1. North York General’s ERM Program The Good, The Bad and The Ugly
Renee Blomme, Corporate Risk Manager
April 16, 2013
Ontario Risk and Insurance Managers Society

3. North York General 3 Sites: General Site – 418 Acute Care Beds
Branson Site – Urgent Care, Diagnostics and Clinics
Seniors’ Health Centre – 192 Long Term Care Beds
Emergency and Urgent Care Visits – 113,030
Outpatient Visits – 211,652
Inpatient Cases – 29,529
Births – 5,865
Serving 440,000 residents within North Central Toronto and Southern York Region
$315M Annual Operating Budget
3,141 Staff
1015 Physicians
900 Volunteers

4. In The Beginning……… Risk Management: a clinically focused approach
examined risks individually
assumed that adverse events occurred resulting in financial losses
focused on protecting the assets of the organization
primarily REACTIVE not PROACTIVE

5. What Did This Result In?

6. My “Ah-Hah” Moment 

8. ENTERPRISE RISK MANAGEMENT

9. Next Steps Reading Consultation Telephone calls Meetings
Educational sessions
Heated discussions

11. Have Realistic Expectations
Don’t expect to
boil the ocean
© NYGH

12. ERM Defined
“Enterprise risk management is a process, effected by an entity’s board of directors, management and other personnel, applied in strategy setting and across the enterprise, designed to identify potential events that may affect the entity, and manage risk to be within its risk appetite, to provide reasonable assurance regarding the achievement of entity objectives”
(Committee of Sponsoring Organizations of the Treadway Commission, 2004, p. 8).

14. Objectives Of ERM an interdisciplinary approach to risk management
To develop and implement:
an interdisciplinary approach to risk management
a continuous, proactive process that enables the organization to make strategic decisions that contribute to the achievement of the organization’s overall objectives
a process where risk management is integrated into daily activities
a culture where risk management becomes everyone’s responsibility

15. Objectives Of ERM – cont’d
Provide opportunity:
for education
to collectively identify risks
to reduce operational surprises and losses

16. ERM Process Identify the risks Analyze the risks Evaluate the risks
Identify gaps through a gap analysis
Mitigate the risks
Monitor & review

17. Potential Risk Example
Impact
Expected Control
BUSINESS RISK – Risks that may relate to the delivery of health care that include internal & external factors impacting on the operations of the department.
QUALITY CARE & PATIENT SAFETY
Monitoring the quality of service is not being performed on a consistent basis.
Opportunities to improve and achieve the best possible outcomes may be missed.
The quality of services is reviewed by selecting/monitoring indicators, collecting/analyzing data, identifying areas to improve and sharing the evaluation results with primary stakeholders (CCHSA Acute Care Services Standard 3.1).
Clients, families and other organizations are involved in the evaluation of services (CCHSA Acute Care Services Standard 3.2).
A process to solicit feedback from clients exists (i.e. complaints, satisfaction surveys, and focus groups) (CCHSA Acute Care Services Standard 3.2).
Service improvements are made on the basis of service outcomes (CCHSA Acute Care Services Standard 3.3).

18. Evaluate the Risk
Likelihood & impact
Inherent risk
Residual risk

19. Risk Identification & Mapping

20. Levels Of Risk Critical Risk High Risk Moderate Risk Low Risk
Certain or likely to occur with major impact
Not willing to accept risk
High Risk
Likely to occur with moderate impact
Possible to occur but major impact
Moderate Risk
Likely to occur with insignificant impact
Unlikely to occur with minor-moderate impact
Willing to accept some risk
Low Risk
Unlikely or rare occurrence with minor impact
Willing to accept risk

21. Communication Of Priorities

22. Gap Analysis
What needs to be done?
Focus on:
Highest risk
Easy wins

23. Controls Hard Controls: Soft Controls: Policies Culture and ethics
Procedures
Regulations
Laws
Checks and Balances
Direct Supervision
Organizational Structure
Soft Controls:
Culture and ethics
Clear objectives
Strong leadership
Transparency

24. Mitigation Strategies
Potential Risk
Significance/ Impact
Likeli-
hood/
Impact
Control
Activities
Strategies to Reduce or Eliminate the Risk
Time-
line
Respon-
sible
Individual
Management and staff are unaware of approved policies
Confusion about
relevant policy
Unintentional
non-compliance
with policy
Likely
Processes are in place
to distribute approved
policies to NYGH
management and staff
Tools are established
and used to facilitate
the communication of
approved policies
(i.e. Intranet)
Possible
Development of
template tools to
include in education
and implementation
guide
Standard teaching
template
Use of “My Learning
Edge” strategies
Sept. 11
Susan,
Paul
Amy
Andy
High
Moderate

25. Corporate Risk Manager

26. Results Completed all domains (12)
Board Updates – last minute scramble
Many action items identified
Minimal ROI
Identification of frequency of leadership turnover
Decision to start again

27. How To Get Started – The Second Time

28. Revised Process Domains need to be reasonable size
Timing – think of others
Accountability structure – does it work?
Where and how to identify risks?

