PS is a Key Component (Dr.adib)

8/10/2019 PS is a Key Component (Dr.adib)

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UTAMAKAN

KESELAMATAN

PASIEN

PATIENT SAFETY AS A KEY

COMPONENT OF RISK MANAGEMENT

Dr.Adib A.Yahya MARS

Ketua Umum PERSI

Workshop Keselamatan Pasien Dan Manajemen

Risiko Klinis

RS ST.CAROLUS Jakarta 1 3 NOV 2006


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2. Why?

1. What?

3. How?


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DEFINISI RISIKODEFINISI RISIKO

RISIKO ADALAH :RISIKO ADALAH :

SUATU POTENSI ANCAMAN YANG DAPATSUATU POTENSI ANCAMAN YANG DAPAT

TIMBUL DARI PROSES SAAT INI ATAUTIMBUL DARI PROSES SAAT INI ATAUKEGIATAN YANG AKAN DATANGKEGIATAN YANG AKAN DATANG

ERM, Risk Management Handbook for Health Care OrganizationERM, Risk Management Handbook for Health Care Organization


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RISK IS :RISK IS :

A possible event or circumstances that canA possible event or circumstances that canhave negative influences on the Enterprise inhave negative influences on the Enterprise inquestion.question. (ERM)(ERM)

Its impact can be on the very existence:Its impact can be on the very existence:-- the resources (human and capital)the resources (human and capital)

-- the products and services, orthe products and services, or-- the customers of the Enterprise,the customers of the Enterprise,

-- as well as external impact on Society,as well as external impact on Society,Markets or the EnvironmentMarkets or the Environment


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RISIKO ADALAH :RISIKO ADALAH : FUNGSI DARIFUNGSI DARIPROBABILITAS (CHANCE, LIKELIHOOD)PROBABILITAS (CHANCE, LIKELIHOOD)

TENTANG KEJADIAN YANG TIDAKTENTANG KEJADIAN YANG TIDAKDIINGINKAN, DAN TINGKAT KEPARAHANDIINGINKAN, DAN TINGKAT KEPARAHAN

DARI DAMPAK YANG DITIMBULKANDARI DAMPAK YANG DITIMBULKAN

probability of an accidentprobability of an accident consequence in lost money or deathconsequence in lost money or death

RiskRisk

events per time periodevents per time period per eventper event

Risk = Probability (of the Event) ConsequenceRisk = Probability (of the Event) Consequence


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RISIKO DI RUMAH SAKITRISIKO DI RUMAH SAKIT

DiDi rumahrumah sakitsakit terdapatterdapat duadua komponenkomponengovernancegovernanceyaitu :yaitu :Corporate governanceCorporate governance dandan Clinical governanceClinical governance..

11) Pelaksanaan) Pelaksanaan Corporate governanceCorporate governance menimbulkanmenimbulkanrisiko perusahaan (risiko perusahaan (corporate risks)corporate risks) sepertiseperti ::

Risiko asetRisiko asetRisiko pendapatan bisnisRisiko pendapatan bisnis

Risiko tuntutan hukumRisiko tuntutan hukum

Risiko kelalaian karyawanRisiko kelalaian karyawan

Risiko akibat kelemahan sistem operasional prosedurRisiko akibat kelemahan sistem operasional prosedur

Risiko korupsi, tindak kriminal, ketidakjujuranRisiko korupsi, tindak kriminal, ketidakjujurankaryawankaryawan


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2)2) Pelayanan medis / klinisPelayanan medis / klinis menyebabkanmenyebabkan

timbulnya risiko klinis (timbulnya risiko klinis (clinical risk)clinical risk) sepertiseperti ::

Risiko kesalahan medisRisiko kesalahan medis (Medical errors)(Medical errors) Risiko kejadianRisiko kejadian--kejadian kritis (kejadian kritis (CriticalCritical

incidents)incidents) Risiko komplain pasienRisiko komplain pasien

Risiko klaim pasienRisiko klaim pasien

Risiko malpraktekRisiko malpraktek RisikoRisiko infeksiinfeksi nosokomialnosokomial

