment Many models! Choose one that is simple – practical – with end- results being same! • Effective and efficient assessment • Effective and efficient risk management program (performance excellence)
Risk Maturity Levels Risk Maturity Key Characteristics Risk Naive No formal approach developed for risk management Risk Aware Scattered silo based approach to risk management Risk Defined Strategy and policies in place and communicated. Risk appetite defined Risk Managed Enterprise wide approach to risk management developed and communicated Risk Enabled Risk management and internal control fully embedded in the operations http://riskquestionnaire.grant-thornton.co.uk/
Risk Maturity Key Characteristics Ad hoc Undocumented; in a state of dynamic change; depends on individual heroics Preliminary Risk defined in different ways and managed in silos. Process discipline is unlikely to be rigorous. Defined A common risk assessment/response framework is in place. Organization-wide view of risk is provided to executive leadership. Action plans implemented in response to high priority risks. Risk Integrated Risk management activities coordinated across business areas. Risk Optimized Risk discussion is embedded in strategic planning, capital allocation, and other processes and in daily decision-making. http://www.theiia.org/Blogs/marks/index.cfm/post/Measuring%20the%20Maturity%20of%2 0Risk%20Management Risk Maturity Levels
Risk Maturity Key Characteristics Naïve Although a project risk management process may have been initiated, its design or application is fundamentally flawed. Novice The project risk management process influences decisions taken by the project team in a way that is likely to lead to improvements in project performance as measured against its objectives. Normalized The project risk management process is formalised and implemented systematically. Natural The risk management process leads to the selection of risk-efficient strategic choices when setting project objectives and choosing between options for project solutions or delivery. http://www.lundhumphries.com/pdf/SamplePages/Project_Risk_Maturity_Model_Hopkinson _Ch1.pdf Risk Maturity Levels
Risk Maturity Key Characteristics Ad hoc Defined Managed Integrated Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon Risk Maturity Levels
Risk Maturity Key Characteristics Ad hoc Organization is unaware of risk management or its benefits No formal policies or procedures Reactive management through “heroic efforts of individuals” Possible blame culture Defined Risk management is function based and maybe inconsistent Some policies are documented, but RM is largely informal Likely ‘silos’ effect Senior management supports but not requires RM Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
Risk Maturity Key Characteristics Managed Common RM understanding and language organization-wide Formalized generic risk management process “Bad news” accepted Senior management requires RM Integrated RM aligned with strategic planning and quality improvement RM is used in decision-making to gain competitive advantage Proactive approach and open culture RM is responsibility of all Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
Results of Survey on Risk Maturity of Sample of Indonesian Hospitals – 2018 - Surabaya Risk Maturity How many hospitals (%) Ad hoc Defined Managed Integrated
Hospital Risk Management – ROJ’s TPORs OVERVIEW HOSPITAL RISK MANAGEMENT
Hospital Risk Management – ROJ’s TPORs OVERVIEW Contents Overview of hospital risk management • What is risk • What is hospital risk management • General, preventive, ultimate goals of HRM • Quality parameters - Assessment checklist • Basic framework and processes of HRM • Risk Management • Critical success factors in HRM • Critical governance factors in HRM • Design and Development Plan - Manual of policies and procedures • Multisectoral coordination and collaboration • Recommendations in developing an integrated sustainable hospital risk management
Risk Management in Hospitals Recommended Resource Materials • ISO 31000 – Risk Management – Principles and Guidelines • Joint Commission International • International Society for Quality in Healthcare (ISQUA) https://isqua.org/docs/default-source/education- /isqua-webinar_july-2016_luke-feeney.pdf?sfvrsn=0 • ISO 9001:2015 – Quality Management System – with current emphasis on Risk-based Thinking
Hospital Risk Management – ROJ’s TPORs Concepts of Risk and Hospital Risk Management What is “RISK”? What is Hospital Risk Management (HRM)?
Hospital Risk Management – ROJ’s TPORs What is “RISK”? Risk is a probability or threat of a damage, injury, liability, loss, or other negative occurrence that is caused by external or internal vulnerabilities, and that may be neutralized through preemptive action. http://www.businessdictionary.com/definition/risk.html
Hospital Risk Management – ROJ’s TPORs What is “RISK”? “Risk” – effect of uncertainty on objectives (ISO 31000) Effect – deviation from the expected – positive and/or negative. Objectives can have different aspects (such as financial, health and safety, and environment goals) and can apply at different levels (such as strategic, organization-wide, project, product and process). Uncertainty is the state, even partial, of deficiency of information related to, understanding or knowledge of an event, its consequence, or likelihood.
Hospital Risk Management – ROJ’s TPORs What is “RISK”? Risk – “any uncertainty that, if it occurs, could have a positive or negative effect on achievement of one or more organizational aims and objectives and is assessed through the combination of magnitude of potential injury (impact) and the probability (likelihood) that the uncertainty will occur.” http://www.who.int/management/general/risk/WhenRiskNotRisk.pdf
Hospital Risk Management – ROJ’s TPORs What is Hospital Risk Management (HRM)? Hospital risk management (HRM) is a system or program that manages the “risks” of a hospital. •Department Risk Management •Disaster Risk Management •Patient Treatment Risk Management (Benefit-Risk; Medical Malpractice Risk Management) •Others
Definition of Risk Management – ISO 31000 “Risk Management” – coordinated activities to direct and control an organization with regard to risk. “Risk Management System” - formalized system that documents processes, procedures and responsibilities for achieving the policies and objectives of Risk Management System.
Concept of Risk Management – ISO 31000 •Risk management can be applied to an entire organization, at its many areas and levels, at any time, as well as to specific functions, projects and activities. Risk Management at - • Board of Directors Level • Operating Room • Pharmacy • Laboratory • Nursing Floors • Outpatient Department • Emergency Room • Etc.
Importance of Managing Risks in Hospitals “Risk” – effect of uncertainty on objectives •Risks can make or break the hospitals •Positive or negative income •Sustained or bankrupt hospital •Proactively manage risk! •Minimize SURPRISES!
Risk Management – Joint Commission International Stipulations Risk Management Program – Clinical and administrative activities that organizations undertake to identify, to evaluate, and to reduce the risk of injury to patients, staff, and visitors and the risk of loss to the organization itself.
Risk Management – Joint Commission International Stipulations Standard QPS.11 •An ongoing program of risk management is used to identify and to proactively reduce unanticipated adverse events and other safety risks to patients and staff.
Risk Management – Joint Commission International Stipulations Intent of QPS.11 Hospitals need to adopt a proactive approach to risk management. One such way is a formalized risk management program whose essential components include a) risk identification; b) risk prioritization; c) risk reporting; d) risk management; e) investigation of adverse events; and f) management of related claims.
Risk Management – Joint Commission International Stipulations Measurable Elements of QPS.11 1. The hospital’s risk management framework includes a) through f) in the intent. 2. At least annually, a proactive risk-reduction exercise is conducted on one of the priority risk processes. 3. High-risk processes are redesigned based on the analysis of the test results.
Risk Management – Joint Commission International Stipulations Standard FMS.3 • One or more qualified individuals oversee the planning and implementation of the facility management program • to reduce and control risks in the care environment.
Risk Management – Joint Commission International Stipulations Intent of FMS.3 Hospitals work to provide safe, functional, and supportive facilities for patients, families, staff, and visitors. To reach this goal, the physical facility, equipment, medical technology, and people must be effectively managed. In particular, management must strive to • reduce and control hazards and risks; • prevent accidents and injuries; and • maintain safe conditions.
Risk Management – Joint Commission International Stipulations Intent of FMS.3 Effective management includes multidisciplinary planning, education, and monitoring as follows: • Hospital leadership plans the space, technology, and resources needed to safely and effectively support the clinical services provided. • All staff are educated about the facility, how to reduce risks, and how to monitor and to report situations that pose risk. • Performance criteria are used to evaluate important systems and to identify needed improvements.
Risk Management – Joint Commission International Stipulations Measurable Elements of FMS.3 1. Program oversight and direction are assigned to one or more individuals qualified by experience and training. 2. Evidence of the training and experience of the qualified individual(s) is documented. 3. The individual(s) plans and implements the program, including elements a) through f) of the intent.
Risk Management – ISO 9001:2015 Stipulations ISO 9001:2015 (Quality Management System) puts emphasis on Risk-based Thinking. Risk-based thinking enables an organization to determine the factors that could cause its processes and its quality management system to deviate from the planned results, to put in place preventive controls to minimize negative effects and to make maximum use of opportunities as they arise.
Risk Management – ISO 9001:2015 Stipulations An organization needs to plan and implement actions to address risks and opportunities. Addressing both risks and opportunities establishes a basis for increasing the effectiveness of the quality management system, achieving improved results and preventing negative effects.
Risk Management – ISO 9001:2015 Stipulations Opportunities can arise as a result of a situation favourable to achieving an intended result, for example, set of circumstances that allow the organization to attract customers, develop new products and services, reduce waste or improve productivity. Actions to address opportunities can also include consideration of associated risks. Risk is the effect of uncertainty and any such uncertainty can have positive or negative effects. A positive deviation arising from a risk can provide an opportunity, but not all positive effects of risk result in opportunities.
Hospital Risk Management – ROJ’s TPORs What are the general goals of HRM? • Maximize all potential risks with positive effects (rejoice and celebrate) • Prevent and mitigate all potential risks wth negative effects • Be prepared in terms of response and recovery in case the risks become real • Control resulting damage, injury, liability, loss, or other negative occurrence to a minimum level
Hospital Risk Management – ROJ’s TPORs What are the general goals of HRM? • Avoid loss of and disability in People (patients, visitors, staff) in the hospital Resources of hospital Business of hospital (business discontinuity) • Avoid complaints related to risk occurrence and consequences!
Hospital Risk Management – ROJ’s TPORs What are the preventive goals of HRM? • Promote safety for ALL patients, visitors, and staff in the hospital • Provide effective assistance and management during emergencies (disasters) • Prevent controllable deaths and disabilities • Prevent and control losses (business, finances, properties, and infrastructure)
Hospital Risk Management – ROJ’s TPORs What are the ultimate goals of HRM? SUSTAINABILITY OF THE HOSPITAL AS LONG AS POSSIBLE (target: 100 years)
Hospital Risk Management – ROJ’s TPORs What are the ultimate goals of HRM? SUSTAINABILITY OF THE HOSPITAL AS LONG AS POSSIBLE (target: 100 years) Sustainable structure-wise Sustainable financial-wise Sustainable service-wise
Hospital Risk Management – ROJ’s TPORs Sustainable structure-wise goal of HRM? Sustainable structure-wise Will NOT collapse NOT be burned NOT be flooded NOT be destroyed by whatever hazards and will continue to operate its business as long as possible (target: 100 years).
Hospital Risk Management – ROJ’s TPORs Sustainable financial-wise goal of HRM? Sustainable financial-wise Will NOT go bankrupt Will have positive income and will continue to operate its business as long as possible (target: 100 years).
Hospital Risk Management – ROJ’s TPORs Sustainable service-wise goal of HRM? Sustainable service-wise Will continue to provide adequate and quality services expected of a hospital for as long as possible, both during crisis and non-crisis situations
Hospital Risk Management – ROJ’s TPORs Quality parameters of an excellent HRM? • Systematically and comprehensively formulated (with document) • With full support and commitment of top management and ALL staff • ALL staff of the hospitals trained and educated on program
