Healthcare risk management
Risk is the possibility of loss or injury, it is a part of everyday life for business and
individuals
Risk in healthcare: The probability that something undesirable will happen
Risk management in health care
– Risk management in healthcare is a complex set of clinical and administrative
systems, processes, procedures, and reporting structures designed to detect, monitor,
assess, mitigate, and prevent risks to patients.
Risk management program components
– Clinical components
– Administrative components:
– 1. Claims management.
– 2. Safety/security programs.
– 3. Patient relations programs.
– 4. Contract and insurance premium review.
– 5. Employee programs/workers' compensation.
– 6. Resource and support system review.
– 7. Linkage with quality, patient safety, and utilization management.
How do you react towards risk?!
- Loss prevention and reduction (clinical and administrative components).
- ● Loss prevention: Proactive is avoiding/preventing risk. (FMEA)
- ● Loss reduction: Reactive is minimizing loss or damage after an adverse/bad event.
(RCA)
The goal of risk management in health care
– 1. To anticipate the possibility of, respond to, control, and decrease harm to patients
(promote patient safety), staff, visitors.
– 2- To decrease the property loss or damage to the organization itself and to protect
organizational assets, resources and the organization from financial losses.
– 3. To decrease incidence of medicolegal issues
Steps of risk Management
1- Risk identification
– Identification of problems or potential problems that can result in loss
– Methods of risk identifications:
1. Failure Modes and Effects Analysis (FMEA): This is widely used in healthcare
to analyze medical processes and identify where they might fail. FMEA helps
in anticipating potential points of failure and implementing solutions before
actual harm occurs.
2. Root Cause Analysis (RCA): When an adverse event occurs, RCA is
employed to delve deeply into the cause and uncover underlying risks. This
method is essential for understanding why an incident happened and how
similar risks can be mitigated in the future.
3. Incident Reporting Systems: Encouraging the reporting of all incidents, near
misses, and accidents, regardless of severity, helps in collecting data on
potential and actual risks, which can then be analysed to improve safety
protocols.
4. Patient Safety Survey & complaints s: Gathering feedback from patients and
families can reveal risks in patient care that might not be evident through
other means.
5. These surveys can cover aspects such as medication management, hospital
environment, and treatment outcomes.
6. Risk Registers: Maintaining a comprehensive risk register that is regularly
updated with identified risks, their potential impact, and mitigation plans is
crucial in healthcare settings. It serves as a dynamic tool for ongoing risk
management.
7. Environmental Scans: This includes examining external factors that could
impact healthcare delivery, such as changes in regulations, technological
advancements, or public health trends.
8. Benchmarking: Comparing safety metrics with other healthcare organizations
can help identify areas of risk that may require improvement. Benchmarking
can provide insights into best practices and areas where your organization
may be lagging.
9. Multidisciplinary Meetings: Regular meetings with staff from various
departments (e.g., nursing, pharmacy, surgery) can provide diverse insights
into potential risks and foster a culture of safety.
10. Device reporting and tracking logs
11. report from accreditation and licensing organization
2- Risk assessment/analysis
– For identified risk:
• Calculate occurrence and impact.
• Prioritization.
• Risk Assessment Matrix.
1. Risk avoidance: not offering a particular service to eliminate the exposure to risk;
e.g.: organ transplantation
2. Risk shifting: to move the liability responsibility from the organization to an external
entity; e.g.: making referrals.
3. Risk control / prevention /mitigation: to eliminate or minimize the adverse events; e.g.:
unit dose medication to minimize dosing errors.
4. Risk acceptance: Monitor if in green zone.Risk handling technique
Risk treatment decisions will be based on risk analysis:
– 1. Tolerate (Accept/Retain) risks that have low likelihood and low impact.
– 2. Treat (Control/Reduce) risks that have high likelihood and low impact.
– 3. Transfer (Transfer/Reduce) risks that have low likelihood and high impact.
– 4. Terminate (Avoid/Eliminate) risks that have high likelihood and high impact
RISK REGISTER
– A Risk Register is a listing of identified risks and its components, usually in table
format.
• summarizing and succinctly describing risks to be Managed
– Risks will be recorded in the risk register in each department and submitted to the risk
manager on quarterly basis
– As a minimum, a risk register must contain:
– 1. Risk description.
– 2. Risk Type.
– 3. Risk owner.
– 4. Ratings of likelihood and impact, for both current risk.
– 5. Action plans.
– 6. Action owner for each action.
– 7. Completion date for each action
1. Financial Risks
– Risk related to financial stability of the organizations,
such as insufficient funds.
2. Operational / Clinical & patient safety Risks
– Operational risks are concerned with maintaining an appropriate
level of service to patients, visitors and staff Human Capital
– Risks related to the workforce, such as staff high turnover and
Absenteeism
3. Strategic Risks
– Strategic risks are concerned with risks that can impact organization development and
delivery of its strategic objectives. Strategic risks pertain to brand, reputation, and
business strategy
4. Legal / Compliance Risks
– Risks pertain to exposure to legal penalties; an organization faces when it fails to act
in accordance with industry laws and regulations for Example : Failure to meet
compliance obligations.
Inadequate compliance training and/or poor compliance monitoring.
5. Technology Risks
– Risk associated with adoption of system
and Loss of information caused by inadequate
IT security resulting in work delay such as:
data loss, electronic health record, and using
advanced technology bar coding, and medical monitoring devices
6. Natural Disaster / Hazard
– Risks related to the physical loss of assets such as risks arising from earthquakes,
windstorms and fires such us: Fire extinguishers are not working due to non-periodic
checking by safety department, which may result in death of patient and staff, in case of
fire
A risk assessment is a process which involves carrying out an assessment in order to
identify potential hazards or risks in a particular environment or activity.
Its purpose is to evaluate the likelihood and potential consequences of these hazards,
and it should determine appropriate measures in order to mitigate or manage the risks.
• By carrying out a risk assessment, individuals or organisations can:
Identify potential risks.
• Understand or predict consequences.
• Prioritise risks in terms of likelihood and severity.
• Develop and implement mitigation strategies.
• Allocate resources prioritising high-priority risks.
• Improve decision-making.
• Improve communication.
• Promote accountability.
• Monitor and review the risk assessment in order to identify any new risks and
assess the effectiveness of the risk management which is currently in place.
Risk assessment is a process to analyse the risks to the whole system, including
patients, staff, visitors and organisations
(To do so, risk assessment in the
context of safety seeks to answer
the questions: “What can go
wrong?”, “How bad is it?”, “How
often does it occur?”
• Look around your workplace and think about what may cause harm (these are
called hazards). Think about:
• how people work and how plant and equipment are used
• what chemicals and substances are used
• what safe or unsafe work practices exist
• the general state of your premises
• Assess the risks
Once you have identified the hazards, decide how likely it is that someone could
be harmed and how serious it could be. This is assessing the level of risk.
Decide:
• who might be harmed and how
• what you're already doing to control the risks
• what further action you need to take to control the risks
• who needs to carry out the action?
• when the action is needed by
• Look at what you're already doing, and the controls you already have in place.
Ask yourself:
• can I get rid of the hazard altogether?
• if not, how can I control the risks so that harm is unlikely?
• If you need further controls, consider:
• redesigning the job
• replacing the materials, machinery or process
• organising your work to reduce exposure to the materials, machinery or process
• identifying and implementing practical measures needed to work safely
• providing personal protective equipment and making sure workers wear it
