3 North York General 3 Sites: General Site – 418 Acute Care Beds Branson Site – Urgent Care, Diagnostics and ClinicsSeniors’ Health Centre – 192 Long Term Care BedsEmergency and Urgent Care Visits – 113,030Outpatient Visits – 211,652Inpatient Cases – 29,529Births – 5,865Serving 440,000 residents within North Central Toronto and Southern York Region$315M Annual Operating Budget3,141 Staff1015 Physicians900 Volunteers
4 In The Beginning……… Risk Management: a clinically focused approach examined risks individuallyassumed that adverse events occurred resulting in financial lossesfocused on protecting the assets of the organizationprimarily REACTIVE not PROACTIVE
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 managementa continuous, proactive process that enables the organization to make strategic decisions that contribute to the achievement of the organization’s overall objectivesa process where risk management is integrated into daily activitiesa culture where risk management becomes everyone’s responsibility
15 Objectives Of ERM – cont’d Provide opportunity:for educationto collectively identify risksto reduce operational surprises and losses
16 ERM Process Identify the risks Analyze the risks Evaluate the risks Identify gaps through a gap analysisMitigate the risksMonitor & review
17 Potential Risk Example ImpactExpected ControlBUSINESS 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 SAFETYMonitoring 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 RiskLikelihood & impactInherent riskResidual risk
20 Levels Of Risk Critical Risk High Risk Moderate Risk Low Risk Certain or likely to occur with major impactNot willing to accept riskHigh RiskLikely to occur with moderate impactPossible to occur but major impactModerate RiskLikely to occur with insignificant impactUnlikely to occur with minor-moderate impactWilling to accept some riskLow RiskUnlikely or rare occurrence with minor impactWilling to accept risk
22 Gap AnalysisWhat needs to be done?Focus on:Highest riskEasy wins
23 Controls Hard Controls: Soft Controls: Policies Culture and ethics ProceduresRegulationsLawsChecks and BalancesDirect SupervisionOrganizational StructureSoft Controls:Culture and ethicsClear objectivesStrong leadershipTransparency
24 Mitigation Strategies Potential RiskSignificance/ ImpactLikeli-hood/ImpactControlActivitiesStrategies to Reduce or Eliminate the RiskTime-lineRespon-sibleIndividualManagement and staff are unaware of approved policiesConfusion aboutrelevant policyUnintentionalnon-compliancewith policyLikelyProcesses are in placeto distribute approvedpolicies to NYGHmanagement and staffTools are establishedand used to facilitatethe communication ofapproved policies(i.e. Intranet)PossibleDevelopment oftemplate tools toinclude in educationand implementationguideStandard teachingtemplateUse of “My LearningEdge” strategiesSept. 11Susan,PaulAmyAndyHighModerate
28 Revised Process Domains need to be reasonable size Timing – think of othersAccountability structure – does it work?Where and how to identify risks?
29 Current ERM Framework – 18 Domains Business RiskRisks that relate to the delivery of healthcare that include internal and external factors impacting on the operationsResource RiskRisks that relate to the resources used by the organization to accomplish its objectivesCompliance RiskRisks that originate from the requirement to comply with a regulatory framework, policies, directives or legal agreementsQuality Care And Patient Safety (7)Human Resources And Staff RelationsEnvironment, Health And SafetyInformed Consent, Care PlansConsults, ReferralsHR Planning, Competency And Staff Development, Performance Management, Labour RelationsHazardous Material Handling, Occupational Health And Safety, Infection ControlCorporate GovernanceFinancialLegal And RegulatoryStrategic Goals And Objectives, Performance Reporting, Culture, Ethics, Org Structure, Partnerships And AlliancesFunding Allocation, Planning And Budgeting, Insurance, Financial Management And Reporting, FraudMedical Staff By-laws, Legislation And Regulations, Contracts And Agreements, Credentialing And LicensingOperations And Business SupportInformation, Systems And TechnologyPoliciesQuality And Risk , Supply Chain, Health Information Management, Security, Disaster ManagementE Health Strategy, Infrastructure, Access Control, Data Integrity, User SupportClinical Policies, Administrative Policies, Internal Guidelines And External DirectivesReputation And Public ImagePhysical AssetsStandardsPublic Relations, Media Relations, Government Relations, Pt RelationsAsset Management, Capital Construction, Equipment Acquisition, Replacement And MaintenanceCCHSA Accreditation Standards, Professional Regulatory Bodies And Standards Committees
30 ERM Accountability Structure Business RiskRisks that relate to the delivery of healthcare that include internal and external factors impacting on the operationsResource RiskRisks that relate to the resources used by the organization to accomplish its objectivesCompliance RiskRisks that originate from the requirement to comply with a regulatory framework, policies, directives or legal agreementsQuality Care And Patient Safety (7)Human Resources And Staff RelationsEnvironment, Health And SafetyProgram Quality CommitteeQuality of Care CommitteeQuality Committee of the BoardHuman Resource TeamHR Committee of the BoardNew TeamCorporate GovernanceFinancialLegal And RegulatorySenior Leadership TeamGovernance Committee of the BoardFinance TeamAudit & Finance Committee of the BoardOperations And Business SupportInformation, Systems And TechnologyPoliciesIS CommitteeReputation And Public ImagePhysical AssetsStandardsCorporate Communications Team Quality Committee of the BoardIPC Committee
36 Revised Process Effective use of Domain Team: Identification of potential risksReview of current processExpert in the roomDevelopment of their own documentAccountability structure – integrate into current reporting structure
37 InternalReports from insurer – Risk Management Claims Analysis Report (RMCAR)Actual and potential medico-legal claimsIncident reporting dataPatient Experience Office dataCritical Incident ReviewsRoot Cause AnalysisFailure Mode Effects Analysis
46 Success Factors Board and Senior Team Support Technology Opportunity for corporate education and learningOpen and Transparent ProcessConsultation with StakeholdersAccountability StructurePlan for ongoing monitoring
47 Lessons Learned Allocate appropriate time Consider dividing large domainsCombine documentsProvide scriptingBe cognizant of changes in leadershipAppreciate competing prioritiesCollective wisdom - having the right people at the table
48 THANK YOU! For more information please contact: Renee Blomme