Hospital Risk Management – ROJ’s TPORs Quality parameters of an excellent HRM? • With testing or exercises done regularly and at planned intervals and as needed • Being reviewed regularly at planned intervals and as needed • Has been tried and tested and has achieved its formulated goals and objectives and specified targets
Risk Management in Hospitals - ISO 31000 PRINCIPLES FRAMEWORK PROCESS
Principles of Risk Management – ISO 31000 To be effective, an organization should at all levels comply with the principles below. • creates and protects value. • is an integral part of all organizational processes. • is part of decision making. • explicitly addresses uncertainty. • is systematic, structured and timely. • is based on the best available information. • is tailored. • takes human and cultural factors into account. • is transparent and inclusive. • is dynamic, iterative and responsive to change. • facilitates continual improvement of the organization.
Hospital Risk Management – ROJ’s TPORs Basic Framework in Hospital Risk Management? Risk Management Framework (ISO 31000) set of components that provide the foundations and organizational arrangements for designing, implementing, monitoring, reviewing and continually improving risk management throughout the organization.
Risk Management Framework for Hospitals From ISO 31000 – Risk Management – Principles and Guidelines
Risk Management Framework for Hospitals From ISO 31000 – Risk Management – Principles and Guidelines
Hospital Risk Management – ROJ’s TPORs Basic processes in Hospital Risk Management? Risk Management Process (ISO 31000) systematic application of management policies, procedures and practices to the activities of communicating, consulting, establishing the context and identifying, analyzing, evaluating, treating, monitoring and reviewing risk.
Risk Management Process – ISO 31000
Risk Management Process – ISO 31000
Risk Management in Hospitals - ISO 31000 PRINCIPLES FRAMEWORK PROCESS
Risk Management Framework and Process for Hospitals
Risk Management Process – ISO 31000 Communication and Consultation – continual and iterative processes that an organization conducts to provide, share and obtain information and to engage in dialogue with stakeholders regarding the management of risk.
Risk Management Process – ISO 31000 Establishing the Context – Defining the external and internal parameters to be taken into account when managing risk, and setting the scope and risk criteria for the risk management policy.
Establishing the Context External context – external environment in which a hospital seeks to achieve its objectives • Cultural, social, political, legal, regulatory, financial, technological, economic, natural and competitive environment, whether international, national, regional or local; • Key drivers and trends having impact on the objectives of the organization; and • Relationships with, and perceptions and values of the external stakeholders. SWOT ANALYSIS – OT
Establishing the Context Internal context – internal environment in which a hospital seeks to achieve its objectives • Governance, organizational structure, roles and accountabilities • Policies, objectives, and the strategies that are in place to achieve them • Capabilities, understood in terms of resources and knowledge (e.g. capital, time, people, processes, systems and technologies) • Information systems, information flows and decision-making processes (both formal and informal); • Relationships with, and perceptions and values of, internal stakeholders • Organizational culture • Standards, guidelines and models adopted by the organization, and • Form and extent of contractual relationships SWOT ANALYSIS – SW
Establishing the Context Scope •Clinical risk (involving medical care of patients) ~ PATIENT SAFETY PROGRAM •Non-clinical risk (not involving medical care of patients)
Establishing the Context INTEGRATION •Clinical risk (involving medical care of patients) ~ PATIENT SAFETY PROGRAM •Non-clinical risk (not involving medical care of patients) •Quality and Risk Management •Quality and Safety and Risk Management
Establishing the Context Risk Management Policy of ROJHMC To always use risk-based thinking and processes in planning and deciding all activities in the hospital so as to minimize negative effects and to maximize positive effects on accomplishment of objectives. This policy shall be realized through: • Understanding the potential risks on quality and safe health care services, products, facility, environment and business development; • Complying with all statutory and regulatory requirements on risk management; • Designing a structured, comprehensive, integrated, effective and efficient risk management system; • Providing adequate resources and highly competent staff to support the implementation of the management system; • Regularly evaluating and reviewing the results of implementation of the management system; • Continually improving the management system with innovations.
Establishing the Context Quality and Safety Policy - ROJHMC To continuously provide quality and safe health care services, products, facility and environment to all our stakeholders (communities, families, patients, workforce and partners). This policy shall be realized through: • Understanding the expectations of our stakeholders on quality and safe health care services, products, facility and environment; • Complying with all statutory and regulatory requirements; • Designing effective and efficient quality and safe management systems • Providing adequate resources and highly competent staff to support the implementation of the management system; • Regularly evaluating and reviewing the results of implementation of the management system; • Continually improving the management system with innovations.
Establishing the Context
Establishing the Context
Risk Criteria – terms of reference against which the significance of a risk is evaluated. Establishing the Context General Framework for Risk Criteria
Risk Criteria Establishing the Context
Risk Criteria Establishing the Context
Risk Criteria Establishing the Context
Risk Management Process – ISO 31000 Risk identification - process of finding, recognizing and describing risks. • Involves identification of risk sources, events, their causes and their potential consequences. • From historical data, theoretical analysis, informed and expert opinions, and stakeholders’ needs.
Risk Management Process – ISO 31000 Risk identification - process of listing potential risks and their characteristics. The results of risk identification are normally documented in a risk register, which includes a list of identified risks along with their sources, potential risk responses, and risk categories.
Risk Management Process – ISO 31000 Risk analysis – process to comprehend the nature of the risk and to determine the level of risk. Risk analysis provides basis for risk evaluation and decisions about risk treatment. Risk analysis includes risk estimation.
Risk Analysis (Estimation) In hospitals, the risk estimation or analysis can be done on a qualitative or quantitative basis or in some combination. Qualitative analysis is based on judgement, previous experience and intuition. Quantitative analysis is generally based on an estimation of the relative magnitude of harm that is likely to result and the possibility that the event will actually occur. Currently, a lot of hospitals do not analyze risk in a quantifiable measure as they feel their risks are too complex or cannot be measured. However, this can be done and in fact, are being done.
Risk Analysis (Estimation) In medical care, quantitative risk assessment is widely practiced nowadays. Examples, there are quantitative risk assessment for perioperative complications with or without laboratory testings; quantitative risk assessment for heart attack and stroke in patients with metabolic syndrome; etc. The statistical techniques commonly being used are the multi-variate regression analysis; likelihood ratios; odds ratios; predictive values; etc.
Risk Analysis (Estimation) In hospitals, the risk is often evaluated by determining the: • degree of injury • degree of patient dissatisfaction • legal grounds for an actual claim • potential public relations or community relations impact • financial loss or projection of loss
Risk Analysis (Estimation) The recommendation is to move towards quantitative risk estimation and analysis whenever and wherever possible to get more specific estimate which will lead to more concrete action plans and evaluation. Another recommendation: start with a qualitative risk analysis then segregate those risks in which a quantitative analysis can be done and recommendable.
Risk Analysis (Estimation)
Samples of Likelihood Guide Level Descriptor Description 5 Almost certain It will happen in the vast majority of cases. 4 Most likely It will happen in a majority of cases. 3 Likely It will happen in some cases. 2 Unlikely It will happen in a few cases. 1 Remote It will happen only in a particular type of case.
Samples of Likelihood Guide Probability Descriptor Description 4 Frequent Likely to occur immediately or within a short period (may happen several times in 1 year) 3 Occasional Probably will occur (may happen several times in 1 to 2 years) 2 Uncommon Possible to occur (may happen sometime in 2 to 5 years) 1 Remote Unlikely to occur (may happen sometime in 5 to 30 years)
Samples of Likelihood Guide Remote (1) Unlikely (2) Likely (3) Most Likely (4) Almost Certain (5) Freq Prob Freq Prob Freq Prob Freq Prob Freq Prob Occurs every 5 years or more 1% Occurs every 2- 5 years 10% Occurs every 1-2 years 50% Bimont hly 75% At least monthl y 99%
Samples of Impact Severity Guides Score Impact 1 Negligible 2 Minor 3 Moderate 4 Major 5 Extreme
Samples of Impact Severity Guides Negligible Minor Moderate Major Extreme Adverse event leading to minor injury not requiring first aid. No impaired psychosocial functioning Minor injury or illness, first aid treatment required <3 days absence <3 days extended hospital stay. Impaired psychosocial functioning greater than 3 days less than one month. Significant injury requiring medical treatment e.g. fracture and / or counselling. >3 days absence 3-8 days extended hospital stay. Impaired psychosocial functioning greater than one month less than 6 months. Major injuries / long term incapacity or disability (loss of limb) requiring medical treatment and / or counseling. Impaired psychosocial functioning greater than 6 months. Incident leading to death or major permanent incapacity. Event which impacts on large number of patients or member of the public. Permanent psychosocial functioning incapacity.
Samples of Impact Severity Guides Level 1 Level 2 Level 3 Level 4 Level 5 Near miss / potential harm / damage. Patients with potential: Event / error results in no harm / damage. Patients with potential: Event / error results in temporary minor harm / damage. Increased length of stay. Event / error results in permanent harm damage. This is a critical incident. Event / error results in death. This is a critical incident.
Sample of Risk Quantification Matrix CONSEQUENCE Insignificant 1 Minor 2 Moderate 3 Major 4 Extreme 5 L I K E L I H O O D Almost Certain – 5 5 10 15 20 25 Most Likely – 4 4 8 12 16 20 Likely – 3 3 6 9 12 15 Unlikely – 2 2 4 6 8 10 Remote – 1 1 2 3 4 5 Key1: 1-5 = Low Risk ; 6-15 = Medium Risk; >15 = High Risk Key2: 1-4 = Low Risk ; 5-10 = Medium Risk; >10 = High Risk
Risk Management Process – ISO 31000 Risk evaluation – process of comparing the results of risk analysis with risk criteria to determine whether the risk and/or its magnitude is acceptable or tolerable. Risk evaluation assists in the decision about risk treatment.
sk Criteria Risk EvaluationRisk evaluation – process of comparing the results of risk analysis with risk criteria to determine whether the risk and/or its magnitude is acceptable or tolerable. Risk evaluation assists in the decision about risk treatment.
Risk Evaluation – Risk Treatment
Risk Management Process – ISO 31000Risk Treatment – process to modify risk Risk treatment can involve • Avoiding the risk by deciding not to start or continue with the activity that gives rise to the risk; • Taking or increasing the risk in order to pursue an opportunity; • Removing the risk source; • Changing the likelihood; • Changing the consequences; • Sharing the risk with another party or parties (including contracts and risk financing); and • Retaining the risk by informed decision. Risk treatment that deal with negative consequences are sometimes referred to as “risk mitigation”, “risk elimination”, “risk prevention” and “risk reduction.”
Risk Management Planning
Risk Management Process – ISO 31000 Monitoring – continual checking, supervising, critically observing or determining the status in order to identify change from the performance level required or expected. Review – activity undertaken to determine the suitability, adequacy and effectiveness of the subject matter to achieve established objectives. Monitoring and review can be applied to a risk management framework, risk management process, risk or control.
Risk Management Form Illustrating Risk Management Process
Risk Management Form Illustrating Risk Management Process Risks identified Causes Date risk identifi ed Likelihood Impact Severity Overall Risk Rating Current Controls in system RISK ASSESSMENT Based on Context / Communication / Consultation • Risk Identification • Risk analysis • Risk evaluation
Risk Management Form Illustrating Risk Management Process Risk Response Strategy (Accept, Control, Transfer, Avoid) Action Required Respon sible Persons Due Date Resou rces Requir ed Risk Treatment Plan