29. Current ERM Framework – 18 Domains
Business Risk
Risks that relate to the delivery of healthcare that include internal and external factors impacting on the operations
Resource Risk
Risks that relate to the resources used by the organization to accomplish its objectives
Compliance Risk
Risks that originate from the requirement to comply with a regulatory framework, policies, directives or legal agreements
Quality Care And Patient Safety (7)
Human Resources And Staff Relations
Environment, Health And Safety
Informed Consent, Care Plans
Consults, Referrals
HR Planning, Competency And Staff Development, Performance Management, Labour Relations
Hazardous Material Handling, Occupational Health And Safety, Infection Control
Corporate Governance
Financial
Legal And Regulatory
Strategic Goals And Objectives, Performance Reporting, Culture, Ethics, Org Structure, Partnerships And Alliances
Funding Allocation, Planning And Budgeting, Insurance, Financial Management And Reporting, Fraud
Medical Staff By-laws, Legislation And Regulations, Contracts And Agreements, Credentialing And Licensing
Operations And Business Support
Information, Systems And Technology
Policies
Quality And Risk , Supply Chain, Health Information Management, Security, Disaster Management
E Health Strategy, Infrastructure, Access Control, Data Integrity, User Support
Clinical Policies, Administrative Policies, Internal Guidelines And External Directives
Reputation And Public Image
Physical Assets
Standards
Public Relations, Media Relations, Government Relations, Pt Relations
Asset Management, Capital Construction, Equipment Acquisition, Replacement And Maintenance
CCHSA Accreditation Standards, Professional Regulatory Bodies And Standards Committees

30. ERM Accountability Structure
Business Risk
Risks that relate to the delivery of healthcare that include internal and external factors impacting on the operations
Resource Risk
Risks that relate to the resources used by the organization to accomplish its objectives
Compliance Risk
Risks that originate from the requirement to comply with a regulatory framework, policies, directives or legal agreements
Quality Care And Patient Safety (7)
Human Resources And Staff Relations
Environment, Health And Safety
Program Quality Committee
Quality of Care Committee
Quality Committee of the Board
Human Resource Team
HR Committee of the Board
New Team
Corporate Governance
Financial
Legal And Regulatory
Senior Leadership Team
Governance Committee of the Board
Finance Team
Audit & Finance Committee of the Board
Operations And Business Support
Information, Systems And Technology
Policies
IS Committee
Reputation And Public Image
Physical Assets
Standards
Corporate Communications Team Quality Committee of the Board
IPC Committee

31. Corporate Governance Quality Care & Patient Safety HR & Staff
Relations
Operations &
Business Support
Finance
SLIP
Accreditation
CIRP
ERM
Information,
Systems &
Technology
Reputation &
Public Image
Hazard
Alerts
RCA
FMEA
Physical
Assets
Environmental,
Health & Safety
Legal &
Regulatory
Standards
Policies

32. Corporate Risk Manager

33. Results Completed all domains (18) Frequent Board Updates
Many action items identified
Decision to start again

34. How To Get Started – The Third Time

35. THINK AHEAD
with the end in mind.
© NYGH

36. Revised Process Effective use of Domain Team:
Identification of potential risks
Review of current process
Expert in the room
Development of their own document
Accountability structure – integrate into current reporting structure

37. Internal
Reports from insurer – Risk Management Claims Analysis Report (RMCAR)
Actual and potential medico-legal claims
Incident reporting data
Patient Experience Office data
Critical Incident Reviews
Root Cause Analysis
Failure Mode Effects Analysis

38. External Listserves Coroner Reports Hazard Alert & Product Recalls
Legislative Updates:

39. Most Important Resource…
What Keeps You Up At Night?

40. Results Completed all domains (22)
1st time Communication of Priorities enacted
Board Updates – combined with Program Reports
Many action items identified
Physician engagement
Capacity building

41. However……..

42. Process Under Construction

43. Revised Process Literature review Visits to experts
Review of current domains
How do corporate committees fit into domains?

44. What Doesn’t Fit?

45. Build The Infrastructure
Facilitation Expertise
Technology
Ongoing
Evaluation
Attitude
Senior Level
Support
Realistic
Expectations
Commitment from
Domain Owner
© NYGH 45

46. Success Factors Board and Senior Team Support Technology
Opportunity for corporate education and learning
Open and Transparent Process
Consultation with Stakeholders
Accountability Structure
Plan for ongoing monitoring

47. Lessons Learned Allocate appropriate time
Consider dividing large domains
Combine documents
Provide scripting
Be cognizant of changes in leadership
Appreciate competing priorities
Collective wisdom - having the right people at the table

48. THANK YOU! For more information please contact: Renee Blomme