Risiko K3Risiko K3


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RISK MANAGEMENT

SUATU PENDEKATAN

PROAKTIF DENGAN TUJUAN

UNTUK IDENTIFIKASI,PENILAIAN DAN

PRIORITASISASI RISIKO, GUNAMENGHILANGKAN ATAU

MEMPERKECIL DAMPAKNYA


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HOSPITAL RISK MANAGEMENTHOSPITAL RISK MANAGEMENT

Kegiatan berupa identifikasi dan evaluasi untuk

mengurangi risiko cedera dan kerugian pada pasien,karyawan rumah sakit, pengunjung dan organisasinya

sendiri (The Joint Commission on Accreditation of

Healthcare Organizations / JCAHO).

Kegiatan meminimalkan bahaya terhadap

pasien, kegiatan untuk menciptakan lingkungan

yang aman bagi karyawan, pasien dan pengunjung

(ASHRM}


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CLINICAL RISK MANAGEMENTCLINICAL RISK MANAGEMENT

Clinical Risk Management is an approach toClinical Risk Management is an approach to

improving the quality and safe delivery of healthimproving the quality and safe delivery of healthcare by :care by :

-- Placing special emphasis on identifyingPlacing special emphasis on identifyingcircumstances that put patients at risk of harm,circumstances that put patients at risk of harm,

andand

--Acting to prevent or control those risksActing to prevent or control those risks


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KATEGORI DAN RUANG LINGKUP MANAJEMEN RISIKO :KATEGORI DAN RUANG LINGKUP MANAJEMEN RISIKO :

Risiko yang berhubungan dengan perawatan pasienRisiko yang berhubungan dengan perawatan pasien(Patient care related risks)(Patient care related risks) Pelayanan yang tidak sesuai SOPPelayanan yang tidak sesuai SOP

Akibat pengobatan yang tidak sesuaiAkibat pengobatan yang tidak sesuai Informed consentInformed consent

Diskriminasi pengobatanDiskriminasi pengobatan

Kehilangan barang milik pasienKehilangan barang milik pasienRisiko yang berhubungan dengan tenaga medisRisiko yang berhubungan dengan tenaga medis

(Medical staff related risks)(Medical staff related risks)

Credential terhadap staf medis ?Credential terhadap staf medis ? Tindakan medis sesuai kompetensi dan prosedur bakuTindakan medis sesuai kompetensi dan prosedur baku

Risiko yang berhubungan dengan karyawanRisiko yang berhubungan dengan karyawan

(Employee related risks)(Employee related risks) Risiko keselamatan dan kecelakaan kerjaRisiko keselamatan dan kecelakaan kerja


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Risiko yang berhubungan dengan propertyRisiko yang berhubungan dengan property

(Property related risks)(Property related risks)

Kerugian akibat kebakaran, bencana dllKerugian akibat kebakaran, bencana dll

Kehilangan laporan dan dokumenKehilangan laporan dan dokumen

Kehilangan barang berhargaKehilangan barang berharga

Risiko keuanganRisiko keuangan (Financial risks)(Financial risks)

Bad DebtBad DebtMeningkatnya suku bungaMeningkatnya suku bunga

Risiko lainRisiko lain (Other risks)(Other risks)Masalah limbah rumahMasalah limbah rumah

DLL.DLL.


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Hosp

osp

Risk

isk

Mgtgt

PatientPatient

R.RiskR.RiskMedicalMedical

StaffStaffR.RisksR.Risks

EmployeeEmployee

R RisksR RisksPropertyProperty

R RisksR Risks

OtherOther

RisksRisks

PatientPatientSafetySafety

Health Risk Mgt for HCO /Health Risk Mgt for HCO /

Hosp : Health Care Risk MgtHosp : Health Care Risk Mgt

is concerned with ais concerned with atremendous variety of issuestremendous variety of issues

and situations that hold theand situations that hold the

potential for liability orpotential for liability or

casualty loses for ancasualty loses for an

organizationorganization

Roberta Caroll, editor : Risk Management Handbook

for Health Care Organizations, 4th edition, Jossey

Bass, 2004


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WHY IS RISK MANAGEMENT AN ISSUEWHY IS RISK MANAGEMENT AN ISSUE

IN HEALTHCARE?IN HEALTHCARE?