Risk Management Form Illustrating Risk Management Process Monitoring and Review Plan and Outcome Post Tx likelihood Post Tx impact severity Post Tx Risk Score Review Date
Risk Management Form Illustrating Risk Management Process Contingency Plan What if risk really happens?
RISK MANAGEMENT PROGRAM = CORPORATE <-> DEPARTMENTAL
SAFE HOSPITAL INITIATIVE PATIENT SAFETY PROGRAM FINANCIAL MANAGEMENT PROGRAM BIOMED EQPT PROGRAM WORK FORCE ENGAGEMENT PROGRAM BUSINESS DEVELOPMENT PROGRAM CORPORATE RISK MANAGEMENT PROGRAM Examples:
Hospital Risk Management – ROJ’s TPORs RISK IDENTIFICATION RISKS commonly encountered in Philippine hospitals Risk for • business non-sustainability (financial viability) • aging (unsettled) account receivables • medico-legal suits (arising from patient care) • technology-related disasters • natural disasters (earthquake, flood, tsunamis, fire, etc.)
Hospital Risk Management – ROJ’s TPORs RISK IDENTIFICATION RISKS commonly encountered in Philippine hospitals Risk for • tarnished corporate or hospital reputation • man-made disasters (fire, felony, bomb threat, terrorism, etc.) • non-medico-legal suits (not arising from patient care, such as workforce legal suits) • biological disasters
Hospital Risk Management – ROJ’s TPORs RISK ASSESSMENT Risk assessment - likelihood of occurrence of identified risks and impact when they occur. Utility of risk assessment - more on prioritization ALL risks identified must have preventive, mitigation, preparedness, response, and recovery plans!
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT •Formulation of strategies and action plans to prevent, mitigate risks and to respond and recover from the consequences of unavoidable risk occurrence ALL hazards approach! BUT ALL risks identified must have specific preventive, mitigation, preparedness, response, and recovery plans!
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT Risks Prevention Mitigation Preparedness Response Recovery Business non- sustainability Account receivables Medicolegal suits Technological disasters Natural disasters Tarnished reputation Man-made disasters Legal suits Biological disasters Example of ALL-HAZARD APPROACH in Disasters 7 Basic Essential (Common) Steps in Response • Declaration of disaster • Creation of an incident command • Notification of concerned authorities • Mobilization and organization of staff and services • Control of disaster • Decongestion and post-disaster reconstruction • Post-disaster evaluation and reporting
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT Risks Prevention Mitigation Preparedness Response Recovery Business non- sustainability Account receivables Medicolegal suits Technological disasters Natural disasters Tarnished reputation Man-made disasters Legal suits Biological disasters Example of ALL-HAZARD APPROACH in “Situations” 7 Basic Essential (Common) Steps in Response • Declaration of “situation” (emergency – crisis) • Creation of a “situation” command • Notification of concerned authorities • Mobilization and organization of “situation” team • Legal team • Crisis communication team • Control of “situation” • Post- “situation” reconstruction • Post- “situation” evaluation and reporting
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT Risks Prevention Mitigation Preparedness Response Recovery Business non- sustainability Account receivables Medicolegal suits Technological disasters Natural disasters Tarnished reputation Man-made disasters Legal suits Biological disasters Example of ALL-HAZARD APPROACH in “B-Situations” 7 Basic Essential (Common) Steps in Response • Declaration of “B-situation” (emergency – crisis) • Creation of a “B-situation” command • Notification of concerned authorities • Mobilization and organization of “B-situation” team • Finance and audit team • Business development team • Control of “B-situation” • Post- “B-situation” reconstruction • Post- “B-situation” evaluation and reporting
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT Risks Structural S Service S Financial S Business non-sustainability √√√√ Account receivables √√√ Medicolegal suits √√ Technological disasters √ √√ Natural disasters √√√ √√ √√ Tarnished reputation √ Man-made disasters √√√ √√ √ Legal suits √ √ Biological disasters √√ √ *S - Sustainability
Hospital Risk Management – ROJ’s TPORs Strategy to Avoid Medico-legal Suits To avoid medico-legal suits All physicians must always take note of the goals in the management of all patients: Resolution of the health problem Live patient No complication No disability Satisfied patient No medicolegal suit
Avoiding Medico-legal Suits PATIENT SAFETY PROGRAM RAPPORT WITH PATIENTS AND RELATIVES COMMUNICATION – INFORMED CONSENT
International Patient Safety Goals Goal 1 - Identify patients correctly Goal 2 - Improve effective communication Goal 3 - Improve the safety of high-alert medications Goal 4 - Ensure correct site, correct procedure, correct patient surgery Goal 5 - Reduce risk of health care-associated infections Goal 6 - Reduce the risk of patient harm resulting from fall
Hospital Risk Management – ROJ’s TPORs Critical steps to ensure success of HRM • Securing of administrative commitment and support • Establishment and continual development of manual of policies and procedures on risk management that include risk preparedness (prevention, mitigation, preparedness, response, and recovery plans) • Regular conduct of risk control exercises
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT •Formulation of strategies and action plans to make the risk management program walk the talk! Leadership Managership Communication Education and Training
Critical Governance Factors Leadership Readiness in Risk Control T r a i n i n g C o m m u n i c a t i o n Managership
“Manage” staff to get commitment and support to achieve goals!
Leaders may delegate responsibilities and competencies to managers. But must know principles of risk preparedness, esp. in managing Incident Command! Critical factors for readiness!
Leaders communicate with managers and staff effectively and efficiently! Timely! Stress importance of risk preparedness! Provide directions! Express commitment and support!
Leaders support training of staff for risk preparedness! Undergo training to gain competency, esp. in Incident Command! To demonstrate engagement and involvement!
Hospital Risk Management – ROJ’s TPORs Manual of Policies and Procedures Recommendations: The management program must be documented and placed in a policies and procedures manual or primer, disseminated to all staff, exercised, reviewed and re- evaluated at planned intervals or as the need arises anytime.
Hospital Risk Management – ROJ’s TPORs The manual can have the following simple outline: • Preface • Scope • Definitions • Program Management • Planning • Implementation • Exercises, evaluation and corrective action • Management Review Manual of Policies and Procedures
Hospital Risk Management – ROJ’s TPORs The manual can have the following simple outline: • Preface • Scope • Definitions • Program Management • Planning • Implementation • Exercises, evaluation and corrective action • Management Review Hospital Risk Management Program Manual Supplementary Manuals on Implementing Guidelines and Instructions (covering the categories of common hospital risks) Manual of Policies and Procedures
Hospital Risk Management – ROJ’s TPORs Multisectoral Task Force / Committee Recommendations: Creation of multisectoral task force / committee to align, coordinate, collaborate, and integrate all risk preparedness programs of the hospital
Hospital Risk Management – ROJ’s TPORs Recommendations: Examples of multisectoral task forces / committees • Corporate Risk Management Committee • Safety Promotion and Disaster Preparedness Committee • Quality Management Committee • Quality and Risk Management Committee Multisectoral Task Force / Committee
Hospital Risk Management – ROJ’s TPORs Recommendations: Examples of multisectoral task forces / committees • Corporate Risk Management Committee • Safety Promotion and Disaster Preparedness Committee • Quality Management Committee • Quality and Risk Management Committeee Multisectoral Task Force / Committee Essentials: Multisectoral in membership Headed by a top / senior management representative Aligning, coordinating, integrating all risk preparedness programs of the entire hospital
Hospital Risk Management – ROJ’s TPORs OVERVIEW Contents Overview of hospital risk management • What is risk • What is hospital risk management • General, preventive, ultimate goals of HRM • Quality parameters - Assessment checklist • Basic framework and processes of HRM • Risk Management • Critical success factors in HRM • Critical governance factors in HRM • Design and Development Plan - Manual of policies and procedures • Multisectoral coordination and collaboration • Recommendations in developing an integrated sustainable hospital risk management
Case Studies of Hospitals on Risk Management Program Difficult to get info! Majority = financial viability and sustainability despite “un-enhanced” risk management program Definite = incurred losses at one time or another Challenges: • Medicolegal suits • Account receivables
Risk Management in Hospitals Hospital Risk Management (HRM) HUGE TOPIC! Given (45-minute lecture and 15-minute discussion) OVERVIEW SOME IMPORTANT EXAMPLES AND TIPS ON PROCESSES Thoughts, Perceptions, Opinions and Recommendations (TPORs)
Risk Maturity Key Characteristics Ad hoc Organization is unaware of risk management or its benefits No formal policies or procedures Reactive management through “heroic efforts of individuals” Possible blame culture Defined Risk management is function based and maybe inconsistent Some policies are documented, but RM is largely informal Likely ‘silos’ effect Senior management supports but not requires RM Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
Risk Maturity Key Characteristics Managed Common RM understanding and language organization-wide Formalized generic risk management process “Bad news” accepted Senior management requires RM Integrated RM aligned with strategic planning and quality improvement RM is used in decision-making to gain competitive advantage Proactive approach and open culture RM is responsibility of all Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
Principles of Risk Management – ISO 31000 To be effective, an organization should at all levels comply with the principles below. • creates and protects value. • is an integral part of all organizational processes. • is part of decision making. • explicitly addresses uncertainty. • is systematic, structured and timely. • is based on the best available information. • is tailored. • takes human and cultural factors into account. • is transparent and inclusive. • is dynamic, iterative and responsive to change. • facilitates continual improvement of the organization.
Principles of Risk Management – ISO 31000 To be effective, an organization should at all levels comply with the principles below. • creates and protects value. • is an integral part of all organizational processes. • is part of decision making. • explicitly addresses uncertainty. • is systematic, structured and timely. • is based on the best available information. • is tailored. • takes human and cultural factors into account. • is transparent and inclusive. • is dynamic, iterative and responsive to change. • facilitates continual improvement of the organization.
Principles of Risk Management – ISO 31000 • Risk management creates and protects value. • Contributes to the demonstrable achievement of objectives and improvement of performance. • Risk management is an integral part of all organizational processes. • Not a stand-alone activity that is separate from the main activities and processes of the organization. Is an integral part of ALL organizational processes. Integrate risk management into the overall management system of the organization.
Principles of Risk Management – ISO 31000 • Risk management is part of decision making. • Helps decision-makers make informed choices, prioritize actions and distinguish among alternative courses of actions. • Risk management explicitly addresses uncertainty. • Explicitly takes account of uncertainty, the nature of that uncertainty, and how it can be addressed.
Principles of Risk Management – ISO 31000 • Risk management is systematic, structured and timely. • Contributes to efficiency and to consistent, comparable and reliable results. • Risk management is based on the best available information. • There must be data no matter how limited. • Risk management is tailored. • Aligned with the organization’s unique external and internal context and risk profile.
Principles of Risk Management – ISO 31000 • Risk management takes human and cultural factors into account. • Recognizes the capabilities, perceptions and intentions of external and internal people that can facilitate or hinder achievement of the organization’s objectives. • Risk management is transparent and inclusive. • Appropriate and timely involvement of stakeholders and decision makers at all levels of the organization, ensures that risk management remains relevant and up- to-date (and known to all and participatory)
Principles of Risk Management – ISO 31000 • Risk management is dynamic, iterative and responsive to change. • Continually senses and responds to change. As external and internal events occurs, context and knowledge change, monitoring and review of risks take place, new risks emerge, some change, and others disappear. • Risk management facilitates continual improvement of the organization. • Improving risk management maturity facilitates continual improvement of organization.
Thank You Terima Kasih Salamat Po Darya-Varia Laboratoria

