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    A Practical Approach to

    Risk ManagementFinancial Management Institute,

    Toronto ChapterFebruary 17 2010

    Corinne Berinstein, BPT, MBA, MHSC, CA, CFIHealth Audit Services Team

    Ontario Internal Audit Division

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    Contact Info:

    Corinne Berinstein, BPT, MBA, MHSC, CA, CFI, Certificate in RiskManagement (Canadian Health Care Association

    Senior Audit Manager

    Health Audit Services Team

    Ontario Internal Audit DivisionProvince of Ontario

    Office: 416-327-7798

    eMail: [email protected]

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    Basic Concepts

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    Objectives of todays session

    Basic principles, concepts, definitions

    A simple framework

    Stocking your toolkiteducation, job aids, templates

    What are you going to do back in the office?

    Q &As

    A caseLets practice!

    Outline

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    Objectives

    Give you a practical approach, framework and tools so

    you can start implementing ERM when you get back to

    the office.

    Share some lessons learned. Share some tips and tricks.

    Practice concepts and tools with a case study so that you

    practice

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    The only alternative to risk management is crisis management --- andcrisis management is much more expensive, time consuming andembarrassing.

    JAMES LAM, Enterprise Risk Management, Wiley Finance 2003

    Without good risk management practices, government cannot manage its

    resources effectively. Risk management means more than preparing for

    the worst; it also means taking advantage of opportunities to improveservices or lower costs.

    Sheila Fraser, Auditor General of Canada

    Why do we need Risk Management?

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    Why bother with RM?

    Increase risk awarenessWhat could affect theachievement of objectives? What could change? What

    could go wrong? What could go right?

    Increase understanding of risksensitivities. What

    makes my risks increase/decrease/disappear?

    Promote a healthy risk culture Its safe to talk about

    risk. Open and transparent.

    Develop a common and consistent approach to risk across

    the organization. Not intuition-based.

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    Why bother with RM? Allows intelligent informed risk-taking.

    Focuses effortshelps prioritize. Top 10 list. Or top 3.Or

    Is proactive. not reactive Prepare for risks before theyhappen. Identify risks and develop appropriate risk

    mitigating strategies.

    Improve outcomesachievement of objectives(corporate, clinical, etc)

    Really comes to down to simple good management

    Enables accountability, transparency and responsibility

    And maybe even mean survival

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    Threats and opportunities

    Threata risk that may HINDER the achievement of objectives

    Opportunities- a risk that may HELP in the achievement of objectives

    Interest rates

    Foreign exchange rates

    Supply of service/product/resources

    Demand/uptake for service/product/resources

    The economy

    The weather

    The stock market

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    Interactive Session #110 minutes

    Introduce yourselves to others at your table

    Pick 1riskdiscuss it as both a threat and

    an opportunity

    Report to the large group. Pick a

    spokesperson.

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    Definition of ERM

    aprocess, effected by an entity's board ofdirectors, management and other personnel, applied

    in strategy setting and across the enterprise,

    designed to identify potential events that may affect

    the entity, and manage risks to be within its riskappetite, to provide reasonable assurance regarding

    the achievement of entity objectives.

    Source: COSO Enterprise Risk ManagementIntegrated Framework. 2004.

    The Committee of Sponsoring Organizations of the Treadway Commission (COSO)

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    Enterprise vs Integrated Risk Management

    Similarities: Formal process

    Consistent and systematic

    Includes projects, programs,

    operations

    Is embedded in key processessuch as strategic planning,

    budgeting, project planning,evaluation, etc

    Must be driven and supported byLeadership

    Adds value to decision-making

    Differences:Enterprise-wide:

    Is organizational-centric

    Success is defined as

    implementation over the entireorganization

    Integrated:

    Take a systems-focus

    May actually create risks for

    individual organizations

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    16Slide 16

    Risk Management Basics Risk (uncertainty) may affect the achievement of

    objectives.

    Effective mitigation strategies/controls can reducenegative risks or increase opportunities.

    Residual risk is the level of risk after evaluating the

    effectiveness of controls.

    Acceptance and action should be based on residual risklevels.

    INHERENT

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    A Simple Framework

    Evaluate

    & TakeAction

    EstablishObjectives

    Identify

    Risks &Controls

    Assess

    Risks &Controls

    Monitor

    &Report

    Step 1 Step 2 Step 3 Step 4 Step 5

    Communicate, learn, improve

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    Risk Management is critical to ALL levels of decisions

    Decisions can be categorized into three types. The amount of risk uncertainty) varies

    with the type of decisions. Most decisions are concerned with implementation.