. because a breach of their duty ofcare has serious and/or far reaching

consequences.



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IN HEALTHCARE?IN HEALTHCARE?

Health Care is a Risky Business

Health Care is a Risky Business ... Financially

Health Care is a Risky Business ... for staff

THE PROBLEM WITH


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THE PROBLEM WITHHEALTHCARE

BANYAK SEKALI PERMASALAHAN YANG

BERSIFAT PERORANGAN. OTONOMI PROFESI YANG TINGGI

TINGKAT REGULASI YANG RENDAH

TINGGINYA TINGKAT EKSPEKTASIPASIEN DAN RENDAHNYA

PEMBERDAYAAN PASIEN HUBUNGAN ANTARA RISIKO DAN

PERMINTAAN

H i l Ri k i bH i l Ri k i b


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Hospital Risk management is about :Hospital Risk management is about :

MinimisingMinimising the likelihood of patients fromthe likelihood of patients fromcoming harmcoming harm

Creating a safe environment for all staff andCreating a safe environment for all staff andvisitorsvisitors

Maintain the good reputation of the Hospital byMaintain the good reputation of the Hospital byconducting relationship with openness andconducting relationship with openness andhonesty and delivering effective and efficienthonesty and delivering effective and efficient

servicesservices Ensuring compliance with all applicableEnsuring compliance with all applicable

legislationlegislation


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Providing a comprehensive approach to riskProviding a comprehensive approach to risk

assessment and managementassessment and management

Assisting with compliance against national,Assisting with compliance against national,regional and local priorities for actionregional and local priorities for action

Supporting and complementing the newSupporting and complementing the new

organisationalorganisational structurestructure

Promoting just and fair culture where staff arePromoting just and fair culture where staff are

encouraged to report risk, incidents and nearencouraged to report risk, incidents and nearmissesmisses

S A AG T C CA GO A CRISK MANAGEMENT & CLINICAL GOVERNANCE


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RISK MANAGEMENT & CLINICAL GOVERNANCERISK MANAGEMENT & CLINICAL GOVERNANCE

The Elements of Clinical Governance

Clinical governance is an aggregation of service improvement processes that are

regulated by a single ideology.
http://en.wikipedia.org/wiki/Image:Smallwhatisclingov.jpg


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Patient safety is a key componentPatient safety is a key component

of risk managementof risk management

Patient SafetyPatient Safety Risk ManagementRisk Management


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Patient SafetyPatient SafetyRisk ManagementRisk Management..

Step 1Step 1 Build a safety cultureBuild a safety culture Create a culture that is open and fairCreate a culture that is open and fair

Step 2Step 2 Lead and support your staffLead and support your staff Establish a clear and strong focus onEstablish a clear and strong focus on

patient safety throughout yourpatient safety throughout your

organisationorganisation

Step 3Step 3 Integrate your risk managementIntegrate your risk managementactivityactivity

Develop systems andDevelop systems andprocesses to manage yourprocesses to manage your

risks and identify and assessrisks and identify and assess

things that could go wrongthings that could go wrong

Step 4Step 4 Promote reportingPromote reporting Ensure your staff can easily reportEnsure your staff can easily report

incidents locally and nationallyincidents locally and nationally

Step 5Step 5 Involve and communicate with patients and theInvolve and communicate with patients and the

publicpublicDevelop ways to communicate openlyDevelop ways to communicate openly

with and listen to patientswith and listen to patients

Step 6Step 6 Learn and share safety lessonsLearn and share safety lessons Encourage staff to use root causeEncourage staff to use root cause

