Risk Management and Safety in Health Care Organizations. DAY 3 Fadi El-Jardali, MPH, PhD November 2016

Transcription

1 Risk Management and Safety in Health Care Organizations DAY 3 Fadi El-Jardali, MPH, PhD November

2 Developing and Implementing Risk Management and Safety Plan 2

3 Why is a Risk Management Plan an essential part of quality care? Demonstrates health center s support for risk management and patient safety Provides authority and responsibility for enacting the plan Achieves consistency of purpose within the organization 3

4 Elements of a Risk Management Plan Statement of purpose Authority and responsibility for implementation Goals and objectives Scope and functions Administrative and committee structure Monitoring and improvement 4

5 Statement of Purpose The Risk Management Plan is designed to 5

6 Authority and Responsibility for Implementation The governing body empowers leadership and management teams to implement risk management strategies 6

7 Goals and Objectives Improve patient safety Prevent errors, system breakdowns, and harm Minimize clinical risks and liability losses Support regulatory, accreditation compliance Protect organization resources 7

8 Scope and Functions Risk Management spans the entire operation and most functional areas Note specific areas with a high impact on risk and safety Describe risk management functions and responsibilities 8

9 Administrative and Committee Structure Risk manager s authority and responsibility Focal point for risk/safety communications Analysis and feedback Flow of information Committee recommendations 9

10 Monitoring and Improvement Risk Management Data Number of claims, costs, adverse events Risk Management Plan Structure Process Outcome Goal and objective achievement 10

11 A Word About Measures In an environment that supports a just culture, as part of a culture of safety, event reports will increase. 11

12 Integrated Committee Structure Risk Management Quality Improvement Patient Safety Risk 12

13 Risk Management Committee Multidisciplinary Review risks and actions to prevent and control risks Reports of events and near-misses Also: Quality of care issues Safety and security 13

14 Steps to Implementation Develop written plan Educate managers, providers and staff Establish systems for communication and information flow Implement systems to support risk identification, prevention, and control 14

15 Develop the Risk Management Plan Develop risk management plan or examine an existing plan Does the plan include the elements listed above? Does the plan reflect the actual practice of your health center or clinic? 15

16 Educate About the RM Plan Risk management basics, patient safety concepts Roles of governance, management, providers, and staff Special emphasis on physicians and other providers Web site Resources: Education and Training Tools Guidance Articles Self-Assessment Questionnaires 16

17 Establish Systems for Communication and Information Flow 17

18 Implement Support Systems Risk Identification Operational assessments Event reporting system Risk Prevention Education and Training Credentialing System improvement Risk Control 18

19 Maintaining the Risk Management Plan Review on an annual basis Revise Changes in services, stakeholders, functions, linkages Program growth Evaluate indicators at least annually Report to the Board of Directors annually 19

20 20 Group work

21 Measuring Success... Establishing outcome measures 1. Must be specific and quantifiable with defined numerators, denominators and thresholds 2. Set realistic thresholds for acceptable performance levels 3. Define the sampling strategy and the timeframe for the measurement 4. Whenever possible, measure the effectiveness of your actions, not the steps in the process related to the action 21

22 Example of Strategic Objectives related to OHS To decrease work-related injuries by 25 per cent next year. Reduce turnover and absenteeism to no more than 15% annually. Decrease acute low-back injuries by 20% next year Decrease lost time injuries by 10% Increase % cases where remedial action was taken within the defined time frame Increase the response time ( to 24 hours) to hazard alert reporting 22

23 Measures, Indicators, Targets Measures (The What ) Quantitative or qualitative attributes that must be measured in order to determine whether the expected results are being achieved (e.g. work-related injuries). Indicators ( The How ) The quantification or qualification of a performance measure (e.g. percentage of workers who had work-related injuries over the last year). Targets (The How Much ) Specific quantitative or qualitative goals against which actual outputs or outcomes will be compared (e.g. 5% of work-related injuries). Targets imply a desired goal that may be more ambitious than a standard. 23

24 Why a Measurement and Reporting System for OHS? Information is crucial to the operation of an effective risk management and safety management system. Data are necessary to measure the effectiveness of prevention activities and to identify problems Maintaining a system of records which demonstrates compliance with the accreditation standards 24

25 Approach for selecting indicators based on the importance of the effect or exposure: Magnitude or extent Severity (mortality or morbidity) Public perception and /or policy concern Amenability to intervention Economic impact 25

26 Phase II Find the right things to Measure Determining the right Indicators occurs in two steps: Step 1. Generate a preliminary list of possible measures and indicators Step 2. Identify the critical few indicators that will be used to measure performance in the short to medium term. 26

27 How to Determine the Critical Few Indicators q Specific - eliminates ambiguity, shows relevance q Linked - clear (cause and effect) linkages to other indicators q Reliable - scientifically and statistically sound, provides an appropriate degree of accuracy q Available data is easily accessible or there is a low level of effort to collect and analyze q Understandable data can be easily grasped by various audiences. 27

