ROJoson’s Lecture – Hospital Risk Management – A Philippine Perspective – 12nov14 – MDH-ACI

ROJoson’s Lecture – Hospital Risk Management – A Philippine Perspective – 12nov14 – MDH-ACI

Before anything else, I like to thank the organizers of the workshop for the honor and privilege to give this introductory talk entitled Hospital Risk Management – A Philippine Perspective.

I am a student in Hospital Risk Management. I do not claim to be an expert in this field. I started being a student in Hospital Risk Management in 1989 when I for the first time became a hospital administrator, specifically, an assistant medical director of Manila Doctors Hospital. I continued my exposure- and experience-cum learning in HRM through the following activities.  I wrote modules and facilitated trainings in disaster programs in MDH, OMMC, DOH, and WHO.  I facilitated trainings in quality and safety programs in MDH, OMMC, and PCS.  In 2008, I conceptualized the risk management program of MDH.  When I became the SVP for corporate affairs of MDH, all the more I have been exposed to hospital risk management.  Despite all these experiences, I still consider myself as a student and I am attending the workshop on risk management to be conducted by Patricia Mckernan.

Patricia Mckernan

Today, I was asked by the organizers of this workshop to give a short presentation on Hospital Risk Management – A Philippine Perspective.  Considering that I am still a student of HRM, the best thing that I can do  is to present to you my thoughts, perceptions, opinions and recommendations based on my anecdotal experiences in hospital risk management during the past 30 years that I have been in the practice of my medical profession and during the past 23 years that I have been in hospital administration. I hope that with my presentation I will be of help not only to the Filipino participants in this workshop but also to the Canadian facilitator.

I will try to give an overview of the hospital risk management in the Philippines, its current status in the Philippines; areas and opportunities for improvement; and recommendation in developing an integrated sustainable hospital risk management based on Philippine environment and perspective.

I hope that what I will present will serve as a framework to which the Filipino participants can add more meat, more substance and refine and strengthen when they get tips and learn from our Canadian facilitator, Patricia Mckernan.

Likewise, I hope that what I will present, particularly the Philippine environment and perspective, will assist the Canadian facilitator in understanding the Philippine situation and thereby making it easier for her to facilitate the workshop with Filipino participants.

What is Risk? Lifted from the businessdictionary, 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.

What is hospital risk management? it is a system or program that manages the “risks” of the hospital.  Within the hospital risk management, there are subsets or subprograms, such as department risk management or risk management program in  a department; disaster risk management; patient treatment risk management or medical malpractice risk management; and others.

There are two basic processes in hospital risk management.  These are:

•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

In risk identification,  one has to identify all potential hazards or threats that occur within the vicinity of the hospital that can cause damage, injury, liability, loss or other negative occurrence of whatever forms and degrees.  The identification of risks must be systematic and systemic or comprehensive.   The hazards identified are usually myriad in number but which can be lumped into a manageable number of categories  of risks, such as:

Risk for business non-sustainability

Risk for natural disasters (earthquake, flood, tsunamis, fire, etc.)

Risk for man-made disasters (fire, felony, bomb threat, terrorism, etc.)

Risk for technology-related disasters

Risk for biological disasters

Risk for medico-legal suits (arising from patient care)

Risk for non-medico-legal suits (not arising from patient care, such as workforce legal suits)

Risk for excessive account receivables

Risk for tarnished corporate or hospital reputation

Risk assessment is done as to the likelihood of occurrence of the identified risks and impact when they occur.  Although the utility of risk assessment or evaluation is more on prioritization, as a matter of good practice, all the hazards and risks identified must have a preventive, mitigation, preparedness, response, and recovery plans.

This is an example of a method in doing risk assessment – a simplified one.

The formula is risk = probability x consequence.

Probability is classified into 3 – rare given a numerical value of (1); possible (2); almost certain to occur (3).

Consequence is classified into 3 – minor given a numerical value of (1); moderate (2); major (3).

Using the formula, if the product score falls in the three green boxes, the hazard is considered low risk.

If the score falls in the yellow boxes, the hazard is considered medium risk.

If the score falls in the red boxes, the hazard is considered high risk.

If I were to rank in the order of decreasing frequency the 9 categories of risks that I mentioned earlier, it will run this way:

•business non-sustainability (financial viability)
•excessive account receivables
•medico-legal suits (arising from patient care)
•technology-related disasters
•natural disasters (earthquake, flood, tsunamis, fire, etc.)

•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

Once again, this slide shows the two basic processes in hospital risk management.  After the risk identification and assessment, the next logical step is formulation of strategies and action plans to prevent, mitigate risks and to respond and recover from the consequences of unavoidable risk occurrence.  I have decided not to tackle this second process as it is long and beside, I am sure, this will taken up in the workshop.

I will now focus on the topics outlined in this slide.

To get the current status of risk management in Philippine hospitals, I did an email survey with 18 questions. I sent the survey to about 50 hospital administrators.  Unfortunately, I have only about 20% response rate.  I intend to continue this survey with you later on.  To get the current status also, I interviewed hospital administrators I know and also my co-faculty in the Master in Hospital Administration at the University of the Philippines College of Public Health.  The rest,  I relied on my personal observations of Philippine hospitals.

