11h - Frank R. Painter

SEGURAN AN A EM SA SA DE CURSO E OFICINA DE TRABALHO SOBRE GERENCIAMENTO DE RISCO E SEGUR
Sao Paulo - SP, Brazil Nov. 5 7, 2007
Risk Management in Healthcare

Frank R. Painter, MS, CCE
Clinical Engineering Internship Program Director University of Connecticut Healthcare Technology Consultant
Advanced Clinical Engineering Workshop - Healthcare Risk Management and Safety Sao Paulo - SP, Brazil Nov. 5 7, 2007
ACCE
American College of Clinical Engineering Professional society of Clinical Engineers
Risk Versus Safety

Safety & Risk; opposite sides of the same coin

If risk goes up, safety goes down If risk goes down, safety goes up Everyone likes safety; no one likes risk
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Risk Versus Safety
Risk management identifies risks, analyzes risk data and mitigates risk Safety programs manage that risk through education, maintenance, design, and personal protective equipment
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Understanding Safety
Safety = The level of risk you are willing to accept Safety is freedom from danger, risk or injury Safety is subjective
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Understanding Risk
Risk is the possibility of suffering harm or loss Probability of an event Severity of an event Risk = Probability x Severity Risk is measured in numbers
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Generally acceptable Acceptable considering the benefit S e v e r i t y
Risk Acceptance
Probability
Generally unacceptable
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Managing Risk
Reduce the severity
Reduce the probability
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Healthcare Risks

Medication Errors Wrong Site Surgery Hospital Acquired Infections Managing Multiple Alarms Patient Restraints Electromagnetic Interference Patient Falls Surgical & ICU Fires Electrosurgical Burns
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Managing Risk
ASSESS RISK
identify, name and categorize risks
ANALYZE
estimate the likelihood and loss of each outcome, under all alternative choices or decisions
MONITOR
monitor risk prevention activities and modify as needed
EVALUATE
compute risk exposures and determine which risks pose the greatest threat, and how they might be averted
CONTROL
take actions to avoid/minimize risks
PLAN ACTION
avoid/minimize risks
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Unusual Conditions in Hospitals Increase Risk

Functions 24 x 7 Multiple functions; patient care, cafeteria, clinical lab, laundry, etc Hospital equipment varied and complex Hazards affect healthy staff as well as severely ill & immobile patients Hazards mean fires, infections, security issues, chemicals and the like Hazards vary with equipment and applications Hazards constantly changing
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Integrated Safety (Tobey Clark) Program
Patient Safety
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Employee Safety
Risk Management
Environmental Safety
Hospital Risk Management Programs
One component of an overall quality control program Historically, treated as separate process Recently integrated into quality assurance and patient safety activities Risk managers, safety officers, quality assurance, & patient safety All integrated at some level
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Hospital Risk Management

(continued)
Risk is an exposure to the chance of injury or financial loss Risk Managers reduce liability & costs by managing risks Accident data analysis Constant systems improvements to reduce risk
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Risk Management
Insurance policies
Malpractice Liability Errors & Omissions
Claims management Risk reduction strategies Incident investigation

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Risk Management Tools

Administrative support Hazard identification Hazard evaluation Training Controls Communications Record keeping Program review & improvement Total involvement
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JCAHO
Environment of Care Standards

Safety Management Security Management Hazardous Materials & Waste Management Emergency Management Life Safety (Fire Safety) Management Medical Equipment Management Utility Systems Management Safety Committee & Safety Officer
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JCAHO
Patient Safety Standards

Annual FMEA (Failure Mode and Effect Analysis) Sentinel Events RCA (Root Cause Analysis) National Patient Safety Goals
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Clinical Engineers as Risk Managers
By definition, clinical engineers apply engineering and managerial skills to the advancement of health care. Engineering education
Scientific method (cause and effect) Analysis of systems and processes (identify root causes)
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Clinical Engineers as Risk Managers
Knowledge:
How technology works How hospitals work How the human body works How the human mind works How to investigate an accident How to work with people How to write technical reports
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Engineering & Risk Reduction
Contributions to risk reduction and patient safety:

Medical equipment planning Medical equipment inspection Medical equipment maintenance Training medical equipment users
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Engineering & Risk Reduction

Management of recalls & hazard alerts Analysis of maintenance records Review of near miss events Incident investigation User Training Quality Improvement
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Systems Approach to Reducing Medical Device Risk

Assure safety of systems & processes Modify systems & processes as recommended by the team Investigate failures
Identify root causes Modify the systems to prevent future failures Benefit from past failures
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Manufacturers

Know their devices Use FMEA in design Use human factors engineering and usability testing in design Keep a complaint file Listen to feedback and improve the design
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Healthcare Workers
Device training
How it works What can go wrong What happens when it goes wrong
Report problems without fear of punishment or ridicule. Competency assessment

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Patients and Family

Device Training
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Clinical Engineers

Device Training Service and inspection Investigate problems Provide feedback to healthcare workers Advise administration
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Administration

Know devices in general

Costs, risks, supplies, maintenance
Support training and improvement Support non-punitive problem reporting Provide record keeping Share information Have a plan
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Government

Regulate medical device quality Create systems to share information Facilitate open communications Publicize trends Encourage quality healthcare systems Acknowledge good performance
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Risk Management Summary
Safety must begin at the top---Ministry of Health, Local Health Authorities , and hospital administrators---but must be implemented by motivated staff members Risk management must be fully integrated into our health care culture, systems and processes
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Risk Management Summary (continued)
Investigation of accidents, incidents and near hits can provide information that will allow improvements in systems and processes Clinical Engineers are valuable team members
Educated, trained and experienced in accident investigation, they can provide the identification of the root causes of failed systems
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perguntas
&
comentrios
36

11h - Frank R. Painter

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SEGURAN AN A EM SA SA DE CURSO E OFICINA DE TRABALHO SOBRE GERENCIAMENTO DE RISCO E SEGUR

Sao Paulo - SP, Brazil Nov. 5 7, 2007

Risk Management in Healthcare

American College of Clinical Engineering Professional society of Clinical Engineers

Risk Versus Safety

Risk Versus Safety

Generally acceptable Acceptable considering the benefit S e v e r i t y

Reduce the severity

Reduce the probability

Unusual Conditions in Hospitals Increase Risk

Integrated Safety (Tobey Clark) Program

Hospital Risk Management Programs

Hospital Risk Management

Claims management Risk reduction strategies Incident investigation

Risk Management Tools

Environment of Care Standards

Patient Safety Standards

Clinical Engineers as Risk Managers

Clinical Engineers as Risk Managers

Engineering & Risk Reduction

Contributions to risk reduction and patient safety:

Engineering & Risk Reduction

Systems Approach to Reducing Medical Device Risk

Report problems without fear of punishment or ridicule. Competency assessment

Patients and Family

Know devices in general

Risk Management Summary

Risk Management Summary (continued)

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