    UNCERTAINTY

    Strategic Strategic

    Programme Prog

    ramme

    Project&Operational Project

    &Opera

    tional

    Strategic Decisions

    Decisions transferring

    strategy into action

    Decisions required for

    implementation

    The HM Treasurys The Orange Book

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    The relationship between IRM & MOHLTCs Complex Risk

    Environment

    MOHLTC Extended

    Enterprise

    External Risk Environment

    MOHLTC

    Risk Environment

    Laws&

    regulatio

    ns

    Capacity

    TheEconom

    y

    Corporate Governance

    Requirements

    Stak

    eholde

    r

    expe

    ctatio

    ns

    Political

    Outcomes

    Public

    Perception

    Oth

    er

    Minis

    trie

    s

    Partner-

    Organizations

    LHINs

    Financial

    Organizational

    Governance

    HumanResources

    Information

    Inform

    atio

    n

    Techn

    ology

    L

    egal/

    Com

    plia

    nce

    Operati

    onal

    Strate

    gic/

    Polic

    y

    TransferP

    ayment

    Accountability&

    Governance

    Communication

    & Learning

    Monito

    r

    Evaluate

    Assess

    Identify

    Estab

    lish

    Communication

    & Learning

    Communication

    & Learning

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    20Slide 20

    Categorizing RiskComprehensive1. Political or Reputational Risk

    2. Financial Risk3. Service Delivery or Operational Risk

    4. People / HR Risk

    5. Information/Knowledge Risk

    6. Strategic / Policy Risk

    7. Stakeholder Satisfaction / Public Perception Risk

    8. Legal / Compliance Risk

    9. Technology Risk

    10. Governance / Organizational Risk

    11. Privacy Risk

    12. Security Risk

    13. Equity Risk

    14. Patient SafetyNEW

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    21Slide 21

    Risk Prioritizationlikelihood and impact

    Likelihood of a risk event occurring

    Very High: Is almost certain to occur

    High: Is likely to occur

    Medium:Is as likely as not to occur

    Low:May occur occasionally

    Very Low:Unlikely to occur

    Risk Impact: Level of damage thatcan occur when a risk eventoccurs

    Very High: Threatens the success ofthe project

    High:Substantial impact on time, costor quality

    Medium:Notable impact on time,cost or quality

    Low:Minor impact on time, cost orquality

    Very Low: Negligible impact

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    Third dimension for rating risks - proximity

    Immediatenow

    Less than 6 months

    Between 6-12 months

    Between 1224 months

    Between 2436 months

    More than 36 months

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    23Slide 23

    Risk rating

    Combining impact and likelihood

    LIKELIHOOD

    IMPACT

    1

    1

    2

    2

    3

    3

    4

    4

    5

    5

    RISKI x L

    RISK

    I x L

    RISK

    I x L

    RISK PRIORITIZATION MATRIX

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    Risk Level Action and Level of Involvement Required

    Critical RiskInform Chief Executive Officer and Board of Directors

    Immediate action required

    High Risk

    Inform Chief Executive OfficerStrategy Team involvement/attention is essential to manage risksprovide report to Board as appropriate

    Moderate RiskManagement mitigation and ongoing monitoring required

    Inform relevant Strategy Team members

    Low Risk Accept, but monitor risksManage by routine procedures within the program and site

    Risk reporting and communications

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    Ke Risk Indicators (KRIs) are linked to

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    Key Risk Indicators (KRIs) are linked to

    strategy, performance and risk

    Risk

    Consequence

    Strategy & objectives

    Cause

    KRI

    KRIs need to be linked to strategy, objectives and target performancelevels, with a good understanding of the drivers to risk.

    Performance

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    EXAMPLES OF KRIs

    Human resource

    Average time to fill vacant

    positions

    Staff absenteeism /sickness

    rates

    Percentage of staff appraisals

    below satisfactory

    Age demographics of key

    managers

    Information Technology

    Systems usage versus

    capacity

    Number of system upgrades/

    version releases

    Number of help desk calls

    Finance

    Daily P&L adjustments (#,

    amt)

    Reporting deadlines missed

    (#)

    Incomplete P&L sign-offs (#,

    aged)

    Legal/compliance

    Outstanding litigation cases

    (#, amt)

    Compliance investigations (#)

    Customer complaints (#)

    Audit

    Outstanding high risk issues

    (#, aged)

    Audit findings (#, severity)

    Revised management actiontarget dates (#)

    Risk management

    Management overrides

    Limit breaches (#, amt)

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    Measure and report RM implementation progress

