Hospital Risk Management - A Philippine Perspective

Hospital Risk Management – A Philippine Perspective

(ROJoson’s Thoughts, Perceptions, Opinions, and Recommendations)[TPORs]

Reynaldo O. Joson, MD, MHA, MHPEd, MSc SurgNovember 14, 2012

ROJoson’s Disclosures and Disclaimers

A student, still a student in Hospital Risk Management (HRM)!

2012

Assistant Medical Director, MDH

SVP- Corp Affairs, MDH

Disaster Programs - MDH, OMMC, DOH & WHO

Quality & Safety Programs - MDH, OMMC, PCS

ACI Workshop on Risk Management – Nov. 14-16, 2012

2008 2010

Concept of HRM - MDH

20051989

Ms. Patricia McKernan



Anecdotal Experiences in HRM30 years in medical practice

23 years in hospital administration

Hopefully

HELPFUL to ALL!

Hospital Risk Management – A Philippine Perspective [ROJ – TPORs]

Contents

Overview of hospital risk management in Philippines

• Current status• Areas and opportunities for improvement• Recommendations in developing an

integrated sustainable hospital risk management based on Philippine environment and perspective


Contents




framework for Filipino participants

to add – to refineduring the ACI

Workshop!


Contents




assist Canadian facilitator in

understanding PH situation

during the ACI Workshop!


Backgrounder

What is “RISK”?

What is Hospital Risk Management (HRM)?


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


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


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


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!


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).


What are the ultimate goals of HRM?

SUSTAINABILITY OF THE HOSPITAL AS LONG AS POSSIBLE

(target: 100 years)


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


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).


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).


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


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


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


Basic processes in Hospital Risk Management?

• Risk identification and assessment

• Formulation of strategies and action plans to prevent, mitigate risks and to respond and recover from the consequences of unavoidable risk occurrence


RISK IDENTIFICATION RISKS commonly encountered in Philippine hospitals?

Risk for •business non-sustainability•natural disasters (earthquake, flood, tsunamis, fire, etc.)•man-made disasters (fire, felony, bomb threat, terrorism, etc.)•technology-related disasters•biological disasters


RISK IDENTIFICATION RISKS commonly encountered in Philippine hospitals?

Risk for •medico-legal suits (arising from patient care)•non-medico-legal suits (not arising from patient care, such as workforce legal suits)•aging (unsettled) account receivables•tarnished corporate or hospital reputation


RISK ASSESSMENT / EVALUATIONRISKS commonly encountered in Philippine hospitals?

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!


RISK ASSESSMENT and PRIORITIZATION 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.)


RISK ASSESSMENT and PRIORITIZATION 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


Basic processes in Hospital Risk Management?

• Risk identification and assessment

• Formulation of strategies and action plans to prevent, mitigate risks and to respond and recover from the consequences of unavoidable risk occurrence


Contents





Contents




• Email survey – 18 questions – hospital administrators

• Interview – hospital administrators, MHA co-faculty at UP – CPH

• Personal observations in PH hospitals

• ACI participants (today)


Survey on PH Hospital Risk Management

None / not being done yet

Beginning Expanding Consistent Advanced

Overall, we have a structured, comprehensive and effective hospital risk management program.

25% 25% 50% 0 0





We have a structured risk identification process.

25% 38% 38% 0 0

We keep track of newly perceived and actual risks and add them to the list of hospital risks.

38% 25% 25% 0 0





We have a structured risk assessment process.

38% 25% 38% 0 0

We prioritize our preparations for risk preparedness based on the risk assessment process.

50% 13% 25% 13% 0





We have preparedness programs for all identified hospital risks.

25% 38% 25% 13% 0

We have a structured risk reduction system.

38% 13% 50% 0 0





We have a structured risk control system (response and recovery program during risk occurrence).

25% 50% 25% 0 0





We have a risk financing program like liability and general insurances.

38% 25% 25% 13% 0





We have a medical malpractice insurance for the hospital.

75% 0 0 25% 0

We have medical malpractice insurance for our healthcare professionals.

75% 0 0 25% 0





We have a comprehensive fire insurance for our properties and capital resources.

13% 0 13% 75% 0





We have a multisectoral taskforce / committee in charge of the hospital risk management program.

25% 13% 38% 25% 0





We have an integrated hospital risk management program where all risks are interconnected as indicated during planning and exercises.

0 38% 38% 13% 13%





We have documented policies and procedures on hospital risk management.

0 50% 25% 25% 0





Our documented policies and procedures on hospital risk management are being reviewed at least at planned intervals.

25% 25% 38% 13% 0

We conduct regular exercises on our risk preparedness program.

13% 38% 13% 38% 0





We have the full commitment and support from the top management for our hospital risk management program.

0 25% 25% 50% 0

Overall, we have a structured, comprehensive and effective hospital risk management program.

25% 25% 50% 0 0


Survey on PH HRM – General and Summary Statements

Most, if not all, Philippine hospitals are aware of, concerned with, and are on guard against their occurrence of the nine (9) general categories of risks.



Majority of the Philippine hospitals do not have a systematic approach even for each general risk category including the specific risks under the general category.

Without a systematic approach, it goes without saying, there is no system of deployment of risk preparedness programs.



Majority of the hospitals do not have well-documented preventive, mitigation, preparedness, response and recovery plans for the general risk categories and also the specific risks.



Majority of the hospitals do not have documented policies and procedures manual or primer; if there are, not disseminated to all staff; not exercised, reviewed and re-evaluated at planned intervals or as the need arises anytime.



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.



The manual can have the following simple outline:• Preface • Scope• Definitions • Program Management • Planning • Implementation • Exercises, evaluation and corrective action • Management Review



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)



Regarding the maturity of the risk management program, majority, if not all, of the Philippine hospitals do not have an integrated system that encompasses all the general risk categories.



Recommendations:

Creation of multisectoral task force / committeeto align, coordinate, collaborate, and integrate all risk

preparedness programs of the hospital



Recommendations:

Examples of multisectoral task forces / committees • Corporate Risk Management Committee• Safety Promotion and Disaster Preparedness Committee• Quality Management Committee



Recommendations:

Examples of multisectoral task forces / committees • Corporate Risk Management Committee• Safety Promotion and Disaster Preparedness Committee• Quality Management Committee

Essentials:

Multisectoral in membership

Headed by a top / senior management representative

Aligning, coordinating, integrating all risk preparedness programs of

the entire hospital



Medical Malpractice Insurances

Majority, if not all, of the PH hospitals do not have medical malpractice insurances for risk financing program.

For the few that have, they do not want to divulge.

Most physicians in PH also do not have medical malpractice insurances.



Medico-legal Suits (Medical Malpractice Suits)

NOT rampant yet in PH

NO medical malpractice law yet (the Medical Malpractice Act of 2002 still pending in Congress – encountering rough sailing)



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


Contents





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!


Contents





Contents




framework for Filipino participants

to add – to refineduring the ACI

Workshop!


Contents




assist Canadian facilitator in

understanding PH situation

during the ACI Workshop!



Reynaldo O. Joson, MD, MHA, MHPEd, MSc Surg

Email: [email protected]@yahoo.comCell No.: 09188040304

www.facebook.com/rjoson2001

Hospital Risk Management - A Philippine Perspective

Healthcare