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Renee Blomme, Corporate Risk Manager April 16, 2013 Ontario Risk and Insurance Managers Society North York Generals ERM Program The Good, The Bad and The.

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Presentation on theme: "Renee Blomme, Corporate Risk Manager April 16, 2013 Ontario Risk and Insurance Managers Society North York Generals ERM Program The Good, The Bad and The."— Presentation transcript:

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

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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

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8 ENTERPRISE RISK MANAGEMENT

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

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11 Have Realistic Expectations Dont expect to boil the ocean © NYGH

12 ERM Defined Enterprise risk management is a process, effected by an entitys 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).

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14 Objectives Of ERM 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 organizations overall objectives a process where risk management is integrated into daily activities a culture where risk management becomes everyones responsibility

15 Objectives Of ERM – contd 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 RiskImpactExpected 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 1.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). Potential Risk Example

18 Evaluate the Risk Likelihood & impact Inherent risk Residual risk

19 Risk Identification & Mapping

20 Critical 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 Not willing to accept risk 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 Levels Of Risk

21 Communication Of Priorities

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

23 Controls Hard Controls: Policies 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 Likeli- hood/ Impact 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 HighModerate

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 1.Domains need to be reasonable size 2.Timing – think of others 3.Accountability structure – does it work? 4.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 GovernanceFinancialLegal 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 ImagePhysical AssetsStandards 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 Quality of Care Committee Quality Committee of the Board Corporate GovernanceFinancialLegal And Regulatory Senior Leadership Team Governance Committee of the Board Finance Team Audit & Finance Committee of the Board Senior Leadership Team Quality Committee of the Board Operations And Business Support Information, Systems And Technology Policies New Team Quality of Care Committee Quality Committee of the Board IS Committee Quality of Care Committee Quality Committee of the Board Quality of Care Committee Quality Committee of the Board Reputation And Public ImagePhysical AssetsStandards Corporate Communications Team Quality Committee of the Board New Team Quality of Care Committee Quality Committee of the Board IPC Committee Quality of Care Committee Quality Committee of the Board

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

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 1.Effective use of Domain Team: a)Identification of potential risks b)Review of current process c)Expert in the room d)Development of their own document 2.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: –http://www.oha.com/CurrentIssues/LegislativeAnalysis/Pages/Default.aspx –http://www.ontla.on.ca/web/bills/bills_current.do?locale=en –http://www.blg.com/EN/HOME/PUBLICATIONS/Pages/default.aspx –http://www.millerthomson.com/en/publications/articles/search

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

40 Results Completed all domains (22) 1 st 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 1.Literature review 2.Visits to experts 3.Review of current domains 4.How do corporate committees fit into domains?

44 What Doesnt Fit?

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

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 Renee.blomme@nygh.on.ca


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