Health Risk Management 29 October 2008, Sofia Health Risk Management Louis Coomans, CEO Eastern Europe

1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise AGENDA

1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise

Changing Perception April 17th, 1906 ...glad I've found at least some work at the construction site. Times are tough and it's one of the few safe jobs you can get nowadays.

Basic Terms Risk The combination of the probability of an appearance of a certain event and its consequences. Risk management The process through which an organisation continuously and methodically studies the risks of its activities in order to achieve a steady positive effect The process of analyzing exposure to risk and determining how to best handle such exposure.

How hazardous is healthcare? DANGEROUS REGULATED ULTRA-SAFE 100,000 Healthcare Driving 10,000 Total lives lost per year 1,000 Scheduled Chartered Airlines 100 Flights Mountain European Climbing Railroads Chemical 10 Bungee Manufacturing Nuclear Power Jumping 1 1 10 100 1,000 10,000 100,000 1,000,000 10,000,000 Number of encounters per fatality Source: University of Miami Centre for Patient Safety 2005

How does an incident come about?

The Process of Risk management Risk identification Risk analysis Risk quantification Risk management Risk transfer Risk elimination Risk reduction Risk acceptance Insurance Contractual

The Process of Risk management

Levels of Risk Management EU, EC Directives, recommendations (Recommendation (2006)7 of the Committee of Ministers towards Member States for control of the patient safety and of prevention of adverse events in healthcare services State- political Laws, legislations, codes and acts Regional Municipality level– projects, programs Company / Hospital ?

3. Patient safety - European Commission priority 1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise

Council of Europe Recommendation Rec(2006)7 of the Committee of Ministers to member states on management of patient safety and prevention of adverse events in health care Recognizing the need to promote open co-ordination of national and international regulations concerning research on patient safety, Council of Europe recommends that governments of member states, according to their competencies: i. ensure that patient safety is the cornerstone of all relevant health policies, in particular policies to improve quality; ii. develop a coherent and comprehensive patient-safety policy framework which makes patient safety a leadership and management priority;

compulsory and controlled. Council of Europe iii. promote the development of a reporting system for patient-safety incidents in order to enhance patient safety by learning from such incidents; this system should include: а) the proactive design of safe health-care systems ; b) the reporting of patient-safety incidents, and learning from the incidents and from the reporting; c) methods to standardise health-care processes ; d) methods of risk identification and management ; e) the development of standardised patient-safety indicators f) the content of training programmes and methods to implement a safety culture; Risk management in healthcare organizations should be compulsory and controlled.

1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise

Patient safety – European Commission priority Content missing?

1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise

Risk Management in Hospitals Governance of Healthcare organizations. Healthcare Risk and Quality management. Patient Safety and Clinical Risk Management Service Continuity Management Blood and Blood Products Supply Chain and Product Liability Absence and Stress Management. Health and Safety Clinical Trails and Medical Devices Education and Training on Risk, Quality, Regulatory and Governance Issues Professional liability for doctors, medical personnel. Professional liability for directors and management Public, Private, Partnership Programmes for finance of new build. Construction Risk Advice and Audit Financial Modeling and Design Actuarial claims prediction and analysis Property Management

1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise

Medical event IT reporting system Internet / intranet reporting Consolidated incident, near miss, adverse events & claims database Analyse trends, patterns, themes Implement change recommendations Improve patient safety / quality of care Bedside, ward, (home) Easy to use Local input by hospital staff Risk management reports Anonymous data Central administration Evidence Based Risk Management system record incidents, AEs and near misses in situ easy to use, contemporaneous anonymised data standard definitions case files reports - standard & bespoke security (patient records, practitioner name) Flexible IT architecture central platform to collect consistent data & info web-enabled to speed response time by mgt validation checks workflow alerts drill down capabilities: ID trends & target areas for corrective action ability to incorporate other data from internal or external IT systems Reactive vs. Proactive (near miss) Management & clinical governance

Medical event IT reporting systems National and regional systems United Kingdom – National Reporting & Learning System, Datex, STARS, Vanguard, etc Ireland – Clinical Indemnity Scheme Netherlands – ‘Sneller Beter’ Safety Management System (VMS) Denmark – Incident Reporting System United States – STARS, Doctor Quality, etc Australia / Tasmania – STARS Italy – STARS Sweden, Switzerland, Czech Republic, etc*. Patient safety programmes and systems for reporting & learning from patient safety incidents single pre-defined taxonomy vs. multiple taxonomy *Source: Council of Europe

Installed medical event IT reporting Benefits – process Supports evidence-based risk management framework and process Process for prevention; i.e. root cause analysis / system failures Monitor risk management recommendations Can reduce rate of claims Helps manage litigation costs Supports accreditation and achievement of quality standards

1. Basic terms 2. Council of Europe recommendations for patient safety 3. Patient safety - European Commission priority 4. Risk management in hospitals 5. Medical event IT reporting system 6. Marsh expertise

Marsh expertise Largest Healthcare Risk and Insurance Advisor in the world Dedicated Healthcare Practice with 600 colleagues globally Clients served in more than 100 countries US$1,000,000,000 in healthcare premiums annually Serving +2,300 diverse healthcare clients worldwide Providing risk management programmes to: Providing insurance and risk management programmes to: France - UK Ireland (country) - Spain (region) Australia - Italy (region) US states, associations ) - Hong Kong (region)

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