risk management presentation - informa conference 31 oct 2014

Risk Risk…Everywhere!

The Benefits of Utilizing an ERM Framework to Prioritize Health Leader Decisionsand Actions

Saskatchewan Cancer AgencyOctober 31st 2014

Jignesh Padia

Session Outline

ERM Framework – What Is It?

Assessing Risk

Applying ERM Framework Case Study # 1 Case Study # 2 Communication and Monitoring

Summary

ERM Framework – What Is It?

Does This Look Familiar?

* ISO 31000 Framework and Risk Management Process

*

Group Discussion:

How far are you in the roll out of your organization’s Enterprise Risk Management (ERM) Program?

What is one thing you are proud of about your ERM program?

What is one way your ERM program could be improved?

Voting…

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

How Far Are You On Your Risk Management Program (Framework) Journey Within Your Organization?

ABCD

A B C D

0% 0%0%0%

We haven’t started yet.We are working on it.We have implemented one, but not tested its effectiveness.We have a fully functional and integrated risk management program.

Lets Start Assessing Risk!

Time to make a Decision…

Do You See Any Risk?

Bald Tire

A. NegligibleB. MinorC. ModerateD. MajorE. Critical

Negligible

Minor

Moderate

Major

Critica

l

0% 0% 0%0%0%


Tire Swing (tied to rope)


Negligible

Minor

ModerateMajor

Critica

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0% 0% 0%0%0%

Do You See Any Risk To A Child Using The Swing?


Negligible

Minor

ModerateMajor

Critica

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0% 0% 0%0%0%

What Was Your Frame Of Reference?

-20

0

20

40

60

80

100

0 0.5 1 1.5 2 2.5 3 3.5

% identified risk as Major


Patients on combined cancer treatments (chemo and radiation therapy) are missing an identifier in the patient registry system when their treatment plan is decided, which lets the agency staff know they are on both treatments.


Negligib

leMinor

Moderate Majo

r

Critica

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0% 0% 0%0%0%


These concurrent therapy patients need to have their therapies coordinated or their therapies will have limited effect.


Negligi

bleMinor

Moderat

eMajo

r

Critic

al

0% 0% 0%0%0%

Do you see any risk?

The missing concurrent therapies identifier is caught and activated when the patient arrives for their first visit, before any coordination of care is necessary.


Negligib

leMinor

Moderate Majo

r

Critica

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0% 0% 0%0%0%

What Was Your Frame Of Reference?

-20

0

20

40

60

80

100

0 0.5 1 1.5 2 2.5 3 3.5

% identified risk as Major

A Framework To Assess Risk …

* ISO 31000 Framework and Risk Management Process

*

Applying an ERM FrameworkCase Study # 1

Case Study # 1: Background Information

Stats from an organization’s annual and Accreditation reports:

35% of all Long Term Care (LTC) facilities were audited by the Health and Wellness Compliance Team in 2008/09

No jurisdiction received 100% compliance. The combined provincial compliance rating was 57%

The common areas of non-compliance are medication management, infection prevention and control, resident safety and staff education

Food Safety Inspections – 95,389 Has 12 independent Health Advisory Councils for various areas of this

province.

Accreditation Survey Result

Assume that you are part of a Long Term Care (LTC) Senior Leadership Team

Based on the given information, if this organization were to end up on the front page of a national or regional newspaper, how severe would the consequences be?


Negligible

Minor

ModerateMajor

Critica

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0% 0% 0%0%0%

What Should Your Response Be?

ABCDEF

Do nothingImprove infection control measuresImprove medication managementImprove the use of restraints and aidsReduce Fire Risks and Install SprinklersOther (e.g. Do more audits)

A B C D E

0% 0% 0%0%0%

Did You Apply a Framework?

Lets try this again….

Supporting Materials…

Envelop # 1

Envelop # 2

Identification, Analysis and Evaluation of Risks Apply the provided document (framework to identify,

assess and evaluate LTC risks) Step # 1 Identify Risks

How? Using the information available in Envelope # 1

Step # 2 Assess each risk How? Based on instruction obtained by completing Step # 1

Step # 3 Evaluate How? Use the information obtained at the end of the Step # 2 to

complete the template

Step 1: Identify Risks

Ask lots of questions…

Formulate the right questions and identify all potential risks

Use envelope # 1

Step 1: Identify Risks

Use envelope # 1 Case Study # 1 Risk Map Template Risk Register Template Some Laminated Cards

Objective: To complete the Risk Register Template – Prioritizing risks using ERM framework.

Step 2: Analyze Risks

Use Envelope # 2 36 pcs It relates to 4 Key risks you identified in Step # 1

Step 2: Analyze Risks

Use Envelope # 2 36 pcs It relates to 4 Key risks you identified in Step # 1

Put all the pieces together… Understand the risk from different angles Gather all relevant information which can assist

you in making your assessment. Flip each puzzle over

Step 3: Evaluate Risks

Did you flip over your puzzles?

Use this information and Risk MAP Template Definitions to complete Severity Rating for Risk Register

Understand and establish the context

Identify your stakeholders

What are some of the things which make this risk possible or more dangerous.