analysis to learn how and why incidentsanalysis to learn how and why incidents

happenhappen

Step 7Step 7 Implement solutions to prevent harmImplement solutions to prevent harm Embed lessons through changes toEmbed lessons through changes to

practice, processes or systemspractice, processes or systems

www.wmin.ac.uk

RISK MANAGEMENT


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RISK MANAGEMENT

CONCEPT

CULTURAL

TRANSFORMATION

INTERGRATED RISK

MANAGEMENT

HOW ?HOW ?METHODE RISK MANAGEMENT

CYCLE

LESSONS LEARNED

PRIMUM NON NOCEREPRIMUM NON NOCERE


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PRIMUM, NON NOCEREPRIMUM, NON NOCERE

FIRST, DO NO HARMFIRST, DO NO HARM

HIPPOCRATESHIPPOCRATES

S TENETS TENET

(460(460--335 BC)335 BC)


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Patient SafetyPatient Safety bukanbukan kegiatankegiatanyangyang barubaru..

Patient SafetyPatient Safety sudahsudah harusharus menyatumenyatu

dengandenganprosesproses pengobatanpengobatan kepadakepadapasienpasien ituitu sendirisendiri


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Patient Safety/Risk managementPatient Safety/Risk managementprograms were born ofprograms were born ofexistingxisting

practicesractices

that werethat were expandedexpanded,,formalizedformalized,, andand centralizedentralized..

CURRENT SITUATION


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incidentreporting

patient

complaints

variance analysisclinical indicator

data

medical negligence

claims

complication

audit

CURRENT SITUATION

HRRI.Healthcare Risk Resources InternationalHRRI.Healthcare Risk Resources International


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BASIC CONCEPTBASIC CONCEPT


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31A Protocol For the Investigat ion and analysis Of Clinical Incidents.CRU & ALARM


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CONTRIBUTING FACTORS INFLUENCINGCONTRIBUTING FACTORS INFLUENCING

CLINICAL PRACTICECLINICAL PRACTICE

1. PATIENT FACTORS

a. Condition complexity and seriousness

b. Language and communication

c. Personality and social factors

2. TASK AND TECHNOLOGY FACTORS

a. Task design and clarity of structure

b. Availability and use of protocols

c. Availability and accuracy of test results

d. Decision-making aids


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3. INDIVIDUAL (STAFF) FACTORS

a. Knowledge skills

b. Competence

c. Physical and mental health

4. TEAM FACTORS

a. Verbal communication

b. Written communication

c. Supervision and seeking help

d. Team structure


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5. WORK ENVIRONMENTAL FACTORS

a. Staffing levels and skill mix

b. Workload and shift patterns

c. Design, availability and maintenance of equipment.

d. Administrative and managerial support

e. Environmentf. Physical


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6. ORGANIZATION AND MANAGEMENT FACTORS

a. Financial resources and constraints

b. Organizational structure

c. Policy, standards and goals

d. Safety culture and priorities

7. INTERNATIONAL FACTORS

a. Economic and regulatory factors

b. Link with other origination line.


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INTEGRATED RISK MANAGEMENTINTEGRATED RISK MANAGEMENT


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Integrated risk management

ntegrated risk management is theis the

process ofprocess ofidentification assessmentdentification assessment

analysis

nalysis andand managementanagement of all risks andof all risks and

incidents forincidents for every level of anvery level of an

organisationrganisation

,, and the aggregation of theand the aggregation of theresults at a corporate level.results at a corporate level.

IN PRACTICE, INTEGRATED RISK MEANS :IN PRACTICE, INTEGRATED RISK MEANS :


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Integrating all risk management functions ( patient safety,Integrating all risk management functions ( patient safety,

OHS, complaints, clinicalOHS, complaints, clinical litigation,etclitigation,etc.).)

IntegratingIntegrating modernisationmodernisation and clinical governanceand clinical governanceactivity to unite strategies and improve outcomes andactivity to unite strategies and improve outcomes and

safety for patients.safety for patients.