More Related Content

PPTX
Healthcare Risk Management
byJoven Botin Bilbao
 
PPTX
Healthcare Risk management overview
byAhmad Thanin
 
PPTX
RISK MANAGEMENT.pptx
byssuser107f14
 
PPTX
Risk management in healthcare
byMujeeb Kandy, MASc, MS, CPHQ, RHIA.
 
PDF
Healthcare Risk Management Plan
byNashwa Elsayed
 
PPTX
Enterprise Risk Management in Healthcare Organisations “Going Beyond Patient ...
byHossam Elamir
 
PPTX
Risk management
byMohamed Mosaad Hasan
 
PPT
Risk Management and Healthcare Organizations
byJohn Cousins
 
Healthcare Risk Management
byJoven Botin Bilbao
 
Healthcare Risk management overview
byAhmad Thanin
 
RISK MANAGEMENT.pptx
byssuser107f14
 
Risk management in healthcare
byMujeeb Kandy, MASc, MS, CPHQ, RHIA.
 
Healthcare Risk Management Plan
byNashwa Elsayed
 
Enterprise Risk Management in Healthcare Organisations “Going Beyond Patient ...
byHossam Elamir
 
Risk management
byMohamed Mosaad Hasan
 
Risk Management and Healthcare Organizations
byJohn Cousins
 

What's hot

PPTX
Effective risk management in healthcare practice-
byDr. AbdulQawi Almohamadi
 
PPS
Risk management in Healthcare
byNadeem Baig
 
PDF
ISO 31000:2018 Risk Management System, Framework and Implementation
byAlvin Integrated Services [AIS]
 
PPTX
ISO 31000 risk management process
byMuizz Anibire
 
PPT
Hospital Risk Management - A Philippine Perspective
byReynaldo Joson
 
PPTX
Risk management intruduction part 1
byMEEQAT HOSPITAL
 
PPTX
Clinical Risk Management
bylimgengyan
 
PPT
Risk Management Process in OH&S
byAhmed-Refat Refat
 
PDF
risk management.pdf
byNisanthThulasidas2
 
PPT
Introduction to Risk Management
byFAA Safety Team Central Florida
 
PPTX
Occupational health and safety in hospitals and health centers
byدكتور تامر عبدالله شراكى
 
PPTX
Disaster management in hospital ppt
byDrDikshaTewari
 
PDF
FMEA training for Healthcare - Sample
byMark H. Davis
 
PPT
Facility Management System
byJoven Botin Bilbao
 
PPT
Occupation Safety & Health Presentation
byHarlequin Consultants
 
PPTX
Standards &amp; survey process orientation sspo cbahi
byMEEQAT HOSPITAL
 
PDF
Hazard Identification & Risk Analysis (HIRA)
bySudip Dey
 
PPTX
Disaster plans in hospitals and health care centers
byDr. Samir Sawli
 
PPTX
CBAHI - ESR
byJoven Botin Bilbao
 
PDF
Guidelines for hospital contingency plan
bynationalguidelines
 
Effective risk management in healthcare practice-
byDr. AbdulQawi Almohamadi
 
Risk management in Healthcare
byNadeem Baig
 
ISO 31000:2018 Risk Management System, Framework and Implementation
byAlvin Integrated Services [AIS]
 
ISO 31000 risk management process
byMuizz Anibire
 
Hospital Risk Management - A Philippine Perspective
byReynaldo Joson
 
Risk management intruduction part 1
byMEEQAT HOSPITAL
 
Clinical Risk Management
bylimgengyan
 
Risk Management Process in OH&S
byAhmed-Refat Refat
 
risk management.pdf
byNisanthThulasidas2
 
Introduction to Risk Management
byFAA Safety Team Central Florida
 
Occupational health and safety in hospitals and health centers
byدكتور تامر عبدالله شراكى
 
Disaster management in hospital ppt
byDrDikshaTewari
 
FMEA training for Healthcare - Sample
byMark H. Davis
 
Facility Management System
byJoven Botin Bilbao
 
Occupation Safety & Health Presentation
byHarlequin Consultants
 
Standards &amp; survey process orientation sspo cbahi
byMEEQAT HOSPITAL
 
Hazard Identification & Risk Analysis (HIRA)
bySudip Dey
 
Disaster plans in hospitals and health care centers
byDr. Samir Sawli
 
CBAHI - ESR
byJoven Botin Bilbao
 
Guidelines for hospital contingency plan
bynationalguidelines
 

Similar to Risk Management in Hospitals - ROJoson - 2018 - Surabaya, Indonesia

PPTX
Risk Management - A Journey
byDebashis Gupta
 
PPTX
Risk management
byAbbasFadhil12
 
PDF
7. risk management in healthcare institutions.pdf
byHayatALAKOUM
 
PDF
Risk Management Maturity Model (RMMM)
byAdnan Naseem
 
PPTX
Risk Management Toolkit
byPeterFranz6
 
PPT
Coso erm
byluisrobles_cl
 
PPT
Coso erm
byHumberto Omar Valverde Taborga
 
PPT
1 -corinne_berinstein
byAahil Malik
 
PPT
1 -corinne_berinstein
bySukumar Reddy
 
PPT
COSO_ERM.ppt
bySashaKing4
 
PPT
COSO_CCCCCCCCCCCCCCCCCCCCCCCCCCCCERM.ppt
byKhairulAbdullah13
 
PPT
Manajemen Risiko Menurut COSO
byDina Pramudianti
 
PPTX
Comprehensive-Healthcare-Risk-Management-Strategy (1).pptx
byssuser7e82f41
 
PPT
An Introduction to Risk Management for Healthcare Institution - ROJoson
byReynaldo Joson
 
PDF
#corpriskforum2016 - Julia Graham
byAlexei Sidorenko, CRMP
 
PPTX
DiSerafino - ORSA_insurance_conference
byLou DiSerafino
 
PPT
1 -corinne_berinstein
byRamaica Ona
 
PPTX
Risk Management
byKathleen Abubo
 
PDF
HFMA Searching for Risk, April 2004
byTheim912
 
DOCX
20 Reasons for Risk management updated 2023 intel document 15.docx
byintel-writers.com
 
Risk Management - A Journey
byDebashis Gupta
 
Risk management
byAbbasFadhil12
 
7. risk management in healthcare institutions.pdf
byHayatALAKOUM
 
Risk Management Maturity Model (RMMM)
byAdnan Naseem
 
Risk Management Toolkit
byPeterFranz6
 
Coso erm
byluisrobles_cl
 
Coso erm
byHumberto Omar Valverde Taborga
 
1 -corinne_berinstein
byAahil Malik
 
1 -corinne_berinstein
bySukumar Reddy
 
COSO_ERM.ppt
bySashaKing4
 
COSO_CCCCCCCCCCCCCCCCCCCCCCCCCCCCERM.ppt
byKhairulAbdullah13
 
Manajemen Risiko Menurut COSO
byDina Pramudianti
 
Comprehensive-Healthcare-Risk-Management-Strategy (1).pptx
byssuser7e82f41
 
An Introduction to Risk Management for Healthcare Institution - ROJoson
byReynaldo Joson
 
#corpriskforum2016 - Julia Graham
byAlexei Sidorenko, CRMP
 
DiSerafino - ORSA_insurance_conference
byLou DiSerafino
 
1 -corinne_berinstein
byRamaica Ona
 
Risk Management
byKathleen Abubo
 
HFMA Searching for Risk, April 2004
byTheim912
 
20 Reasons for Risk management updated 2023 intel document 15.docx
byintel-writers.com
 

More from Reynaldo Joson

PPTX
ROJoson PEP Talk: October Breast Cancer Awareness Month - What Is It? 2025
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Do ALL Operations Need Antibiotics?
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Why Laypeople Hesitant to Use Tap Water in Wound Cleaning
byReynaldo Joson
 
PPTX
October Breast Cancer Awareness - What to be Aware of - Part 2 - Diagnostic T...
byReynaldo Joson
 
PPTX
ROJoson Orientation and Introduction - UPCM-PGH LU7 SGD - 2025
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: October Breast Cancer Awareness Month - What to be Aware of...
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: October Breast Cancer Awareness Month - What to be Aware of...
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: How to Live a Life with Threat for Cancer Development, Recu...
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Symptom-Sign-Based Breast Cancer Surveillance - How I Usual...
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Cancer Journey Sharing Among ROJoson Cancer Crusaders
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: What / Who is a General Surgeon in the Philippines?
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Beware of New Year Eve's Health Dangers - 2025
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Breast Cancer Surveillance after Definitive Treatment
byReynaldo Joson
 
PPTX
Management Algorithm for Women with Breast Complaints for Basic Physicians an...
byReynaldo Joson
 
PPTX
Introduction - 38th Cancer Crusaders Club Annual Christmas Get-Together Virtu...
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: ROJoson Cancer Crusaders and Club - Who, What and How
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Can Wounds Be Wet and How to Clean Them
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Patient Story: Short Suffering in an Advanced Pancreatic Ca...
byReynaldo Joson
 
PPTX
ROJoson PEP Talk: Dangerous to Swallow Santol Seeds
byReynaldo Joson
 
PPTX
ROJoson-PEP-Talk-GOITER-Sa-Loob-o-Sa-Labas-A-Layfolk-Descriptor-A-Clarification
byReynaldo Joson
 
ROJoson PEP Talk: October Breast Cancer Awareness Month - What Is It? 2025
byReynaldo Joson
 
ROJoson PEP Talk: Do ALL Operations Need Antibiotics?
byReynaldo Joson
 
ROJoson PEP Talk: Why Laypeople Hesitant to Use Tap Water in Wound Cleaning
byReynaldo Joson
 
October Breast Cancer Awareness - What to be Aware of - Part 2 - Diagnostic T...
byReynaldo Joson
 
ROJoson Orientation and Introduction - UPCM-PGH LU7 SGD - 2025
byReynaldo Joson
 
ROJoson PEP Talk: October Breast Cancer Awareness Month - What to be Aware of...
byReynaldo Joson
 
ROJoson PEP Talk: October Breast Cancer Awareness Month - What to be Aware of...
byReynaldo Joson
 