Review any previous occurrences and factor that into your consideration for severity, consequences and likelihood

Identify existing Risk Controls (+)&Gaps (-)

Benchmark your processes and controls

Use this information and Template to identify Risk Map Categoryand Risk Domains

Use this information and Risk MAP Template Definitions to complete Likelihood Rating for Risk Register

Step 3: Evaluate Risks

Did you flip over your puzzles?

Transcribe the Severity, Likelihood and Consequences information into the template.

Complete the template…

Map the risk on the Heat map

Document and understand consequences

Assign relative priority

End of Step # 3

Based on the Analysis and information, if this organization were to end up on the front page of a national or regional newspaper, how severe would the consequences be?


Negligible

Minor

ModerateMajor

Critica

l

0% 0% 0%0%0%

EDMONTON — More than 80 health-care facilities in Alberta, including three rural hospitals and 10 health centres, are not equipped with fire-suppression sprinklers and another 50 only have sprinklers in some areas.

Documents obtained from Alberta Health Services under a freedom of information request reveal a number of facilities aren’t equipped with full fire suppression systems — from small four-bed rural health centres to 100-plus bed urban mental and acute-care hospitals.

The province says the cost of renovating the continuing-care facilities is approximately $60 million.

Health Minister Fred Horne was not available for an interview, but said in a written statement the Quebec fire showed “that we need to go further” in ensuring fire safety.

The Herald reported this summer that 455 of the province’s 657 seniors facilities are not fully equipped with sprinkler systems. It reported at the time the cost of installing sprinklers in all facilities could top $250 million.

But Prentice vowed to address the issue if he was selected premier.

Concern for the safety of Alberta seniors and hospital patients was heightened last January when a fire swept through a Quebec seniors residence, killing 32 people.

What Should Your Response Be?

ABCDEF

Do nothingImprove infection control measuresImprove medication managementImprove the use of restraints and aidsReduce Fire Risks and Install SprinklersOther (e.g. Do more audits)

A B C D E

0% 0% 0%0%0%

Applying an ERM FrameworkCase Study # 2

Case Study # 2: Background Information

800 patient events reported in the last year. 350 are related to patient information errors 170 are related to patient medication errors 150 are related to radiation treatment errors 90 are related to scheduling errors 40 are related to falls

Money has been made available to purchase another linear accelerator to reduce wait times for patients receiving radiation treatments.

Money has been made available to redevelop the pediatric treatment area to shorten appointment times.

End of Step #1

Identified Risk(s)

Based On The Given Information What Should The Top Strategic Priority Of The Organization Be For The Next Year?

ABCDEFG

Patient Information ManagementMedication Process ImprovementRadiation Treatment PlanningPatient Appointment ManagementPatient Falls PreventionOperationalize a new Linear AcceleratorRedesign the Pediatric Treatment Area

A B C D E F G

0% 0% 0% 0%0%0%0%

Let’s Assume We Need To Dig Deeper Before Deciding…

Review package #1 at your table…

End of Step # 2

Identified Risk(s) Likelihood Severity

Based On The Given Information What Should The Top Strategic Priority Of The Organization Be For The Next Year?

ABCDEFG

Patient Information ManagementMedication Process ImprovementRadiation Treatment PlanningPatient Appointment ManagementPatient Falls PreventionOperationalize a new Linear AcceleratorRedesign the Pediatric Treatment Area

A B C D E F G

0% 0% 0% 0%0%0%0%

End of Step # 3

3 Months Later…

Senior leadership comes out with a strategic plan. Falls prevention is the top priority.

Now it is up to the managers at the clinic to decide how to reduce falls…

So What Do We Do To Prevent The Risk…?

Review package #2 at your table…

What Strategy Should We Employ First?

A

B

CD

Redesign falls assessment and patient support processes to focus on the elderly (at risk) patient population.Audit facilities for handrails, easements, and other falls related supports.Review external environment for risks.Examine medication reconciliation processes to determine med related falls risks.

A B C D

0% 0%0%0%

But Wait… There’s More!

Luckily the SCA has a risk program that is good at integrating with planning and communicating risks and mitigation opportunities.

Review the last package (#3) at your table…

What Strategy Should We Employ First?

A

B

CD

Redesign falls assessment and patient support processes to focus on the elderly (at risk) patient population.Audit facilities for handrails, easements, and other falls related supports.Review external environment for risks.Examine medication reconciliation processes to determine med related falls risks.

A B C D

0% 0%0%0%

Any Guesses What’s Causing The Falls?

Does Your Risk Program Provide You With Timely Decision Support, In Time Of Crisis?

Determine the overall impact of the incident.

Make appropriate decisions about the incident.

Alert the relevant people to handle the incident.

Applying an ERM FrameworkCommunication and Monitoring

From Information to Decision Making: Communication and Monitoring

Summary

Select a relevant and evidence based framework for ERM

Identify ALL risks

Assess ALL risks

Evaluate ALL risks

Manage or Mitigate ALL risks

Make an informed decision

Questions?

Jignesh [email protected]

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risk management presentation - informa conference 31 oct 2014

Healthcare