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Risk Management Workshop
National Kidney and Transplant Institution
February 16, 2013
Risk Management Workshop
National Kidney and Transplant Institution
February 16, 2013
Acknowlegements:
Dr. Aileen Riego-Javier (Executive Director); Dr. Zenaida Antonio (Deputy Director, Adm. Services); Dr. Ernie Que; Dr.
Mike Jaro; Organizing Committee; others
An Introduction to Risk Management for Healthcare Institution
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Risk Management Workshop
National Kidney and Transplant Institution
February 16, 2013
An Introduction to Risk Management for Healthcare Institution
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Objectives:
•Provide understanding of the Risk Management Framework in a healthcare institution.•Discuss the process of developing a Risk Management Program for healthcare institution.•Discuss the components of Risk Management Plan.
An Introduction to Risk Management for Healthcare Institution
(Hospital Setting)
ROJoson’s TPORs(Thoughts, Perceptions, Opinions, and Recommendations)
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Objectives:
•Provide understanding of the Risk Management Framework in a healthcare institution (hospital).•Discuss the process of developing a Risk Management Program for healthcare institution (hospital).•Discuss the components of Risk Management Plan.
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Objectives:
•Provide understanding of the Risk Management Framework in a healthcare institution (hospital).•Discuss the process of developing a Risk Management Program for healthcare institution (hospital).•Discuss the components of Risk Management Plan.
Risk Management
Framework
Risk Management
Program
Risk Management
Plan
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Risk Management
Framework
Risk Management
Program
Risk Management
Plan
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Risk Management
Framework
Risk Management
Program
Risk Management
Plan
INTEGRATION
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Risk Management Framework
Risk Management
ProgramRisk
Management Plan
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Risk Management Program
Risk Management Framework
Risk Management
Plan
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Risk Management Plan
Risk Management Framework
Risk Management
Program
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Risk Management
Framework
Risk Management
Program
Risk Management
Plan
INTEGRATION
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Main Concern:
Starting a Risk Management Program in NKTI!
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Starting a Risk Management Program in NKTI!
What are the things needed to be done?
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Starting a Risk Management Program in NKTI!What are the things needed to be done?
(Assumption: decided to have the program!]
Concepts / Rationale / Goals / Objectives / Framework
Program / Projects
PlansStrategic Plans
Operational PlansDeployment PlansMonitoring PlansEvaluation Plans
Continual Improvement Plans Others
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Starting a Risk Management Program in NKTI!What are the things needed to be done?
(Assumption: decided to have the program!]
Concepts / Rationale / Goals / Objectives / Framework
Program / Projects
PlansStrategic Plans
Operational PlansDeployment PlansMonitoring PlansEvaluation Plans
Continual Improvement Plans Others
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Starting a Risk Management Program in NKTI!What are the things needed to be done?
(Assumption: decided to have the program!]
Concepts / Rationale / Goals / Objectives / Framework
Program / Projects
PlansStrategic Plans
Operational PlansDeployment PlansMonitoring PlansEvaluation Plans
Continual Improvement Plans Others
An Introduction to Risk Management for Healthcare Institution
(Hospital Setting)
ROJoson’s TPORs(Thoughts, Perceptions, Opinions, and Recommendations)
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Objectives:
•Provide understanding of the Risk Management Framework in a healthcare institution (hospital).•Discuss the process of developing a Risk Management Program for healthcare institution (hospital).•Discuss the components of Risk Management Plan.
Hospital Risk Management – ROJ’s TPORs
ContentsOverview of hospital risk management • What is risk• What is hospital risk management• General, preventive, ultimate goals of HRM• Quality parameters - Assessment checklist• Basic processes of HRM• 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 Framework
ProgramPlan
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
occurrencethat 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 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
Hospital Risk Management – ROJ’s TPORs
What are the general goals of HRM?
• Prevent and mitigate all potential risks
• 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 inPeople (patients, visitors, staff) in the hospitalResources of hospitalBusiness 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-wiseSustainable financial-wiseSustainable service-wise
Hospital Risk Management – ROJ’s TPORs
Sustainable structure-wise goal of HRM?