    Excellent

    Advanced capabilities to identify, measure, manage all risk exposures withintolerances

    Advanced implementation, development and execution of ERM parameters

    Consistently optimizes risk adjusted returns throughout the organization

    Strong

    Clear vision of risk tolerance and overall risk profile

    Risk control exceeds adequate for most major risks

    Has robust processes to identify and prepare for emerging risks Incorporates risk management and decision making to optimize risk adjusted

    returns

    Adequate

    Has fully functioning control systems in place for all of their major risks

    May lack a robust process for identifying and preparing for emerging risks

    Performing good classical silo based risk management Not fully developed process to optimize risk adjusted returns

    Weak Incomplete control process for one or more major risks

    Inconsistent or limited capabilities to identify, measure or manage major riskexposures

    Source: Standard & Poor

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    Progress to DateERM Report Card

    Quality of Care and Patient SafetyCorporate Governance

    Operation & Business Support

    Reputation and Public Image

    Human Resources and Staff RelationsFinancial Resources

    Information Systems and Technology

    Physical Assets

    Legal and RegulatoryEnvironmental Health and Safety

    Policies

    Standards

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    The Approach

    Incorporates risk information into the strategic direction-

    setting, making decisions that consider established risk

    tolerance levels.

    Takes a systems approach to managing risk at thestrategic, operational and project levels which is

    continuous, proactive and systematic.

    Fosters a working culture that values learning, innovation,responsible risk-taking and continuous improvement.

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    We wanted to add value not work. We developed formsand templates.

    So we developed and delivered educational sessions

    usually attended by all team members. Included risk 101and then time for the team members to discuss how to

    apply concepts to their work.

    We assisted teams in actual risk assessments. Sometimes

    we used voting software.

    We trained the trainer.

    Your toolkiteducation, job aids, templates

    f

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    A Process for Embedding IRMHAST Sessions Components Participant Outcomes

    Risk 101Presentation

    IntroductionIntegrated Risk Management

    Introduction to basic risk concepts and terminologies

    Introduction to the MOHLTCs Integrated Risk

    Framework

    Status of IRM in MOHLTC

    (Most effective when followed-up with facilitated riskassessment workshop or application to actual project)

    Understanding of risk management process

    Understanding of how risk management is relevant to their day-to-daywork

    Knowledge of IRM in MOHLTC

    Management IRM

    Planning Meeting

    Planning

    Discuss best way to implementation IRM in area

    Proposed IRM implementation plan presented for area

    Clarify roles & responsibilities for risk management

    Commitment to IRM implementation in area or stream of work

    Risk management roles and responsibilities clearly defined

    Review of IRM roll-out; timelines , deliverables, related forums

    Commitment to continuous risk communication & learning

    Risk AssessmentWorkshop

    Facilitated Training

    Identification of risks &mitigation strategies

    Identification of objectives

    Brainstorming and identification of risks to meetingobjectives (for project, branch, initiative, etc. )

    Identification of source, mitigation strategies, ownershipand residual risk for each risk category

    Hands-on experience allowing assimilation of consistent riskmanagement techniques

    Hands-on practice of IRM process, enabling application of riskmanagement principles and tools to work

    Greater understanding of work and inter-dependencies

    Risk Prioritization

    & Voting

    Workshop

    Facilitated TrainingAssessment of mitigationstrategies & prioritization

    Review of risks, mitigation strategies and ownership

    Anonymous voting on the impact and probability of eachrisk

    Prioritization of risks on heat map

    Discussion of mitigation strategies for high priority risks

    Review of risks, mitigation strategies, ownership, residual risk to theirwork in a seamless manner

    Unbiased risk prioritization and identification of high risks

    Enables application of complete risk management process to everyday work

    Risk follow-up

    Session

    Monitoring & Review

    Review of risks six months after initial assessment

    Review mitigation strategies and residual risks

    Review of risks and status

    Continuous improvement

    Communication& Learning

    Monit

    or

    Evaluat

    e

    Assess

    Id

    entify

    Esta

    blish

    Communication& Learning

    Monito

    r

    Evaluate

    Assess

    Identify

    Estab

    lish

    Communication& Learning

    Monit

    or

    Evaluate

    Assess

    Identify

    Estab

    lish

    Communication& Learning

    Monit

    or

    Evaluate

    Assess

    Identify

    Es

    tablish

    IRM RISKS AND CONTROLS

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    The following table describes the risks and mitigating controls and related information. As controls are implemented or changed, their status will be updated.