ROJoson PEP Talk: How to Live a Life with Threat for Cancer Development, Recu...
byReynaldo Joson
 
ROJoson PEP Talk: Symptom-Sign-Based Breast Cancer Surveillance - How I Usual...
byReynaldo Joson
 
ROJoson PEP Talk: Cancer Journey Sharing Among ROJoson Cancer Crusaders
byReynaldo Joson
 
ROJoson PEP Talk: What / Who is a General Surgeon in the Philippines?
byReynaldo Joson
 
ROJoson PEP Talk: Beware of New Year Eve's Health Dangers - 2025
byReynaldo Joson
 
ROJoson PEP Talk: Breast Cancer Surveillance after Definitive Treatment
byReynaldo Joson
 
Management Algorithm for Women with Breast Complaints for Basic Physicians an...
byReynaldo Joson
 
Introduction - 38th Cancer Crusaders Club Annual Christmas Get-Together Virtu...
byReynaldo Joson
 
ROJoson PEP Talk: ROJoson Cancer Crusaders and Club - Who, What and How
byReynaldo Joson
 
ROJoson PEP Talk: Can Wounds Be Wet and How to Clean Them
byReynaldo Joson
 
ROJoson PEP Talk: Patient Story: Short Suffering in an Advanced Pancreatic Ca...
byReynaldo Joson
 
ROJoson PEP Talk: Dangerous to Swallow Santol Seeds
byReynaldo Joson
 
ROJoson-PEP-Talk-GOITER-Sa-Loob-o-Sa-Labas-A-Layfolk-Descriptor-A-Clarification
byReynaldo Joson
 

Recently uploaded

PPTX
Patient-Health-Monitoring-App-for-a-Diabetes-Management-Center.pptx
bymithaiiman0309
 
PPTX
Part I(II-V)_locked.pptxdbbdbxndndbxbdbfb
bymengeshakasaw1221
 
PDF
Aagami Corporate Presentation January 2026
byAagami, Inc.
 
PPTX
NUT207 PPT ABOUT Patient or client dietition ethics
bynut2024uni
 
PDF
Marc Wanis - A Pre-Medical Scholar
byMarc Wanis
 
PPTX
"occupational hazards-physical hazards".
byNishadTaskeen
 
PPTX
Metformin safety during pregnancy in women with gestational diabetes mellitus
byDr. Om J Lakhani
 
PPTX
Spondylosis Physiotherapy, Aayushi Bodiwala
byAayushiBodiwala
 
PDF
Bsc nursing syllabus and subject details.pdf
bypavitra8057
 
PPTX
Ulcerative Colitis Treatment in Hyderabad – Comprehensive Care at PACE Hospit...
byPACE Hospitals
 
PPTX
Understanding Medication_Administration.pptx
bysofiasofi191980
 
PPTX
Bariatric_Doctor_Near_Me_experts_weight_loss
bySuhan Malik
 
PDF
3 Diabetes complications €& »?!!&&&&.pdf
byy2dyjdrrjk
 
PPTX
CGH RADIATION HAZARDS THE BASIC FACTS YOU SHOULD KNOW
byMuhammad Akhtar
 
PPTX
Modular Operating Room Layout & Specifications
byGaddiel Industries
 
PPTX
neoplasia prentation.pptx for pathology
bydrdaaha2
 
PPTX
Congenital Adrenal Hyperplasia (CAH) and SIADH in Neonates
bylidulidiyasolomon
 
PPTX
Ante partum hemorrhage- Etiology, diagnosis and management
byDrAkashGajjar
 
PPTX
10- TIVA total intravenous anesthesia for anesthesia
byseabdelbagi
 
PPTX
IUGR_Management_Presentation-1.pptx for BSc students
byaddis18
 
Patient-Health-Monitoring-App-for-a-Diabetes-Management-Center.pptx
bymithaiiman0309
 
Part I(II-V)_locked.pptxdbbdbxndndbxbdbfb
bymengeshakasaw1221
 
Aagami Corporate Presentation January 2026
byAagami, Inc.
 
NUT207 PPT ABOUT Patient or client dietition ethics
bynut2024uni
 
Marc Wanis - A Pre-Medical Scholar
byMarc Wanis
 
"occupational hazards-physical hazards".
byNishadTaskeen
 
Metformin safety during pregnancy in women with gestational diabetes mellitus
byDr. Om J Lakhani
 
Spondylosis Physiotherapy, Aayushi Bodiwala
byAayushiBodiwala
 
Bsc nursing syllabus and subject details.pdf
bypavitra8057
 
Ulcerative Colitis Treatment in Hyderabad – Comprehensive Care at PACE Hospit...
byPACE Hospitals
 