28 Phase III Build a Data Collection Strategy The aim of this Phase is to determine in a step-by-step approach what is required to report regularly on each of the indicators that has been selected. Phase III is made up of two steps: Step 1. Develop a Data Collection Strategy Step 2. Complete Data Collection Templates for Chosen Indicators. 28

29 Step 1 Develop a Data Collection Strategy For each indicator, it is important to clarify key points such as: q individuals responsible for data collection and reporting; q data source(s); q data availability; and q the timeline and resource requirements to initiate data collection. 29

30 Sample Performance Report 30

31 31 Group work

32 Safety Culture 32

33 Changing the Culture We need to expect errors to occur 100% of pilots believe they make mistakes vs. 30% of HCP s believe they make mistakes 33

34 Why should individuals or health care organizations report on Adverse Events and Errors? 34

35 You ve made a mistake Will it show? Yes Can you hide it? Yes Conceal it before anyone finds out No No Can you blame someone else, or special circumstances? Yes Bury it No Could an admission damage your career prospects? N o Get in first with your version of events 35 Problem avoided Yes Sit tight and hope the problem goes away

36 What is a culture of safety? Components of a safety culture include: Commitment to safety as the primary priority Availability of the necessary resources Incentives, and rewards for safety Openness about errors and problems Commitment to organizational learning Unity, loyalty, and teamwork among staff Non Punitive Environment 36

37 Challenges to Creating a Culture of Safety Internal Factors: Over Self-confidence of Healthcare providers Routine work/work Load Lack of resources Lack of Information about the magnitude of the problem Lack of commitment from PHC leaders Lack of effective supervision Competency of Staff 37

38 Challenges to Creating a Culture of Safety External Factors: External Environment Lack of supportive Infrastructure Community Awareness Individual behavior Culture of Fear Medico-Legal Practice 38

39 You wouldn't just decide to forget about recovering the black box after an air crash. So why should it be thought so strange to want to learn from every accident in health care." Liam Donaldson 39

40 You ve made a mistake Take ownership of the problem and assess the possible consequences Are they potentially serious? No Take corrective action and inform those affected Investigate why the mistake occurred Yes Tell someone senior immediately Co-operate fully to correct the error and review procedures Is there a flaw in the system? Yes Share your discovery and improve the process 40 No Try and learn from your mistake Problem solved

41 Always Remember Culture eats strategy for breakfast 41 41

42 CHOICES = CULTURE I know, I know. I cannot reach the top. Hey, do we have a third ladder? Hurry, Bob, the game is going to start in 10 minutes

43 A BETTER USE OF SANCTION?

44 THE THREE BEHAVIORS At-risk behavior is generally the biggest threat to system safety The amount of at-risk behavior is the key measure of safety culture

45 WE MUST UNDERSTAND WHAT WE CAN CONTROL

46 ORGANIZATIONS CAN BUILD A STRONG SAFETY CULTURE Articulating safety as an organizational value Designing systems to support safe choices Auditing (look for safety supportive choices) Being a role model (resolve dilemmas in a manner that demonstrates your commitment to safety) Mentoring (help others resolve dilemmas in the right way) Coaching (call it out when you see choices that are unsafe) Holding everyone accountable for the right choices (unresponsive to coaching, or reckless -- go home)

47 7 STEPS TO PATIENT SAFETY 1. Build a safety Culture 2. Lead and support your staff 3. Integrate your risk management activity 4. Promote reporting 5. Involve patients and the public 6. Learn and share safety lessons 7. Implement solutions to prevent harm 47 47

48 The Critical Role for Health Leaders and Managers Drive cultural change by demonstrating commitment to safety through Accreditation Leaders need to: Communicate patient safety objectives and goals Support resources and tools required to create value based organizations Provide visible commitment to data collection, measurement, reporting and sharing of information Demonstrate commitment to professional development Patient safety needs to be a strategic Priority in health organizations 48

49 "To err is human, to cover up is unforgivable, and to fail to learn is inexcusable." Liam Donaldson 49

50 Key messages in managing risk: Actions taken to mange risks should be integrated with existing planning and operational processes. Effective management of risk depends on good quality information Everyone is responsible and accountable for managing risk in their work People should be encouraged and supported in by their leaders to manage risks. There are risks to be managed in all work. 50

51 Safe healthcare organizations s is not a matter of luck. It is also not just a result of careful employees It is a matter of knowledge and good risk management and safety system 51

52 The Challenge of Ethical Responsibility If you don t measure it, you don t know whether you ve achieved it; If you don t know whether you ve achieved it; then you don t know whether you are effective; If you don t know whether you are effective, then you haven t discharged your duty; If you haven t discharged your duty, then you haven t met your ethical responsibility 52

53 53 Can You Make a Difference?

54 54

55 Thank you. Fadi El-Jardali, MPH, PhD 55