Dear Colleagues, I would like to share this Topic (RISK MANAGEMENT) with you.. I have presented in one of the Khartoum congresses few years ago. It may be of value for some of you mainly those taking their second part exam or those providing save women health services

1. Risk Management Awareness Raising Dr.Ahmed Eltigani Elmahdi Hussain Consultant Obstetrician&Gynaecologist Cavan General Hospital, IRELAND

4. Risk Managent – Definitions …The culture, processes and structures that are directed towards the effective management of potential opportunities and adverse events Source: AS/NZS 4360 :1999 R M Standard …The process wherebye an organisation anticipates the potential for injuries or losses and acts to avoid those injuries before and/or to ameliorate them after they occur Source: R M in Health Care – Dr. G. Roberts

5. Risk Management - Process …The systemic appllication of management policies, procedures and practices to the task of establishing the context, identifying, analysing, evaluating, treating, monitoring and communicating risk Source: AS/NZS 4360 : 1999 R M tandard

17. Clinical care The environment of care Financial resources CLINICAL GOVERNANCE ORGANISATIONAL CONTROLS FINANCIAL CONTROLS Health & Safety Human Resources Integrated Care Due Diligence Risk Strategy Quality Reviews Risk Reviews Clinical Audit Practice Developments Claims Management Education & training Performance Management Re-engineering of Systems Service Continuity Planning Healthcare Risk Management

19. Establish Context Identify Risks Analyse Risks Treat Risks MON I TOR Evaluate Risks The Context – The Risk Management Process AS/NZS 4360:1999 Risk Management Standard COMMUNI CATE

20. Stop it Accident Incident Investigation Task Person Discipline them Past Approach: Person centred investigations Situation ??????

22. Defence Barriers J. Reason 1994 Case Analysis Using Reason’s Statistical failures in defences Organisational Accident Causation Model

23. J. Reason 1994 Case Analysis Using Reason’s Organisational Accident Causation Model Statistical failures in defences Situation Task Errors Violations Corporate Culture Management decisions and organisational processes Local climate Error- producing conditions Violation- producing conditions Defence Barriers Latent failures in defences

24. Focus on process not individual “ People and perfect processes make a quality health service. Poor quality results from a badly designed and operated process, not from lazy or incompetent health care workers” Source: John Øvretviet, 1992 Health Service Quality

25. And Risk Management involves….. (AS/NZS 4360 and HSA “Workplace Health & Safety Management” ) IMPLEMENT MONITOR & REVIEW PLAN POLICY

26. And Risk Management involves….. (AS/NZS 4360, Chapter 2) IMPLEMENT MONITOR & REVIEW PLAN POLICY Objectives “ Criteria” Safety Statement RM Policy

31. Identifying Hazards and Risks “ Comprehensive identification using a well-structured systematic process is critical” It is important to identify both things that have happened (retrospective identification) and those that might (prospective identification)

33. Assessing Risks “ To avoid subjective bias, the best available information sources and techniques should be used when analysing consequences and likelihood .”

34. Measuring Risk A B Likelihood Consequences

36. Rating the Severity * Based on national comparisons In accordance with AS/NZS 4360:1999 Risk Management Standard Category Severity Quality & Prof. Guidelines Finance & Info . Fear, disempowerment & conflict of interest Safety (staff, patients/clients & NEHB population) Reputation/ Community Expectation (& Equity) Legal Requirements (and Equality) Low Minor non-compliance < €5K Minor loss of info. Minor cuts/ bruises Within unit Local press < 1 day coverage Minor out-of- court settlement. Minor legislative breach, no consequences Minor Single failure to meet internal standards or follow protocol € 5K - €25K Claim below excess Verbal representation from minority groups. Concerns expressed by staff in 1 area/Dept . Cuts/ bruises < 3 days absence < 3 days extended hospital stay Emotional distress Regulator concern Local press < 7 day of coverage Civil action Improvement Direction. Moderate Repeated failures to meet internal standards or follow protocols € 25K - €1M Loss of or unauthorised access to confidential information Sustained campaign by minority group(s). Consistent indication of fear/concern across 1 or more sites Single system injury e.g. fracture, > 3 days absence, 3-8 days extended hospital stay HSA reportable Semi-permanent physical/emotional trauma Regional/ National media < 3 day coverage Department notification/ executive action Class action – no defence Criminal prosecution Improvement Notice Severe Failure to meet national norms*/stds. Repeated failure to meet professional std. € 1M - €5M Loss or corruption of key clinical information Judicial review finds conflict of interest. Collapse of management relations across Hosp. Group. Increased sickness absence/resignations >9 days extended hospital stay Fatality Permanent physical/emotional disability/trauma National media > 3 day of coverage Questions in the D áil . Independent external enquiry Criminal prosecution - no defence. Executive officer fined or imprisoned. Prohibition Notice . Catastrophic Gross failure to meet professional standards > €5M Multiple Fatalities Multiple permanent physical/emotional injuries/trauma Full Public Enquiry Prohibition Notice Widespread culture of bullying.

38. Risk Rating Matrix Catastrophic Severe Moderate Minor Low 5 4 3 2 1 Rare 10 8 6 4 2 Unlikely 15 12 9 6 3 Possible 20 16 12 8 4 Likely 25 20 15 10 5 Almost Certain Likelihood Severity

39. Recording the Outcome of the Assessment (The Risk Register) Having completed the assessment of risk, the outcome is entered onto a risk register. The risk register then becomes a summary of all known hazards/risks and is used to decide priorities for actions to control hazards/risks and to monitor the progress of those actions.

40. The Risk Register

41. Risk Control Options Eliminate Accept Transfer Reduce

42. Reducing Risk Likelihood Severity Risk Prevention Risk Mitigation

44. Making it Happen “ The responsibility, authority and the inter-relationship of personnel who perform and verify work affecting risk management shall be defined and documented”

45. A Plan not a Strategy? IMPLEMENT MONITOR PLAN POLICY Local Risk Assessments Feedback on risks Prioritise resources/responses Training Actions Responsibility Results of risk assessments Incident Reporting Claims Complaints Audits/Inspections Sickness Absence

47. C0NCLUSION Blame culture “ We don’t make mistakes” culture “ So what” culture Silo or “tribal” culture “ not my business” culture Support don’t blame We all make mistakes Feedback & meaning Team culture It is everyone’s business