In the survey, NONE have a well-established structured, comprehensive and effective hospital risk management program.  How about you?  How many of you have a well-established structured, comprehensive and effective hospital risk management program?

In the survey, NONE have a well-established structured risk identification process.  None have a well-established system of keeping track of newly perceived and actual risks.  How about you?  How many of you have a well-established structured risk identification process? How many of you have a well-established system of keeping track of newly perceived and actual risks and adding them to the list of hospital risks?

In the survey, NONE have a well-established structured risk assessment process.  How about you?

In the survey, NONE have a well-established structured risk control system (in terms of response and recovery program during risk occurrence).  How about you?

In the survey, majority have no medical malpractice insurance for the hospital and for their healthcare professionals.  How about you?  How many of you have medical malpractice insurance for your hospital? How many of you have medical malpractice insurance for your healthcare professionals?

Majority have comprehensive fire insurance.  How about you?  How many have NO fire insurance?

Majority have no well-established multisectoral taskforce / committee in charge of their hospital risk management program.  How about you?  How many have a well-established multisectoral taskforce / committee in charge of their hospital risk management program?

Majority have no well-established documented policies and procedures on hospital risk management.  How about you?  How many have a well-established documented policies and procedures on hospital risk management?

Majority have no well-established integrated hospital risk management program where all risks are interconnected as indicated during planning and exercises.  How about you?  How many have a well-established integrated hospital risk management program where all risks are interconnected as indicated during planning and exercises?

Majority of the documented policies and procedures on hospital risk management are NOT being reviewed at least at planned intervals.  How about you?  How many of you review your documented policies and procedures on hospital risk management regularly at planned intervals?

Majority  do not conduct regular exercises on their risk preparedness program.  How about you?  How many of you conduct regular exercises on your risk preparedness program?

50% have full commitment and support from the top management for their hospital risk management program.  But despite this full commitment, none have a well-established structured,  comprehensive and effective hospital risk management program.

How about you?  How many of you have full commitment and support from the top management for your hospital risk management program?

From the interview of hospital administrators  and from my personal observations, here are some of my general and summary statements on the status of risk management in Philippine hospitals. 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. Right?

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.

Here are my recommendations for this identified area of improvement. 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, following the format of ISO standards:

•Preface
•Scope
•Definitions
•Program Management
•Planning
•Implementation
•Exercises, evaluation and corrective action
•Management Review

I suggest coming out with a corporate or hospital Risk Management Program Manual together with Supplementary Manuals on Implementing Guidelines and Instructions covering the 9 categories of common hospital risks that I mentioned before.

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.

My recommendations for this identified area of improvement:

Create a multisectoral task force / committee  to align, coordinate, collaborate, and integrate all risk preparedness programs of the hospital.

Examples of multisectoral task forces / committees

• Corporate Risk Management Committee
•Safety Promotion and Disaster Preparedness Committee
•Quality Management Committee

They can have other names.  What are essential are the following: Multisectoral in membership; Headed by a top / senior management representative; Aligning, coordinating, integrating all risk preparedness programs of the entire hospital.

As to 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. (secret).  Most physicians in PH also do not have medical malpractice insurances.

As medicolegal suits are, fortunately, not rampant yet in the Philippines.   In the Philippines, there is NO medical malpractice law yet.  The 2002 proposed Medical Malpractice Act of 2002 is still pending in Congress.  Fortunately, there is NO mandatory medical malpractice insurances required of the physicians practicing in the Philippines.

This is what I have teaching my students in medical schools and hospitals for the past 15 years – the goals in the management of all patients – resolve the health problem ending in a live patient, no complication, and no disability as much as possible and do it in such a way, even if your patient dies, develops complications and disability, that you end up with a satisfied patient and relatives and you don’t have a medico-legal suits in your hand.  This constant reminder is a simple strategy in avoiding medicolegal suits for the physicians.

The last batch of recommendations I will share with you is on the critical steps to ensure success of your hospital risk management program.  These are the following: 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.

I constructed this diagram to show the interplay of these 4 critical administrative factors in ensuring readiness in risk control.

The leaders must manage the staff to get commitment and support to achieve the goals in risk control.

Although the leaders may delegate, they must know the principles of risk preparedness, especially in managing incident command and the critical factors for readiness.

The leaders must communicate with their managers and staff effectively, efficiently, and timely.  They must stress the importance of risk preparedness, provide directions, and express commitment and support.

Lastly, leaders must support training of staff for risk preparedness, undergo training to gain competency, especially, in handling the incident command.  They must demonstrate engagement and involvement, not just lip service.  This is my last slide for the lecture proper.

In summary and concluding, I have shared with you all the topics shown in this slide.

I hope that what I have presented will serve as a framework to which the Filipino participants can add more meat, more substance and refine and strengthen when they get tips and learn from our Canadian facilitator, Patricia Mckernan.

Likewise, I hope that what I have presented, particularly the Philippine environment and perspective, will assist the Canadian facilitator in understanding the Philippine situation and thereby making it easier for her to facilitate the workshop with Filipino participants.

On that note, I thank you for your attention.  If you want to interact with me, here are my contact information.

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