Understanding Medication_Administration.pptx
bysofiasofi191980
 
Bariatric_Doctor_Near_Me_experts_weight_loss
bySuhan Malik
 
3 Diabetes complications €& »?!!&&&&.pdf
byy2dyjdrrjk
 
CGH RADIATION HAZARDS THE BASIC FACTS YOU SHOULD KNOW
byMuhammad Akhtar
 
Modular Operating Room Layout & Specifications
byGaddiel Industries
 
neoplasia prentation.pptx for pathology
bydrdaaha2
 
Congenital Adrenal Hyperplasia (CAH) and SIADH in Neonates
bylidulidiyasolomon
 
Ante partum hemorrhage- Etiology, diagnosis and management
byDrAkashGajjar
 
10- TIVA total intravenous anesthesia for anesthesia
byseabdelbagi
 
IUGR_Management_Presentation-1.pptx for BSc students
byaddis18
 

Risk Management in Hospitals - ROJoson - 2018 - Surabaya, Indonesia

  • 1.
    Risk Management inHealthcare Institution Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg Darya-Varia Laboratoria Multidiscipline Scientific Forum Surabaya, Indonesia February 10, 2017
  • 2.
    Thank You Terima Kasih SalamatPo Darya-Varia Laboratoria
  • 3.
    2017 - Yogyakarta Value-basedHealthcare Service in National Health Care
  • 4.
    Risk Management inHealthcare Institution For Hospital Administrators Risk Management in Hospitals Hospital Risk Management (HRM) Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg Darya-Varia Laboratoria Multidiscipline Scientific Forum Surabaya, Indonesia February 10, 2017 (45-minute lecture and 15-minute discussion)
  • 5.
    Risk Management inHospitals Hospital Risk Management (HRM) HUGE TOPIC! Given (45-minute lecture and 15-minute discussion) OVERVIEW SOME IMPORTANT EXAMPLES AND TIPS ON PROCESSES Thoughts, Perceptions, Opinions and Recommendations (TPORs)
  • 6.
    Survey on RiskMaturity of Sample of Indonesian Hospitals – 2018 – Surabaya Guide in ROJoson’s Lecture Self-assessment of Hospital Owners and Administrators
  • 7.
    Self-assessment on RiskMaturity important and first step in developing and continually improving a risk maturity program of hospitals / organizations! IDENTIFY GAPS ACTION PLANS
  • 8.
    Hospital Risk Maturity– ROJ’s TPORs Concepts of Hospital Risk Maturity What is Hospital Risk Maturity? Level of development of the Risk Management Program / Capability of a hospital
  • 9.
    Hospital Risk Maturity– ROJ’s TPORs Concepts of Hospital Risk Maturity What is importance of Hospital Risk Maturity Assessment? To know the current status or level of development of the Risk Management Program / Capability of a hospital and then to move forward or improve.
  • 10.
    Hospital Risk Maturity– ROJ’s TPORs Concepts of Hospital Risk Maturity How is the Hospital Risk Maturity Assessment done? Self-assessment Checklists - Questionnaire Observation Critical Incident Reports External assessment Checklists-Questionnaire Observation Evaluation of Critical Incident Reports
  • 11.
    Hospital Risk Maturity– ROJ’s TPORs Concepts of Hospital Risk Maturity Questionnaires on Hospital Risk Maturity Assessment Many models! Choose one that is simple – practical – with end- results being same! • Effective and efficient assessment • Effective and efficient risk management program (performance excellence)
  • 12.
    Risk Maturity Levels RiskMaturity Key Characteristics Risk Naive No formal approach developed for risk management Risk Aware Scattered silo based approach to risk management Risk Defined Strategy and policies in place and communicated. Risk appetite defined Risk Managed Enterprise wide approach to risk management developed and communicated Risk Enabled Risk management and internal control fully embedded in the operations http://riskquestionnaire.grant-thornton.co.uk/
  • 13.
    Risk Maturity KeyCharacteristics Ad hoc Undocumented; in a state of dynamic change; depends on individual heroics Preliminary Risk defined in different ways and managed in silos. Process discipline is unlikely to be rigorous. Defined A common risk assessment/response framework is in place. Organization-wide view of risk is provided to executive leadership. Action plans implemented in response to high priority risks. Risk Integrated Risk management activities coordinated across business areas. Risk Optimized Risk discussion is embedded in strategic planning, capital allocation, and other processes and in daily decision-making. http://www.theiia.org/Blogs/marks/index.cfm/post/Measuring%20the%20Maturity%20of%2 0Risk%20Management Risk Maturity Levels
  • 14.
    Risk Maturity KeyCharacteristics Naïve Although a project risk management process may have been initiated, its design or application is fundamentally flawed. Novice The project risk management process influences decisions taken by the project team in a way that is likely to lead to improvements in project performance as measured against its objectives. Normalized The project risk management process is formalised and implemented systematically. Natural The risk management process leads to the selection of risk-efficient strategic choices when setting project objectives and choosing between options for project solutions or delivery. http://www.lundhumphries.com/pdf/SamplePages/Project_Risk_Maturity_Model_Hopkinson _Ch1.pdf Risk Maturity Levels
  • 15.
    Risk Maturity KeyCharacteristics Ad hoc Defined Managed Integrated Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon Risk Maturity Levels
  • 16.
    Risk Maturity KeyCharacteristics Ad hoc Organization is unaware of risk management or its benefits No formal policies or procedures Reactive management through “heroic efforts of individuals” Possible blame culture Defined Risk management is function based and maybe inconsistent Some policies are documented, but RM is largely informal Likely ‘silos’ effect Senior management supports but not requires RM Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
  • 17.
    Risk Maturity KeyCharacteristics Managed Common RM understanding and language organization-wide Formalized generic risk management process “Bad news” accepted Senior management requires RM Integrated RM aligned with strategic planning and quality improvement RM is used in decision-making to gain competitive advantage Proactive approach and open culture RM is responsibility of all Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
  • 18.
    Results of Surveyon Risk Maturity of Sample of Indonesian Hospitals – 2018 - Surabaya Risk Maturity How many hospitals (%) Ad hoc Defined Managed Integrated
  • 19.
    Hospital Risk Management– ROJ’s TPORs OVERVIEW HOSPITAL RISK MANAGEMENT
  • 20.
    Hospital Risk Management– ROJ’s TPORs OVERVIEW Contents Overview of hospital risk management • What is risk • What is hospital risk management • General, preventive, ultimate goals of HRM • Quality parameters - Assessment checklist • Basic framework and processes of HRM • Risk Management • Critical success factors in HRM • Critical governance factors in HRM • Design and Development Plan - Manual of policies and procedures • Multisectoral coordination and collaboration • Recommendations in developing an integrated sustainable hospital risk management
  • 21.
    Risk Management inHospitals Recommended Resource Materials • ISO 31000 – Risk Management – Principles and Guidelines • Joint Commission International • International Society for Quality in Healthcare (ISQUA) https://isqua.org/docs/default-source/education- /isqua-webinar_july-2016_luke-feeney.pdf?sfvrsn=0 • ISO 9001:2015 – Quality Management System – with current emphasis on Risk-based Thinking
  • 22.
    Hospital Risk Management– ROJ’s TPORs Concepts of Risk and Hospital Risk Management What is “RISK”? What is Hospital Risk Management (HRM)?
  • 23.
    Hospital Risk Management– ROJ’s TPORs What is “RISK”? Risk is a probability or threat of a damage, injury, liability, loss, or other negative occurrence that is caused by external or internal vulnerabilities, and that may be neutralized through preemptive action. http://www.businessdictionary.com/definition/risk.html
  • 24.
    Hospital Risk Management– ROJ’s TPORs What is “RISK”? “Risk” – effect of uncertainty on objectives (ISO 31000) Effect – deviation from the expected – positive and/or negative. Objectives can have different aspects (such as financial, health and safety, and environment goals) and can apply at different levels (such as strategic, organization-wide, project, product and process). Uncertainty is the state, even partial, of deficiency of information related to, understanding or knowledge of an event, its consequence, or likelihood.
  • 25.
    Hospital Risk Management– ROJ’s TPORs What is “RISK”? Risk – “any uncertainty that, if it occurs, could have a positive or negative effect on achievement of one or more organizational aims and objectives and is assessed through the combination of magnitude of potential injury (impact) and the probability (likelihood) that the uncertainty will occur.” http://www.who.int/management/general/risk/WhenRiskNotRisk.pdf
  • 26.
    Hospital Risk Management– ROJ’s TPORs What is Hospital Risk Management (HRM)? Hospital risk management (HRM) is a system or program that manages the “risks” of a hospital. •Department Risk Management •Disaster Risk Management •Patient Treatment Risk Management (Benefit-Risk; Medical Malpractice Risk Management) •Others
  • 27.
    Definition of RiskManagement – ISO 31000 “Risk Management” – coordinated activities to direct and control an organization with regard to risk. “Risk Management System” - formalized system that documents processes, procedures and responsibilities for achieving the policies and objectives of Risk Management System.
  • 28.
    Concept of RiskManagement – ISO 31000 •Risk management can be applied to an entire organization, at its many areas and levels, at any time, as well as to specific functions, projects and activities. Risk Management at - • Board of Directors Level • Operating Room • Pharmacy • Laboratory • Nursing Floors • Outpatient Department • Emergency Room • Etc.
  • 29.
    Importance of ManagingRisks in Hospitals “Risk” – effect of uncertainty on objectives •Risks can make or break the hospitals •Positive or negative income •Sustained or bankrupt hospital •Proactively manage risk! •Minimize SURPRISES!
  • 30.
    Risk Management –Joint Commission International Stipulations Risk Management Program – Clinical and administrative activities that organizations undertake to identify, to evaluate, and to reduce the risk of injury to patients, staff, and visitors and the risk of loss to the organization itself.
  • 31.
    Risk Management –Joint Commission International Stipulations Standard QPS.11 •An ongoing program of risk management is used to identify and to proactively reduce unanticipated adverse events and other safety risks to patients and staff.
  • 32.
    Risk Management –Joint Commission International Stipulations Intent of QPS.11 Hospitals need to adopt a proactive approach to risk management. One such way is a formalized risk management program whose essential components include a) risk identification; b) risk prioritization; c) risk reporting; d) risk management; e) investigation of adverse events; and f) management of related claims.
  • 33.
    Risk Management –Joint Commission International Stipulations Measurable Elements of QPS.11 1. The hospital’s risk management framework includes a) through f) in the intent. 2. At least annually, a proactive risk-reduction exercise is conducted on one of the priority risk processes. 3. High-risk processes are redesigned based on the analysis of the test results.
  • 34.
    Risk Management –Joint Commission International Stipulations Standard FMS.3 • One or more qualified individuals oversee the planning and implementation of the facility management program • to reduce and control risks in the care environment.
  • 35.
    Risk Management –Joint Commission International Stipulations Intent of FMS.3 Hospitals work to provide safe, functional, and supportive facilities for patients, families, staff, and visitors. To reach this goal, the physical facility, equipment, medical technology, and people must be effectively managed. In particular, management must strive to • reduce and control hazards and risks; • prevent accidents and injuries; and • maintain safe conditions.
  • 36.
    Risk Management –Joint Commission International Stipulations Intent of FMS.3 Effective management includes multidisciplinary planning, education, and monitoring as follows: • Hospital leadership plans the space, technology, and resources needed to safely and effectively support the clinical services provided. • All staff are educated about the facility, how to reduce risks, and how to monitor and to report situations that pose risk. • Performance criteria are used to evaluate important systems and to identify needed improvements.
  • 37.
    Risk Management –Joint Commission International Stipulations Measurable Elements of FMS.3 1. Program oversight and direction are assigned to one or more individuals qualified by experience and training. 2. Evidence of the training and experience of the qualified individual(s) is documented. 3. The individual(s) plans and implements the program, including elements a) through f) of the intent.
  • 38.
    Risk Management –ISO 9001:2015 Stipulations ISO 9001:2015 (Quality Management System) puts emphasis on Risk-based Thinking. Risk-based thinking enables an organization to determine the factors that could cause its processes and its quality management system to deviate from the planned results, to put in place preventive controls to minimize negative effects and to make maximum use of opportunities as they arise.
  • 39.
    Risk Management –ISO 9001:2015 Stipulations An organization needs to plan and implement actions to address risks and opportunities. Addressing both risks and opportunities establishes a basis for increasing the effectiveness of the quality management system, achieving improved results and preventing negative effects.
  • 40.
    Risk Management –ISO 9001:2015 Stipulations Opportunities can arise as a result of a situation favourable to achieving an intended result, for example, set of circumstances that allow the organization to attract customers, develop new products and services, reduce waste or improve productivity. Actions to address opportunities can also include consideration of associated risks. Risk is the effect of uncertainty and any such uncertainty can have positive or negative effects. A positive deviation arising from a risk can provide an opportunity, but not all positive effects of risk result in opportunities.
  • 41.
    Hospital Risk Management– ROJ’s TPORs What are the general goals of HRM? • Maximize all potential risks with positive effects (rejoice and celebrate) • Prevent and mitigate all potential risks wth negative effects • Be prepared in terms of response and recovery in case the risks become real • Control resulting damage, injury, liability, loss, or other negative occurrence to a minimum level
  • 42.