    Risk Rating Impact = significant, moderate or minor (S, M, m) and Likelihood = high, medium or low (H, M, or L)

    ID Number

    Responsible Org &

    Name (Implement /Operate) Risk Control

    Risk

    Rating(Impact)

    Risk

    Rating(likelihood) Date Required Status

    Category: Financial

    Category: Equity

    Category: Service Delivery or Operational

    064 Person A 055 Insufficient knowledge transfer

    102 Conflicting managementinstructions

    Update impacted policies and procedures

    for integration into knowledge support tools.Harmonizing policies and procedures (e.g.,

    access procedures X has one and Y has

    one there needs to be one

    process/policy/procedure).

    M M 31-Mar-09 Refer to Privacy

    Action Plan Work onOngoing Operations

    Commitments

    Report

    065 Person B 056 Lack of communication (Serious

    service delivery issues)

    352 Different business and IT

    processes (incident management)

    (a) IT incident and Triage (harmonization

    between IT and Business).

    (b) X and Y need to develop an incident

    management process/service to deal withissues that arise during service delivery.

    Roles and responsibilities need to be

    defined in both organizations: from a

    stewardship perspective on the ministry

    side, and from a service delivery/reporting

    perspective on the agency side. The

    process/service ensures that incident/issues

    are communicated as per agreement

    requirements; well tracked and reported.

    M M 31-Mar-09 (a, b) Refer to

    ongoing Operations

    IRM document

    IRM RISKS AND CONTROLS

    None in this category

    None in this category

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    The Cyclist and the Risk Manager

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    Interactive Session #215 minutes

    Identify risks that the cyclists faces in

    cycling to work.

    Report back.

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    Risk Factorsthe cyclist

    .

    http://tm.wc.ask.com/r?t=an&s=p&uid=098E1493A9EC1C514&sid=11DA886A45F270C14&qid=829E8A0EADF4CE4EBCA964773D7792AD&io=14&sv=za5cb0de8&o=8187&ask=traffic+ticket&uip=8e148eb7&en=is&eo=0&pt=&ac=24&qs=32&pg=3&u=http://pictures.ask.com/redir?bpg=http%3a%2f%2fpictures.ask.com%2fpictures%3fq%3dtraffic%2bticket%26o%3d8187%26page%3d3&q=traffic+ticket&u=http%3a%2f%2fwww.speedsk8in.com%2farticles%2ffeb2000%2fdefense.htm&s=p&bu=http%3a%2f%2fwww.speedsk8in.com%2farticles%2ffeb2000%2fdefense.htm&qte=0&o=8187&isimageSearch=true&fromImagePage=False&iskey=&thumbsrc=http%3a%2f%2fimages.picsearch.com%2fis%3f37655786706&imagesrc=http%3a%2f%2fwww.speedsk8in.com%2farticles%2ffeb2000%2ftraffic2.jpg&thumbwidth=128&thumbheight=96http://tm.wc.ask.com/r?t=an&s=p&uid=098E1493A9EC1C514&sid=11DA886A45F270C14&qid=2CF4A17580AA02488EDF37EFE872C174&io=6&sv=za5cb0de9&o=8187&ask=alice+in+wonderland+&uip=8e148eb7&en=is&eo=1&pt=&ac=11&qs=32&pg=1&u=http://pictures.ask.com/redir?bpg=http%3a%2f%2fpictures.ask.com%2fpictures%3fq%3dalice%2bin%2bwonderland%2b%26o%3d8187%26page%3d1&q=alice+in+wonderland+&u=http%3a%2f%2fwww1.thny.bbc.co.uk%2foxford%2fgoing_out%2f2003%2f03%2foxford_story.shtml&s=p&bu=http%3a%2f%2fwww1.thny.bbc.co.uk%2foxford%2fgoing_out%2f2003%2f03%2foxford_story.shtml&qte=0&o=8187&isimageSearch=true&fromImagePage=False&iskey=&thumbsrc=http%3a%2f%2fimages.picsearch.com%2fis%3f654728293862&imagesrc=http%3a%2f%2fwww1.thny.bbc.co.uk%2foxford%2fgoing_out%2f2003%2f03%2fimages%2foxford_story_270.jpg&thumbwidth=128&thumbheight=78http://tm.wc.ask.com/r?t=c&s=p&id=30751&sv=z6f5372c5&uid=098E1493A9EC1C514&sid=157E092258E460C14&p=%2fimagetop&o=8187&u=http://www.kenpapai.com/racing/sf2002/lance0451z.jpg
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    Risk Factorsthe driver

    .