Integrating all sources of information related to risk andIntegrating all sources of information related to risk and

safety.safety.

Integrating risk assessments of all types of risk forIntegrating risk assessments of all types of risk for

organisationorganisation at every levelat every level

IN PRACTICE INTEGRATED RISK MEANS ( tIN PRACTICE INTEGRATED RISK MEANS ( td)d)


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IN PRACTICE, INTEGRATED RISK MEANS : (contIN PRACTICE, INTEGRATED RISK MEANS : (contd)d)

A consistent approach to the training, management,A consistent approach to the training, management,

analysis and investigation for all risksanalysis and investigation for all r isks

Incorporating all risk into anIncorporating all risk into an organisationorganisationss riskrisk

assessmentassessment programmeprogramme and risk register, using riskand risk register, using risk

assessment tools to identify all potential risks toassessment tools to identify all potential risks to

organisationalorganisational strategy and policy.strategy and policy.

Integrating processes and decisions about all r isk intoIntegrating processes and decisions about all r isk into

future business and strategic plansfuture business and strategic plans ..

BASIC CONCEPTSBASIC CONCEPTS


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I. Risk management is not primarily about avoiding ormitigating claims; rather, it is a tool for improving the

quality of care. Risk management is also as much about

learning from claims as it is about mitigating claims.

II. Risk management is not simply the reporting of patient

safety incidents.

Incident reporting is only one aspect of the identification of

risk. In one sense, incident reporting is on the reactive side

of risk management. More emphasis needs to be placed on

the proactive side

III. Risk management is actually the business of all

stakeholders in the organisation, clinicians and

nonclinicians.

IV. The primary focus of risk management should now be

patient safety

Basic questions addressed by risk managementBasic questions addressed by risk management


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Basic questions addressed by risk managementBasic questions addressed by risk management

What could go wrong ?What could go wrong ? Risk identificationRisk identif ication

What are the chances of it goingWhat are the chances of it going Risk analysis andRisk analysis and

evaluationevaluation

wrong and what would be the impact ?wrong and what would be the impact ?

What can we do to minimize the chanceWhat can we do to minimize the chance Risk treatment. TheRisk treatment. The

cost ofcost of

of this happening or to mitigate damageof this happening or to mitigate damage prevention isprevention is

compared withcompared with

when it has gone wrong ?when it has gone wrong ? the cost of getting it wrongthe cost of getting i t wrong

What can we learn from things thatWhat can we learn from things that Risk control; sharing andRisk control; sharing and

have gone wrong ?have gone wrong ? LearningLearning

Royal College of Obstetricians andRoyal College of Obstetricians and Gynaecologists.ClinicalGynaecologists.Clinical Governance Advice No.2Governance Advice No.2


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METHODEMETHODE

RISK MANAGEMENT PROCESSRISK MANAGEMENT PROCESS

RISK MANAGEMENT TOOLSRISK MANAGEMENT TOOLS

RISK MANAGEMENT PROCESSRISK MANAGEMENT PROCESS


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Risk Identi fication

Risk AnalysisCommunication

&ConsultationEvaluation and

Prioritisation

RiskAss

essment

Monitor

&

Review

Risk Treatment

IDENTIFIKASIIDENTIFIKASI


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RiskRisk

IdentificationIdentification

Incident reportingIncident reporting

Case ReportCase Report

ComplaintComplaint

Claim dataClaim data

Clinical care reviewClinical care review

AuditAudit MedisMedis

Occurrence Screening /Occurrence Screening /

Medical Record ReviewMedical Record Review

Survey / SelfSurvey / SelfAssesmentAssesment

ANALISIS RISIKOANALISIS RISIKO


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ANALISIS RISIKOANALISIS RISIKO

Matrix

Assesment

(Risk Grading)

RCA (Root Cause

Analysis)

FMEA (Failure

Mode & EffectsAnalysis)

