Risk Management and Quality Management Techniques - Case Study Example

? Case Study Analysis First al Affiliation The satisfaction of a patient with the Emergency Department (ED) in a local hospital depends on the amount of time spent waiting for the medical treatments. Excessive waiting in the overcrowded ED can decrease the efficiency, quality and staff performance which in turn decreases the hospital’s profitability. In this case study we analyse the local hospital's initiatives by applying quality and risk management concepts, measures, and tools. In case of risk management planning they decided to embark on a nine months plan to measure, analyse and improve the quality of patient care for the ED. A Top 10 Risk Item Tracking tool can be applied for maintaining an awareness of the risks involved. The emergency department can rely on the ideas, intuitive feelings and past expert experience of the staff to help identify potential risks. They can perform quantitative risk analysis by using the technique called Monte Carlo analysis. We must keep up with certain quality standards by the help of quality management to ensure that the new services will completely satisfy the needs of each patient efficiently. Incorporating these quality standards into the hospital’s new policies and procedures is very important. Keywords: excessive waiting, risk management, quality management, risk analysis, Monte Carlo analysis, quality standards, Top 10 Risk Item Tracking tool, Patient’s satisfaction. The Hospital Administrator, Physician Director of Emergency Department, Director of Hospital Performance Improvement held a meeting to review and identify the disturbing trends being faced by the patients as well as the staff of the Emergency Department. To achieve the goals of Risk Management they had to minimize the potential risks like “patient elopement” or “patient falling”, while maximizing potential opportunities like minimum wait time, patient satisfaction with services delivered and timeliness of initiation of patient care. In case of risk management planning they decided to embark on a nine months plan to measure, analyse and improve the quality of patient care for the ED. The main processes included were risk identification, which was carried out by determining and documenting which risks were likely to affect the performance improvement plan (PMBOK, 237). Qualitative risk analysis as well as quantitative risk analysis that included measuring the probability and consequences of risks. Risk response planning and risk monitoring and control which involved monitoring known risks, identifying new risks, reducing risks, and evaluating the effectiveness of risk reduction (PMBOK, 237). The main output of risk management planning is a risk management plan. The ED team should review documents and understand the hospital’s and any sponsor’s approach to risk. The ED team will always have trained staff that will recognize and handle time sensitive conditions as part of their contingency plan. For example, the greeter will always escort chest pain or stroke patients to triage nurse as part of their predefined emergency actions (Power, D.J, Gannon, M. et al., 1986). There can be three kinds of risks in this case study: 1. Market risk: Will the new changes be useful to the hospital’s ED or serviceable to the patients? Will the patients accept and use the services? 2. Financial risk: Can the hospital afford to undertake these changes? Are these changes the best way to use the hospital’s financial resources? 3. Technology risk: Are these services technically feasible? Could the technology be obsolete before the end of the 9 months plan? (Maps of World Finance) There are several risk identification tools and techniques that can be used for identifying potential unsatisfactory outcomes. These tools and techniques are: -Brainstorming -Interviewing -The Delphi technique -SWOT (Strength, Weaknesses, Opportunities, Threats) analysis (Schwalbe K., 2005) A Top 10 Risk Item Tracking tool can be applied for maintaining an awareness of the risks involved. The list of top 10 risk items can be monitored over the 9 months trial which compares a risk item’s current ranking, previous ranking, the number of times the risk appears on the list over a period of time, and a summary of the progress made in resolving that risk item. (Schwalbe K., 2005) Table 1 Top 10 Risk Item Tracking tool for a 9 month trial risk assessment Monthly Ranking Risk Item This Month Last Month Number of Months Risk Resolution Progress Excessive waiting time 1 2 4 Hire a greeter to establish contact with every patient Patient falling 2 3 3 Move triage to waiting area to identify