How improving your hospital s risk management program reduce cost and provide better value

• How is risk management related to quality and safety?. • How do you start a risk management program?. • How do you know if your risk management program is effective?... Risk managemen

How improving your hospital’s

Risk Management Program reduces cost and provides

better value

Jose M Acuin, MD

Outline of presentation

• What is risk?

• What is risk management?

• How is risk management related to quality and safety?

• How do you start a risk management

program?

• How do you know if your risk management program is effective?

What is risk?

Webster’s Definition of “Risk”

• A dangerous element or factor

• Possibility of loss or injury

• The degree of probability of such loss

Asians and risk management

Risk management, quality and

safety

Quality

design

Quality function deployment Failure

mode and effects analysis Quality

planning Process

capability studies Statistical

process control

Audit and review

Quality:

“Fitness for use” – Juran

“Conformance to requirements” – Crosby

The scope of a RCA of a

a medication error

SENTINEL

EVENT

Immediate Containment Action

Reporting and Notification

Investigation and Review

Action Plan

& Monitoring

How to Deal with a Sentinel

Event / Adverse Event

Unit heads / dept chairs

AP, Unit heads / dept chairs + Customer

dept chairs, AP, Team

+ Risk Management Office

Unit heads / dept chairs, SQD + MQIO

Persons accountable

Human factors engineering in

risk management

• Crew resource management

• Device procurement

• In-house product / service development

– Avoid reliance on memory

– Use forcing functions

– Avoid reliance on vigilance

– Simplify

– Standardize

• Surveillance activities

• Staff training

• Root cause analyses

• Corrective action formulation

Hierarchy of Barriers for Error Reduction

Least Effective

Knowledge

in the World

Knowledge

in my Head

Building an error proof culture

• Set a clear example

• Publish a quality and safety policy

• Create a system for reporting safety concerns

• Build openness into the workplace

Communication – the ultimate

loss reduction technique

Eight steps to respond to unexpected outcomes

1 Care for the patient

2 Preserve the evidence

3 Document in the medical record

4 Report the event

5 Disclose factual information

6 Analyze the event to prevent

recurrence and/or improve outcome

7 Follow Through with subsequent

disclosure discussion(s)

8 Heal the Health Care Team

Some organization prerequisites for effective risk

Conducting case-based review

Perform case-based review

No Does care meet criterion?

Apply case-based criteria Clinical data for one patient

Applying medical review criteria to cases

to construct a performance rate

Performance rate

Aggregate with criterion status of many

cases and divide by total number of cases

Criterion status = "met"

Yes

Criterion status = "not met"

No Does case meet criterion?

Apply medical review criteria derived from a TA/guideline

Clinical data for one patient

Applying standards of quality to a

performance rate

Quality improvement

intervention if needed

Re-assess periodically Analysis

Apply comparative standard

Yes

Quality improvement intervention if needed

Analysis

No Does rate meet standard?

Apply prescripive standard Performance rate

Summary of presentation

• The key to improving

safety lies not in changing

the human condition, but in

changing the conditions

under which humans work.

• Effectively managing risks

posed by health care

require executive

commitment, hospital staff

buy-in and data-driven

pursuit of quality.

A Surgical Safety Checklist to Reduce Morbidity

and Mortality in a Global Population

Safe Surgery Saves Lives Study Group N Engl J Med 2009;360:491-9.

Overall Nosocomial Infection Rates

Intensive Care Unit

per 1000 patient-days care

Needle Stick Injury

11 11

8 7

Needle Stick Rates 2008-2009

Frequency per Month

Staff Accident Data

ICU Standardized Mortality Rates

Oct 2007- Feb 2009

0 0.1 0.2 0.3 0.4 0.5 0.6

Actual Mort SMR