ANALYZE

RISK

EVALUASI RISIKO


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EVALUASI RISIKO

Evaluasi

Risiko

Risk Ranking

Priority the risk

PENATALAKSANAAN RISIKOPENATALAKSANAAN RISIKO


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Penatalaksanaan

Risiko

StrategiStrategipenatalaksanaanpenatalaksanaan risikorisiko dibagidibagi 2,2,yiyi ::

1.1. KontrolKontrol risikorisiko (risk control)(risk control)

HindariHindari (Risk avoid/ prevention) :(Risk avoid/ prevention) : tidaktidakmelakukanmelakukan aktifitasaktifitasygyg berisikoberisiko

ReduksiReduksi / Mitigation (Risk reduction :/ Mitigation (Risk reduction :

mereduksimereduksi atauatau meminimalkanmeminimalkan berulangnyaberulangnya atauataudampakdampakkejadiankejadian..

2.2. PembiayaanPembiayaan risikorisiko (Risk Financing(Risk Financing))

Transfer (Risk transfer):Transfer (Risk transfer): membagimembagi bebanbeban atauataurisikorisiko kekeAsuransiAsuransi,, kontrakkontrakkerjasamakerjasama, joint, joint

ventures,dllventures,dll

TerimaTerima (Risk acceptance / retention):(Risk acceptance / retention): beberapabeberaparisikorisiko mungkinmungkin minimalminimal dandan dptdpt diterimaditerima

RISK MAPPING


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S G

Impact vs. ProbabilityImpact vs. Probability

C o n t r o l

Sh a r e M i t i g a t e & Co n t r o l

A c c e p t

High Risk

Medium Risk

Medium Risk

Low Risk

High

I

M

PA

C

T

Low PROBABILITY High

www.coso.org

SARANSARAN--SARAN :SARAN :


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SOSIALISASIKAN KONSEP DAN PRINSIPSOSIALISASIKAN KONSEP DAN PRINSIP--PRINSIP RISKPRINSIP RISK

MANAGEMENTMANAGEMENT

BANGUN NETWORK ANTARA PIMPINAN DANBANGUN NETWORK ANTARA PIMPINAN DAN

DEPARTEMEN ATAU UNITDEPARTEMEN ATAU UNIT

DUKUNG IMPLIMENTASI PROGRAMDUKUNG IMPLIMENTASI PROGRAM--PROGRAMPROGRAM

MANAJEMEN RISIKOMANAJEMEN RISIKO

BANGUN TIM INTERDISIPLINER UNTUKBANGUN TIM INTERDISIPLINER UNTUK

IMPLEMENTASI DANMONITOR PROGRAM MANAJEMENIMPLEMENTASI DANMONITOR PROGRAM MANAJEMENRISIKORISIKO

PENDIDIKAN DAN PELATIHAN PADAPENDIDIKAN DAN PELATIHAN PADA


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PENDIDIKAN DAN PELATIHAN PADAPENDIDIKAN DAN PELATIHAN PADA

TINGKAT MANAJER DAN PELAKSANATINGKAT MANAJER DAN PELAKSANA

KEMBANGKAN STRATEGI UNTUKKEMBANGKAN STRATEGI UNTUK

IMPLEMENTASI RISK MANAGEMENTIMPLEMENTASI RISK MANAGEMENT

IMPLEMENTASIKAN PROSESIMPLEMENTASIKAN PROSES--PROSESPROSES

PENILAIANPENILAIAN

MONITOR EFEKTIFITAS DARI PROSESMONITOR EFEKTIFITAS DARI PROSESMANAJEMEN RISIKOMANAJEMEN RISIKO

KESIMPULANKESIMPULAN


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Those who do not learn from theirThose who do not learn from their

mistakes are condemned to repeat themmistakes are condemned to repeat them

We cannot change the human condition, butWe cannot change the human condition, but

we can change the conditions under whichwe can change the conditions under whichhumans work.humans work.


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PS is a Key Component (Dr.adib)

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