seriously ill patients Delayed services 3 1 2 Re-organized functions of staff Hired additional staff Poor quality of care 4 4 3 Performance based incentives Patient elopement 5 5 3 Revising schedule estimates The emergency department can rely on the ideas, intuitive feelings and past expert experience of the staff to help identify potential risks. They can help categorize risks as high, medium, or low. They can use better tools from other performance improvement organisations. They can perform quantitative risk analysis by using the technique called Monte Carlo analysis that involves determining the impact of the identified risks by running simulations to identify the range of possible outcomes for a number of scenarios. (Kwak Y. H., Ingall L., 2007) Table 2 Monte Carlo analysis to identify the impact of the identified risks Tasks Best-case estimate Most likely estimate Worst-case estimate New policies and procedures 4 months 6 months 8 months Re-organized functions of staff 5 months 7 months 9 months Hired additional staff 6 months 7 months 9 months Performance based incentives 6 months 5 months 9 months Total duration 6 months 7 months 9 months After identifying and quantifying risks, we can decide how to respond to them by using any of these 4 strategies: Risk avoidance, Risk acceptance, Risk transference or Risk mitigation. Controlling risks involves carrying out the risk management plans as risks occur. Risk monitoring and control are the corrective actions wisely taken by the ED team. We can even employ a database system to keep track of these risks. If they successfully execute new policies and procedures after the 9 months trial period then we must keep up with certain quality standards by the help of quality management to ensure that the new services will completely satisfy the needs of each patient efficiently. Quality management involves establishing effective relationships with the patients to meet their stated and implied needs, as mentioned in Rose, Kenneth H. (2005). This can be done by surveys, questionnaires, reviews, etc. Quality management consists of Quality Planning, Quality Assurance and Quality Control. Incorporating these quality standards into the hospital’s new policies and procedures is very important. Following Litten David (2010), we can use Pareto Chart as a quality control tool to identify the vital few contributors that account for most of the quality problems. It is sometimes also referred to as the 80-20 rule (80 % of problems due to 20% of causes). Discussion Summarizing, risk management and quality management techniques help enhance the ED’s efficiency, increases quality of care and therefore increases the hospital’s profitability. The main output of risk management planning is a risk management plan. The ED team should review documents and understand the hospital’s and any sponsor’s approach to risk. If they successfully execute the new policies and procedures after the 9 months trial period then we must keep up with certain quality standards by the help of quality management to ensure that the new services will completely satisfy the needs of each patient efficiently. References Project Management Institute (2008) A Guide to the Project Management Body of Knowledge, edition 4 Project Management Institute, 237. Project Management Institute (2008) A Guide to the Project Management Body of Knowledge, edition 4 Project Management Institute, 242. Power, D. J., Gannon, M., McGinnis, M. and Schweiger, D., (1986) Strategic Management Skills, Reading, MA: Addison-Wesley, What is contingency planning? Retrieved from http://planningskills.com/askdan/6.php Maps of World Finance Types of Risk Management. Retrieved from http://finance.mapsofworld.com/risk-management/types/ ISO/DIS 31000 (2009). Risk management — Principles and guidelines on implementation. International Organization for Standardization. Retrieved from http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=43170. Schwalbe K., (2005) Information Technology Project Management, Chapter 11: Project Risk Management (5th ed) Jonathan Hulbert Kwak Y. H., Ingall L. (2007) Exploring Monte Carlo Simulation Applications for Project Management. Risk Management, 9, 44–57 Rose, Kenneth H. (2005). Project Quality Management: Why, What and How. Fort Lauderdale, Florida: J. Ross Publishing. 41. Retrieved from http://books.google.com/?id=b5F08Z0QRosC&pg=PA41&dq=Quality+management+quality+planning+quality+control#v=onepage&q=Quality%20management%20quality%20planning%20quality%20control&f=false. Litten David (2010) Project Risk and Risk Management, Retrieved May 16, 2010 Retrieved from http://en.wikipedia.org/wiki/Pareto_analysis Read More