    Hospital Risk Management– ROJ’s TPORs What are the general goals of HRM? • Avoid loss of and disability in People (patients, visitors, staff) in the hospital Resources of hospital Business of hospital (business discontinuity) • Avoid complaints related to risk occurrence and consequences!
  • 43.
    Hospital Risk Management– ROJ’s TPORs What are the preventive goals of HRM? • Promote safety for ALL patients, visitors, and staff in the hospital • Provide effective assistance and management during emergencies (disasters) • Prevent controllable deaths and disabilities • Prevent and control losses (business, finances, properties, and infrastructure)
  • 44.
    Hospital Risk Management– ROJ’s TPORs What are the ultimate goals of HRM? SUSTAINABILITY OF THE HOSPITAL AS LONG AS POSSIBLE (target: 100 years)
  • 45.
    Hospital Risk Management– ROJ’s TPORs What are the ultimate goals of HRM? SUSTAINABILITY OF THE HOSPITAL AS LONG AS POSSIBLE (target: 100 years) Sustainable structure-wise Sustainable financial-wise Sustainable service-wise
  • 46.
    Hospital Risk Management– ROJ’s TPORs Sustainable structure-wise goal of HRM? Sustainable structure-wise Will NOT collapse NOT be burned NOT be flooded NOT be destroyed by whatever hazards and will continue to operate its business as long as possible (target: 100 years).
  • 47.
    Hospital Risk Management– ROJ’s TPORs Sustainable financial-wise goal of HRM? Sustainable financial-wise Will NOT go bankrupt Will have positive income and will continue to operate its business as long as possible (target: 100 years).
  • 48.
    Hospital Risk Management– ROJ’s TPORs Sustainable service-wise goal of HRM? Sustainable service-wise Will continue to provide adequate and quality services expected of a hospital for as long as possible, both during crisis and non-crisis situations
  • 49.
    Hospital Risk Management– ROJ’s TPORs Quality parameters of an excellent HRM? • Systematically and comprehensively formulated (with document) • With full support and commitment of top management and ALL staff • ALL staff of the hospitals trained and educated on program
  • 50.
    Hospital Risk Management– ROJ’s TPORs Quality parameters of an excellent HRM? • With testing or exercises done regularly and at planned intervals and as needed • Being reviewed regularly at planned intervals and as needed • Has been tried and tested and has achieved its formulated goals and objectives and specified targets
  • 51.
    Risk Management inHospitals - ISO 31000 PRINCIPLES FRAMEWORK PROCESS
  • 52.
    Principles of RiskManagement – ISO 31000 To be effective, an organization should at all levels comply with the principles below. • creates and protects value. • is an integral part of all organizational processes. • is part of decision making. • explicitly addresses uncertainty. • is systematic, structured and timely. • is based on the best available information. • is tailored. • takes human and cultural factors into account. • is transparent and inclusive. • is dynamic, iterative and responsive to change. • facilitates continual improvement of the organization.
  • 53.
    Hospital Risk Management– ROJ’s TPORs Basic Framework in Hospital Risk Management? Risk Management Framework (ISO 31000) set of components that provide the foundations and organizational arrangements for designing, implementing, monitoring, reviewing and continually improving risk management throughout the organization.
  • 54.
    Risk Management Frameworkfor Hospitals From ISO 31000 – Risk Management – Principles and Guidelines
  • 55.
    Risk Management Frameworkfor Hospitals From ISO 31000 – Risk Management – Principles and Guidelines
  • 56.
    Hospital Risk Management– ROJ’s TPORs Basic processes in Hospital Risk Management? Risk Management Process (ISO 31000) systematic application of management policies, procedures and practices to the activities of communicating, consulting, establishing the context and identifying, analyzing, evaluating, treating, monitoring and reviewing risk.
  • 57.
  • 58.
  • 59.
    Risk Management inHospitals - ISO 31000 PRINCIPLES FRAMEWORK PROCESS
  • 60.
    Risk Management Frameworkand Process for Hospitals
  • 61.
    Risk Management Process– ISO 31000 Communication and Consultation – continual and iterative processes that an organization conducts to provide, share and obtain information and to engage in dialogue with stakeholders regarding the management of risk.
  • 62.
    Risk Management Process– ISO 31000 Establishing the Context – Defining the external and internal parameters to be taken into account when managing risk, and setting the scope and risk criteria for the risk management policy.
  • 63.
    Establishing the Context Externalcontext – external environment in which a hospital seeks to achieve its objectives • Cultural, social, political, legal, regulatory, financial, technological, economic, natural and competitive environment, whether international, national, regional or local; • Key drivers and trends having impact on the objectives of the organization; and • Relationships with, and perceptions and values of the external stakeholders. SWOT ANALYSIS – OT
  • 64.
    Establishing the Context Internalcontext – internal environment in which a hospital seeks to achieve its objectives • Governance, organizational structure, roles and accountabilities • Policies, objectives, and the strategies that are in place to achieve them • Capabilities, understood in terms of resources and knowledge (e.g. capital, time, people, processes, systems and technologies) • Information systems, information flows and decision-making processes (both formal and informal); • Relationships with, and perceptions and values of, internal stakeholders • Organizational culture • Standards, guidelines and models adopted by the organization, and • Form and extent of contractual relationships SWOT ANALYSIS – SW
  • 65.
    Establishing the Context Scope •Clinicalrisk (involving medical care of patients) ~ PATIENT SAFETY PROGRAM •Non-clinical risk (not involving medical care of patients)
  • 66.
    Establishing the Context INTEGRATION •Clinicalrisk (involving medical care of patients) ~ PATIENT SAFETY PROGRAM •Non-clinical risk (not involving medical care of patients) •Quality and Risk Management •Quality and Safety and Risk Management
  • 67.
    Establishing the Context RiskManagement Policy of ROJHMC To always use risk-based thinking and processes in planning and deciding all activities in the hospital so as to minimize negative effects and to maximize positive effects on accomplishment of objectives. This policy shall be realized through: • Understanding the potential risks on quality and safe health care services, products, facility, environment and business development; • Complying with all statutory and regulatory requirements on risk management; • Designing a structured, comprehensive, integrated, effective and efficient risk management system; • Providing adequate resources and highly competent staff to support the implementation of the management system; • Regularly evaluating and reviewing the results of implementation of the management system; • Continually improving the management system with innovations.
  • 68.
    Establishing the Context Qualityand Safety Policy - ROJHMC To continuously provide quality and safe health care services, products, facility and environment to all our stakeholders (communities, families, patients, workforce and partners). This policy shall be realized through: • Understanding the expectations of our stakeholders on quality and safe health care services, products, facility and environment; • Complying with all statutory and regulatory requirements; • Designing effective and efficient quality and safe management systems • Providing adequate resources and highly competent staff to support the implementation of the management system; • Regularly evaluating and reviewing the results of implementation of the management system; • Continually improving the management system with innovations.
  • 69.
  • 70.
  • 71.
    Risk Criteria –terms of reference against which the significance of a risk is evaluated. Establishing the Context General Framework for Risk Criteria
  • 72.
  • 73.
  • 74.
  • 75.
    Risk Management Process– ISO 31000 Risk identification - process of finding, recognizing and describing risks. • Involves identification of risk sources, events, their causes and their potential consequences. • From historical data, theoretical analysis, informed and expert opinions, and stakeholders’ needs.
  • 76.
    Risk Management Process– ISO 31000 Risk identification - process of listing potential risks and their characteristics. The results of risk identification are normally documented in a risk register, which includes a list of identified risks along with their sources, potential risk responses, and risk categories.
  • 77.
    Risk Management Process– ISO 31000 Risk analysis – process to comprehend the nature of the risk and to determine the level of risk. Risk analysis provides basis for risk evaluation and decisions about risk treatment. Risk analysis includes risk estimation.
  • 78.
    Risk Analysis (Estimation) Inhospitals, the risk estimation or analysis can be done on a qualitative or quantitative basis or in some combination. Qualitative analysis is based on judgement, previous experience and intuition. Quantitative analysis is generally based on an estimation of the relative magnitude of harm that is likely to result and the possibility that the event will actually occur. Currently, a lot of hospitals do not analyze risk in a quantifiable measure as they feel their risks are too complex or cannot be measured. However, this can be done and in fact, are being done.
  • 79.
    Risk Analysis (Estimation) Inmedical care, quantitative risk assessment is widely practiced nowadays. Examples, there are quantitative risk assessment for perioperative complications with or without laboratory testings; quantitative risk assessment for heart attack and stroke in patients with metabolic syndrome; etc. The statistical techniques commonly being used are the multi-variate regression analysis; likelihood ratios; odds ratios; predictive values; etc.
  • 80.
    Risk Analysis (Estimation) Inhospitals, the risk is often evaluated by determining the: • degree of injury • degree of patient dissatisfaction • legal grounds for an actual claim • potential public relations or community relations impact • financial loss or projection of loss
  • 81.
    Risk Analysis (Estimation) Therecommendation is to move towards quantitative risk estimation and analysis whenever and wherever possible to get more specific estimate which will lead to more concrete action plans and evaluation. Another recommendation: start with a qualitative risk analysis then segregate those risks in which a quantitative analysis can be done and recommendable.
  • 82.
  • 83.
    Samples of LikelihoodGuide Level Descriptor Description 5 Almost certain It will happen in the vast majority of cases. 4 Most likely It will happen in a majority of cases. 3 Likely It will happen in some cases. 2 Unlikely It will happen in a few cases. 1 Remote It will happen only in a particular type of case.
  • 84.
    Samples of LikelihoodGuide Probability Descriptor Description 4 Frequent Likely to occur immediately or within a short period (may happen several times in 1 year) 3 Occasional Probably will occur (may happen several times in 1 to 2 years) 2 Uncommon Possible to occur (may happen sometime in 2 to 5 years) 1 Remote Unlikely to occur (may happen sometime in 5 to 30 years)
  • 85.
    Samples of LikelihoodGuide Remote (1) Unlikely (2) Likely (3) Most Likely (4) Almost Certain (5) Freq Prob Freq Prob Freq Prob Freq Prob Freq Prob Occurs every 5 years or more 1% Occurs every 2- 5 years 10% Occurs every 1-2 years 50% Bimont hly 75% At least monthl y 99%
  • 86.
    Samples of ImpactSeverity Guides Score Impact 1 Negligible 2 Minor 3 Moderate 4 Major 5 Extreme
  • 87.
    Samples of ImpactSeverity Guides Negligible Minor Moderate Major Extreme Adverse event leading to minor injury not requiring first aid. No impaired psychosocial functioning Minor injury or illness, first aid treatment required <3 days absence <3 days extended hospital stay. Impaired psychosocial functioning greater than 3 days less than one month. Significant injury requiring medical treatment e.g. fracture and / or counselling. >3 days absence 3-8 days extended hospital stay. Impaired psychosocial functioning greater than one month less than 6 months. Major injuries / long term incapacity or disability (loss of limb) requiring medical treatment and / or counseling. Impaired psychosocial functioning greater than 6 months. Incident leading to death or major permanent incapacity. Event which impacts on large number of patients or member of the public. Permanent psychosocial functioning incapacity.
  • 88.
    Samples of ImpactSeverity Guides Level 1 Level 2 Level 3 Level 4 Level 5 Near miss / potential harm / damage. Patients with potential: Event / error results in no harm / damage. Patients with potential: Event / error results in temporary minor harm / damage. Increased length of stay. Event / error results in permanent harm damage. This is a critical incident. Event / error results in death. This is a critical incident.
  • 89.
    Sample of RiskQuantification Matrix CONSEQUENCE Insignificant 1 Minor 2 Moderate 3 Major 4 Extreme 5 L I K E L I H O O D Almost Certain – 5 5 10 15 20 25 Most Likely – 4 4 8 12 16 20 Likely – 3 3 6 9 12 15 Unlikely – 2 2 4 6 8 10 Remote – 1 1 2 3 4 5 Key1: 1-5 = Low Risk ; 6-15 = Medium Risk; >15 = High Risk Key2: 1-4 = Low Risk ; 5-10 = Medium Risk; >10 = High Risk
  • 90.
    Risk Management Process– ISO 31000 Risk evaluation – process of comparing the results of risk analysis with risk criteria to determine whether the risk and/or its magnitude is acceptable or tolerable. Risk evaluation assists in the decision about risk treatment.
  • 91.
    sk Criteria Risk EvaluationRiskevaluation – process of comparing the results of risk analysis with risk criteria to determine whether the risk and/or its magnitude is acceptable or tolerable. Risk evaluation assists in the decision about risk treatment.
  • 92.
    Risk Evaluation –Risk Treatment
  • 93.
    Risk Management Process– ISO 31000Risk Treatment – process to modify risk Risk treatment can involve • Avoiding the risk by deciding not to start or continue with the activity that gives rise to the risk; • Taking or increasing the risk in order to pursue an opportunity; • Removing the risk source; • Changing the likelihood; • Changing the consequences; • Sharing the risk with another party or parties (including contracts and risk financing); and • Retaining the risk by informed decision. Risk treatment that deal with negative consequences are sometimes referred to as “risk mitigation”, “risk elimination”, “risk prevention” and “risk reduction.”
  • 94.
  • 95.
