Darlington Chamburuka Acting Chief Risk Officer Dec 2015 Risk Management Darlington Chamburuka Acting Chief Risk Officer Dec 2015

What is Risk Management (RM)? The culture, process and structures that are directed towards realizing potential opportunities whilst managing adverse effects”

Why do we need Risk Management? The only alternative to risk management is crisis management --- and crisis management is much more expensive, time consuming and embarrassing. JAMES LAM, Enterprise Risk Management, Wiley Finance © 2003 Without good risk management practices, Medical Institutions cannot manage its resources effectively. Risk management means more than preparing for the worst; it also means taking advantage of opportunities to improve services or lower costs.

Drivers for Risk Management Public expectation in the face of scandals and growing awareness Many services were not subject to independent regulation and inspection Variations in the standard of care and treatment Advances in medicine, technology and professional practice Medicine used to be simple, ineffective and relatively safe, Now it is complex, effective and potentially dangerous Corporate Governance Rising indemnity costs

An effective risk management system can bring you from this……….

To this……………………

Probability of the occurrence of harm and the Potential source of harm Risk and Hazard It is important to differentiate between a ‘Hazard’ & ‘Risk’: Hazard: a situation with the potential to cause harm Risk: the combination of likelihood and consequence of hazards being realised Probability of the occurrence of harm and the severity of that harm. Potential source of harm

Culture It is essential that the Risk Management System is supported from the top – without support and backing from management it will not succeed. A fundamental part of Risk Management is about changing behaviour towards safer care. This change comes about through learning; from the level of the individual healthcare provider to the level of management and all points in between Imperative that staff are supported by their Enterprise in the incident management process. • Finger pointing does not work • The most valuable asset of any enterprise is its staff. • It is essential to provide organisational learning by providing regular feedback to staff. • All primary stakeholders should be involved in the planning and implementing of a proactive Risk Management System

Process Risk Assessment is a proactive process in which information is collected about an organisation in order to identify what risks may exist The process of risk assessment seeks to answer four simple questions: What can go wrong? How bad? How often? Is there a need for action?

The benefits of risk assessment Strives for the optimal balance of risk by focusing on the reduction or mitigation of risk while supporting innovation. Helps organisations comply with standards. Supports better decision making through a solid understanding of all risks and their likely impact Highlights the weakness and vulnerability in procedures, practices & policy change

We all make mistakes Errors and accidents are, by definition, unintentional. Nobody sets out to make an intentional mistake. Any product or system that depends on perfect human performance is fatally flawed”. In America, preventable errors contribute to the deaths of 210,000 hospital patients annually.(2013) That would make medical errors the third-leading cause of death in America, behind heart disease, which is the first, and cancer, which is second

Risk Factors Patient factors Condition e.g. complexity and seriousness Language and communication Personality and social factors Task factors Task design and clarity of structure Availability and use of protocols Availability and accuracy of test results Decision-making aids Individual (staff) factors Knowledge and skills Competence Physical and mental health Team factors Verbal communication Written communication Supervision and seeking help Team structure (congruence, consistency, leadership etc.) Work environmental factors Staffing levels and skills mix Workload and shift patterns Design, availability and maintenance of equipment Administrative and managerial support Organisational and management factors Financial resources and constraints Organisational structure Policy, standards and goals Safety culture and priorities Institutional factors Economic and regulatory context

Interactive Session #1 – 5 minutes Introduce yourselves to others at your table Discuss the root causes of errors in surgery and what actions should be taken to minimize the errors Report to the large group. Pick a spokesperson.

Structures Quality Management and Risk Management are inextricably linked. Where high quality care exists, risk is invariably low. Conversely, where quality is compromised the risk to the patient increases

There must be structures to keep records Records/Documentation Accuracy Retention Storage

Structure- there must be structures to carry out incident reporting? All human activities carry a degree of risk and their success or failure depends on their management Methods of Learning From Reporting It can generate alerts regarding significant new hazards Lessons learned by health-care organizations from investigating a serious event can be disseminated. Analysis of multiple reports can lead to insights into underlying systems failures and generate recommendations for “best practices” for all to follow. Incident Reporting Identifies potential risks or exposures Prevents subsequent recurrences Flags adverse events Develops a body of knowledge Provide record of events Allows ranking of risks Makes staff aware that there is a spectrum of outcome Makes organisations more safety conscious

Why are many incidences not reported Reasons for not reporting Fear of Blame High Workload Belief that incident did not warrant report Solutions Simplified methods of Reporting Clear Definitions Education Feedback Reassurance to staff re purpose

Risk Reporting -Risk Prioritization – likelihood and impact Likelihood of a risk event occurring Very High: Is almost certain to occur High: Is likely to occur Medium: Is as likely as not to occur Low: May occur occasionally Very Low: Unlikely to occur Risk Impact: Level of damage that can occur when a risk event occurs Very High: Threatens the success of the project High: Substantial impact on time, cost or quality Medium: Notable impact on time, cost or quality Low: Minor impact on time, cost or quality Very Low: Negligible impact Slide 20

Third dimension for rating risks - proximity Immediate – now Less than 6 months Between 6-12 months Between 12 – 24 months Between 24 – 36 months More than 36 months

Risk rating …Combining impact and likelihood Slide 22

Back at the office Why is the organization interested in RM? What are they hoping will be achieved with its implementation? Who is doing what? Roles & responsibilities must be clearly defined. Make sure Leadership supports RM and uses RM results to make decisions. Everyone is a risk manager. Make sure that all risks have owners and the responsibilities for mitigation are assigned How will it be implemented? What is your framework? What is the common language? How will risks be measured and reported? Where will you start? Choices could be where you can most easily succeed or where it is needed the most or where interest is high. When will it be implemented? It is a journey not a destination; 3-5 years for complete roll-out; how often will risks be assessed; when will mitigation plans be implemented and monitored; when will risks be reported.

Ask questions and develop your approach Do we understand our major risks? Do we know what is causing our risks to increase, decrease or stay the same? Have we assessed the likelihood and impact of our risks? Have we identified the sources and causes of our risks? How well are we managing our risks? Are we trying to prevent the downside risks from happening? Or are we trying to simply recover from them? Who is accountable for these risks? How do we talk about risk? Do we have a common language across branches, across divisions, across the ministry, across the OPS, across the health care system? Are we taking too much risk? Or not enough risk? Are the right people taking the right risks at the right time? What’s our culture? Are we risk adverse or are we risk-takers? Or are we somewhere in between?

TAKE SMALL BITES TO IMPLEMENT

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Darlington Chamburuka UAP-Old Mutual Group Darlington.chamburuka@oldmutualkenya.com (+254) 703-754-298