    http://images.google.ca/imgres?imgurl=http://www.connectingstanislaus.com/files/u46/ID_0.jpg&imgrefurl=http://www.connectingstanislaus.com/Youth/Get_Drivers_License_State%2BID_Card&usg=__oZNiU6g0bwPY_hAQhaoPkNxR67U=&h=282&w=424&sz=85&hl=en&start=7&itbs=1&tbnid=5zLQKXfj3xye5M:&tbnh=84&tbnw=126&prev=/images%3Fq%3Dyoung%2Bdriver%26gbv%3D2%26hl%3Denhttp://images.google.ca/imgres?imgurl=http://www.connectingstanislaus.com/files/u46/ID_0.jpg&imgrefurl=http://www.connectingstanislaus.com/Youth/Get_Drivers_License_State%2BID_Card&usg=__oZNiU6g0bwPY_hAQhaoPkNxR67U=&h=282&w=424&sz=85&hl=en&start=7&itbs=1&tbnid=5zLQKXfj3xye5M:&tbnh=84&tbnw=126&prev=/images%3Fq%3Dyoung%2Bdriver%26gbv%3D2%26hl%3Denhttp://images.google.ca/imgres?imgurl=http://www.grandprix.com/jpeg/phc/pmon05/fri/schumacher1-rg.jpg&imgrefurl=http://current.com/items/88709101_race-car-driver-takes-over-taxi-to-catch-flight.htm&usg=__4zWF4xQraHBB-5XUQlWkx1rmR9E=&h=450&w=300&sz=24&hl=en&start=14&itbs=1&tbnid=c7OdL3Gia1z1YM:&tbnh=127&tbnw=85&prev=/images%3Fq%3Drace%2Bcar%2Bdriver%26gbv%3D2%26hl%3Den
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    Risks

    Threats:

    Death

    Head Injury

    Injury

    Reputation

    Financial

    Damage to the bike

    Sunburn/frost bite

    Opportunities:

    Exercise

    Sunlight

    Reputation

    Financial

    Role model

    Environment

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    Mitigation Strategies for threats

    Death, head injury, other injuryhelmet, bright clothes, lights, bell,

    CANbike course, obeying traffic laws, positive attitude, anger

    management course

    Reputationgreat outfit, change of wrinkle-free clothes, shower,

    time management

    Financialhigh quality locks, beater, stopping at stop signs

    Damage to the bikeregular maintenance, avoiding pot holes

    Sunburn/frost bitesunscreen, mittens, hats, token/change

    Dehydration- filled water bottle

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    Keep it simple

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    Back at the office

    Why is the organization interested in RM?What are they hopingwill be achieved with its implementation?

    Who is doing what? Roles & responsibilities must be clearlydefined. Make sure Leadership supports RM and uses RM results tomake decisions. Everyone is a risk manager. Make sure that all risks

    have owners and the responsibilities for mitigation are assigned

    How will it be implemented?What is your framework? What is thecommon language? How will risks be measured and reported?

    Where will you start?Choices could be where you can most easily

    succeed or where it is needed the most or where interest is high.

    When will it be implemented? It is a journey not a destination; 3-5years for complete roll-out; how often will risks be assessed; whenwill mitigation plans be implemented and monitored; when will risks

    be reported.

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    Ask questions and develop your approach

    Do we understand our major risks? Do we know what is causing ourrisks to increase, decrease or stay the same?

    Have we assessed the likelihood and impact of our risks?

    Have we identified the sources and causes of our risks?

    How well are we managing our risks?

    Are we trying to prevent the downside risks from happening? Or arewe trying to simply recover from them?

    Who is accountable for these risks?

    How do we talk about risk? Do we have a common language acrossbranches, across divisions, across the ministry, across the OPS, across

    the health care system?

    Are we taking too much risk? Or not enough risk?

    Are the right people taking the right risks at the right time?

    Whats our culture? Are we risk adverse or are we risk-takers? Or arewe somewhere in between?

    TAKE SMALL BITES IRM IMPLEMENTATION

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    TAKE SMALL BITES. IRM IMPLEMENTATION

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    Questions?

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    Case 1The Pan Am Games 2015

    Case 2The provincial response to the next Pandemic

    Case 3The extension of Hwy 404

    Case 4The rescue efforts in Haiti

    Case 5Human Resources in the Ontario Public Services

    Case 6A big teaching hospital in Toronto

    The case - You are responsible for Risk Management

    for:

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    Consider the 13 categories of risk

    Identify top 5 threats (downside) and top 5opportunities (upside)

    Propose mitigation strategies

    Discuss how the following risk factors would affect your assessment:

    Economy

    Demographics

    Weather

    Technology

    Timing of events such an election

    Others

    The case

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    Questions?