    Risk Management Process– ISO 31000 Monitoring – continual checking, supervising, critically observing or determining the status in order to identify change from the performance level required or expected. Review – activity undertaken to determine the suitability, adequacy and effectiveness of the subject matter to achieve established objectives. Monitoring and review can be applied to a risk management framework, risk management process, risk or control.
  • 96.
    Risk Management FormIllustrating Risk Management Process
  • 97.
    Risk Management FormIllustrating Risk Management Process Risks identified Causes Date risk identifi ed Likelihood Impact Severity Overall Risk Rating Current Controls in system RISK ASSESSMENT Based on Context / Communication / Consultation • Risk Identification • Risk analysis • Risk evaluation
  • 98.
    Risk Management FormIllustrating Risk Management Process Risk Response Strategy (Accept, Control, Transfer, Avoid) Action Required Respon sible Persons Due Date Resou rces Requir ed Risk Treatment Plan
  • 99.
    Risk Management FormIllustrating Risk Management Process Monitoring and Review Plan and Outcome Post Tx likelihood Post Tx impact severity Post Tx Risk Score Review Date
  • 100.
    Risk Management FormIllustrating Risk Management Process Contingency Plan What if risk really happens?
  • 103.
    RISK MANAGEMENT PROGRAM= CORPORATE <-> DEPARTMENTAL
  • 104.
  • 105.
    Hospital Risk Management– ROJ’s TPORs RISK IDENTIFICATION RISKS commonly encountered in Philippine hospitals Risk for • business non-sustainability (financial viability) • aging (unsettled) account receivables • medico-legal suits (arising from patient care) • technology-related disasters • natural disasters (earthquake, flood, tsunamis, fire, etc.)
  • 106.
    Hospital Risk Management– ROJ’s TPORs RISK IDENTIFICATION RISKS commonly encountered in Philippine hospitals Risk for • tarnished corporate or hospital reputation • man-made disasters (fire, felony, bomb threat, terrorism, etc.) • non-medico-legal suits (not arising from patient care, such as workforce legal suits) • biological disasters
  • 107.
    Hospital Risk Management– ROJ’s TPORs RISK ASSESSMENT Risk assessment - likelihood of occurrence of identified risks and impact when they occur. Utility of risk assessment - more on prioritization ALL risks identified must have preventive, mitigation, preparedness, response, and recovery plans!
  • 108.
    Hospital Risk Management– ROJ’s TPORs RISK MANAGEMENT •Formulation of strategies and action plans to prevent, mitigate risks and to respond and recover from the consequences of unavoidable risk occurrence ALL hazards approach! BUT ALL risks identified must have specific preventive, mitigation, preparedness, response, and recovery plans!
  • 109.
    Hospital Risk Management– ROJ’s TPORs RISK MANAGEMENT Risks Prevention Mitigation Preparedness Response Recovery Business non- sustainability Account receivables Medicolegal suits Technological disasters Natural disasters Tarnished reputation Man-made disasters Legal suits Biological disasters Example of ALL-HAZARD APPROACH in Disasters 7 Basic Essential (Common) Steps in Response • Declaration of disaster • Creation of an incident command • Notification of concerned authorities • Mobilization and organization of staff and services • Control of disaster • Decongestion and post-disaster reconstruction • Post-disaster evaluation and reporting
  • 110.
    Hospital Risk Management– ROJ’s TPORs RISK MANAGEMENT Risks Prevention Mitigation Preparedness Response Recovery Business non- sustainability Account receivables Medicolegal suits Technological disasters Natural disasters Tarnished reputation Man-made disasters Legal suits Biological disasters Example of ALL-HAZARD APPROACH in “Situations” 7 Basic Essential (Common) Steps in Response • Declaration of “situation” (emergency – crisis) • Creation of a “situation” command • Notification of concerned authorities • Mobilization and organization of “situation” team • Legal team • Crisis communication team • Control of “situation” • Post- “situation” reconstruction • Post- “situation” evaluation and reporting
  • 111.
    Hospital Risk Management– ROJ’s TPORs RISK MANAGEMENT Risks Prevention Mitigation Preparedness Response Recovery Business non- sustainability Account receivables Medicolegal suits Technological disasters Natural disasters Tarnished reputation Man-made disasters Legal suits Biological disasters Example of ALL-HAZARD APPROACH in “B-Situations” 7 Basic Essential (Common) Steps in Response • Declaration of “B-situation” (emergency – crisis) • Creation of a “B-situation” command • Notification of concerned authorities • Mobilization and organization of “B-situation” team • Finance and audit team • Business development team • Control of “B-situation” • Post- “B-situation” reconstruction • Post- “B-situation” evaluation and reporting
  • 112.
    Hospital Risk Management– ROJ’s TPORs RISK MANAGEMENT Risks Structural S Service S Financial S Business non-sustainability √√√√ Account receivables √√√ Medicolegal suits √√ Technological disasters √ √√ Natural disasters √√√ √√ √√ Tarnished reputation √ Man-made disasters √√√ √√ √ Legal suits √ √ Biological disasters √√ √ *S - Sustainability
  • 113.
    Hospital Risk Management– ROJ’s TPORs Strategy to Avoid Medico-legal Suits To avoid medico-legal suits All physicians must always take note of the goals in the management of all patients: Resolution of the health problem Live patient No complication No disability Satisfied patient No medicolegal suit
  • 114.
    Avoiding Medico-legal Suits PATIENTSAFETY PROGRAM RAPPORT WITH PATIENTS AND RELATIVES COMMUNICATION – INFORMED CONSENT
  • 115.
    International Patient SafetyGoals Goal 1 - Identify patients correctly Goal 2 - Improve effective communication Goal 3 - Improve the safety of high-alert medications Goal 4 - Ensure correct site, correct procedure, correct patient surgery Goal 5 - Reduce risk of health care-associated infections Goal 6 - Reduce the risk of patient harm resulting from fall
  • 116.
    Hospital Risk Management– ROJ’s TPORs Critical steps to ensure success of HRM • Securing of administrative commitment and support • Establishment and continual development of manual of policies and procedures on risk management that include risk preparedness (prevention, mitigation, preparedness, response, and recovery plans) • Regular conduct of risk control exercises
  • 117.
    Hospital Risk Management– ROJ’s TPORs RISK MANAGEMENT •Formulation of strategies and action plans to make the risk management program walk the talk! Leadership Managership Communication Education and Training
  • 118.
    Critical Governance Factors Leadership Readinessin Risk Control T r a i n i n g C o m m u n i c a t i o n Managership
  • 119.
    “Manage” staff toget commitment and support to achieve goals!
  • 120.
    Leaders may delegate responsibilitiesand competencies to managers. But must know principles of risk preparedness, esp. in managing Incident Command! Critical factors for readiness!
  • 121.
    Leaders communicate with managers andstaff effectively and efficiently! Timely! Stress importance of risk preparedness! Provide directions! Express commitment and support!
  • 122.
    Leaders support training ofstaff for risk preparedness! Undergo training to gain competency, esp. in Incident Command! To demonstrate engagement and involvement!
  • 123.
    Hospital Risk Management– ROJ’s TPORs Manual of Policies and Procedures Recommendations: The management program must be documented and placed in a policies and procedures manual or primer, disseminated to all staff, exercised, reviewed and re- evaluated at planned intervals or as the need arises anytime.
  • 124.
    Hospital Risk Management– ROJ’s TPORs The manual can have the following simple outline: • Preface • Scope • Definitions • Program Management • Planning • Implementation • Exercises, evaluation and corrective action • Management Review Manual of Policies and Procedures
  • 125.
    Hospital Risk Management– ROJ’s TPORs The manual can have the following simple outline: • Preface • Scope • Definitions • Program Management • Planning • Implementation • Exercises, evaluation and corrective action • Management Review Hospital Risk Management Program Manual Supplementary Manuals on Implementing Guidelines and Instructions (covering the categories of common hospital risks) Manual of Policies and Procedures
  • 126.
    Hospital Risk Management– ROJ’s TPORs Multisectoral Task Force / Committee Recommendations: Creation of multisectoral task force / committee to align, coordinate, collaborate, and integrate all risk preparedness programs of the hospital
  • 127.
    Hospital Risk Management– ROJ’s TPORs Recommendations: Examples of multisectoral task forces / committees • Corporate Risk Management Committee • Safety Promotion and Disaster Preparedness Committee • Quality Management Committee • Quality and Risk Management Committee Multisectoral Task Force / Committee
  • 128.
    Hospital Risk Management– ROJ’s TPORs Recommendations: Examples of multisectoral task forces / committees • Corporate Risk Management Committee • Safety Promotion and Disaster Preparedness Committee • Quality Management Committee • Quality and Risk Management Committeee Multisectoral Task Force / Committee Essentials: Multisectoral in membership Headed by a top / senior management representative Aligning, coordinating, integrating all risk preparedness programs of the entire hospital
  • 129.
    Hospital Risk Management– ROJ’s TPORs OVERVIEW Contents Overview of hospital risk management • What is risk • What is hospital risk management • General, preventive, ultimate goals of HRM • Quality parameters - Assessment checklist • Basic framework and processes of HRM • Risk Management • Critical success factors in HRM • Critical governance factors in HRM • Design and Development Plan - Manual of policies and procedures • Multisectoral coordination and collaboration • Recommendations in developing an integrated sustainable hospital risk management
  • 130.
    Case Studies ofHospitals on Risk Management Program Difficult to get info! Majority = financial viability and sustainability despite “un-enhanced” risk management program Definite = incurred losses at one time or another Challenges: • Medicolegal suits • Account receivables
  • 131.
    Risk Management inHospitals Hospital Risk Management (HRM) HUGE TOPIC! Given (45-minute lecture and 15-minute discussion) OVERVIEW SOME IMPORTANT EXAMPLES AND TIPS ON PROCESSES Thoughts, Perceptions, Opinions and Recommendations (TPORs)
  • 132.
    Risk Maturity KeyCharacteristics Ad hoc Organization is unaware of risk management or its benefits No formal policies or procedures Reactive management through “heroic efforts of individuals” Possible blame culture Defined Risk management is function based and maybe inconsistent Some policies are documented, but RM is largely informal Likely ‘silos’ effect Senior management supports but not requires RM Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
  • 133.
    Risk Maturity KeyCharacteristics Managed Common RM understanding and language organization-wide Formalized generic risk management process “Bad news” accepted Senior management requires RM Integrated RM aligned with strategic planning and quality improvement RM is used in decision-making to gain competitive advantage Proactive approach and open culture RM is responsibility of all Risk Maturity Levels Loosemore et al, 2006 Risk Management in Projects, 2nd ed, Taylor & Francis, Oxon
  • 134.
    Principles of RiskManagement – ISO 31000 To be effective, an organization should at all levels comply with the principles below. • creates and protects value. • is an integral part of all organizational processes. • is part of decision making. • explicitly addresses uncertainty. • is systematic, structured and timely. • is based on the best available information. • is tailored. • takes human and cultural factors into account. • is transparent and inclusive. • is dynamic, iterative and responsive to change. • facilitates continual improvement of the organization.
  • 135.
    Principles of RiskManagement – ISO 31000 To be effective, an organization should at all levels comply with the principles below. • creates and protects value. • is an integral part of all organizational processes. • is part of decision making. • explicitly addresses uncertainty. • is systematic, structured and timely. • is based on the best available information. • is tailored. • takes human and cultural factors into account. • is transparent and inclusive. • is dynamic, iterative and responsive to change. • facilitates continual improvement of the organization.
  • 136.
    Principles of RiskManagement – ISO 31000 • Risk management creates and protects value. • Contributes to the demonstrable achievement of objectives and improvement of performance. • Risk management is an integral part of all organizational processes. • Not a stand-alone activity that is separate from the main activities and processes of the organization. Is an integral part of ALL organizational processes. Integrate risk management into the overall management system of the organization.
  • 137.
    Principles of RiskManagement – ISO 31000 • Risk management is part of decision making. • Helps decision-makers make informed choices, prioritize actions and distinguish among alternative courses of actions. • Risk management explicitly addresses uncertainty. • Explicitly takes account of uncertainty, the nature of that uncertainty, and how it can be addressed.
  • 138.
    Principles of RiskManagement – ISO 31000 • Risk management is systematic, structured and timely. • Contributes to efficiency and to consistent, comparable and reliable results. • Risk management is based on the best available information. • There must be data no matter how limited. • Risk management is tailored. • Aligned with the organization’s unique external and internal context and risk profile.
  • 139.
    Principles of RiskManagement – ISO 31000 • Risk management takes human and cultural factors into account. • Recognizes the capabilities, perceptions and intentions of external and internal people that can facilitate or hinder achievement of the organization’s objectives. • Risk management is transparent and inclusive. • Appropriate and timely involvement of stakeholders and decision makers at all levels of the organization, ensures that risk management remains relevant and up- to-date (and known to all and participatory)
  • 140.
    Principles of RiskManagement – ISO 31000 • Risk management is dynamic, iterative and responsive to change. • Continually senses and responds to change. As external and internal events occurs, context and knowledge change, monitoring and review of risks take place, new risks emerge, some change, and others disappear. • Risk management facilitates continual improvement of the organization. • Improving risk management maturity facilitates continual improvement of organization.
  • 141.
    Thank You Terima Kasih SalamatPo Darya-Varia Laboratoria