Sustainable structure-wise
Will NOT collapse NOT be burnedNOT 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
Hospital Risk Management – ROJ’s TPORs
Basic processes in Hospital Risk Management?
• Risk Identification
• Risk Assessment
• Risk Management
Hospital Risk Management – ROJ’s TPORs
RISK IDENTIFICATIONRISKS 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 IDENTIFICATIONRISKS 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 RecoveryBusiness non-sustainabilityAccount receivablesMedicolegal suitsTechnological disastersNatural disastersTarnished reputationMan-made disastersLegal suits
Biological disasters
Hospital Risk Management – ROJ’s TPORs RISK MANAGEMENT
Risks Prevention Mitigation Preparedness Response RecoveryBusiness non-sustainabilityAccount receivablesMedicolegal suitsTechnological disastersNatural disastersTarnished reputationMan-made disastersLegal 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 RecoveryBusiness non-sustainabilityAccount receivablesMedicolegal suitsTechnological disastersNatural disastersTarnished reputationMan-made disastersLegal 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 RecoveryBusiness non-sustainabilityAccount receivablesMedicolegal suitsTechnological disastersNatural disastersTarnished reputationMan-made disastersLegal 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 SBusiness 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 problemLive patientNo complicationNo disabilitySatisfied patientNo medicolegal suit
Hospital Risk Management – ROJ’s TPORs
RISK MANAGEMENT
•Formulation of strategies and action plans to make the risk management program walk the talk!
LeadershipManagership
CommunicationEducation and Training
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
Critical Governance Factors
Leadership
Readiness in Risk Control
Training
Communication
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 9 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 / committeeto 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
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
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
None / not being done yet
Beginning Expanding Consistent Advanced
Overall, we have a structured, comprehensive and effective hospital risk management program.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have a structured risk identification process.We keep track of newly perceived and actual risks and add them to the list of hospital risks.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have a structured risk assessment process.
We prioritize our preparations for risk preparedness based on the risk assessment process.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have preparedness programs for all identified hospital risks.
We have a structured risk reduction system.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have a structured risk control system (response and recovery program during risk occurrence).
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have a risk financing program like liability and general insurances.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have a comprehensive fire insurance for our properties and capital resources.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have a multisectoral taskforce / committee in charge of the hospital risk management program.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have an integrated hospital risk management program where all risks are interconnected as indicated during planning and exercises.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
We have documented policies and procedures on hospital risk management.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
None / not being done yet
Beginning Expanding Consistent Advanced
Our documented policies and procedures on hospital risk management are being reviewed at least at planned intervals.We conduct regular exercises on our risk preparedness program.
Assessment Checklist on Hospital Risk Management
Hospital Risk Management – ROJ’s TPORs
Assessment Checklist on Hospital Risk Management
None / not being done yet
Beginning Expanding Consistent Advanced
We have the full commitment and support from the top management for our hospital risk management program.Overall, we have a structured, comprehensive and effective hospital risk management program.
Hospital Risk Management – ROJ’s TPORs
ContentsOverview of hospital risk management • What is risk• What is hospital risk management• General, preventive, ultimate goals of HRM• Quality parameters - Assessment checklist• Basic processes of HRM• 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 Framework
ProgramPlan
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Starting a Risk Management Program in NKTI!What are the things needed to be done?
(Assumption: decided to have the program!]
Concepts / Rationale / Goals / Objectives / Framework
Program / Projects
PlansStrategic Plans
Operational PlansDeployment PlansMonitoring PlansEvaluation Plans
Continual Improvement Plans Others
An Introduction to Risk Management for Healthcare Institution
(Hospital Setting)
ROJoson’s TPORs(Thoughts, Perceptions, Opinions, and Recommendations)
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Objectives:
•Provide understanding of the Risk Management Framework in a healthcare institution (hospital).•Discuss the process of developing a Risk Management Program for healthcare institution (hospital).•Discuss the components of Risk Management Plan.
An Introduction to Risk Management for Healthcare Institution
(Hospital Setting)
ROJoson’s TPORs(Thoughts, Perceptions, Opinions, and Recommendations)
Risk Management Workshop National Kidney and Transplant Institution
February 16, 2013
Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg
Email: [email protected] No.: 09188040304
www.facebook.com/rjoson2001
