Risk Management in Large Hospitals - Research Paper Example

Risk Management in Large Hospitals Increased mortality rates are the result of unsafe health practices inmany hospitals worldwide. Research studies show that many patients die because of poor health care systems or due to negligence of health care providers. Health care methods in medical institutions are now regarded to be crucial as statistics reveals that poor health care systems cause more deaths annually than the many dreaded diseases, AIDS and breast cancer. Approximately, 2.9% to 16.6% of hospitalized patients suffer from above complications and 5% to 13% succumb and die. Experts estimate that a half of the complications that occur in health care provision can be prevented. Critical evaluation and analysis of health management systems would show that the most systems are wanting. Lack of proper management of patients is directly correlated to deficient health care systems. The main aim of conducting this research paper is to study the design and implement proper risk management systems in large hospitals that are based on internationally accepted standards and WHO’s (World health Organization) patient’s security framework (Adibi et al, 2012). Methodology Worldwide reports on patient safety will be evaluated as well as WHO’s guidelines In order to establish a sound risk management system. Attainment of the study’s goal, questionnaires will be used to gather data. The proposed risk management system will then be submitted to a panel of experts where it will be further discussed and later on be approved. The panel will constitute of professionals who have a wealth of experience in risk management, patient safety and other related issues. The task of the committee will be defining a good information system, upgrading of infrastructure and planning education campaigns to enlighten health practitioners on patient safety. The exercise will be value and commitment based. Two approaches, reactive and proactive will be used. This research will be based on a case study of a large hospital in Iran. The health institution will be assessed to determine its inherent limitations. Results of findings will later be discussed (Adibi et al., 2012). Risk Management System Risk management system in the context of health care can be defined as the steps taken clinically as well as administratively to minimize risks of patient, staff and visitor injuries. The definition also includes mitigating any loss to the health facility or institution as a whole. The risk management process and practice have been developed in a way that it involves seven steps i.e. identification, evaluation, analysis, treatment of risks, review and monitoring, communication and lastly consultation. It is of paramount importance that health institutions worldwide have this management system in place (Adibi et al., 2012). Overview of Risk Management Framework A risk management system need be developed in accordance to the laid guidelines by WHO regarding patient safety programs. The system in this case study was designed after a thorough review of various patient safety reports in different nations. The hospital with university facilities and a bed capacity of 600 was evaluated by use of questionnaires, interviews with the staff and observation of wards and divisions. With the conceptual framework of the risk management system in place, a committee panel comprising of senior management of the hospital, supervising nurses and faculty staff were tasked to validate the framework. Selection of committee members was on the basis of their roles and level of experience in risk management and patient safety. A questionnaire was drawn up to gather expert opinions concerning validation of the model. The contents of the questionnaire were approved by experts, and its alpha level as per Cronbach’s coefficient equaled 0.76.The level of the coefficient indicates the confidence level to be placed on the questionnaire (Adibi et al., 2012). The risk management program involved choosing a leader, a coordinator, redefining communications with hospital committees, process definition, improving infrastructure for patient safety and culture-building. The program also had proactive and reactive methods, not forgetting unfavorable event reporting, the chief cause, and failure and effect analysis. The figure below demonstrates the above risk management process diagrammatically. Figure A: Risk management system Values and commitment system Four principles are the core to a risk management system. The principles are: maintenance of patient safety, learning from mistakes and events, confidentiality and provision of feedback to health care team. The mandate of management of health facilities should be to recruit competent and qualified staff and to provide the necessary resources to sustain patient safety program. Feedback reports would be sent through advertisements in safety boards, safety alerts and enlightenment of target group on possible solutions. Several challenges were noted in providing feedback. The key challenge was how to disseminate information without losing its confidentiality or causing blame shifts amongst team members. Work overload and high level of documentation tasks were other barriers to effective listening of security alerts. It was recommended that staff be equipped with safety walk rounds as a measure to overcome the above challenge and to increase faster responsiveness to security alerts (Adibi et al., 2012). Education and Culture-building Special emphasis was laid on the different methods of training available. Workshops, continuous professional education and conferences, are such examples. Frequent visits by health personnel to other medical institutions for purposes of auditing risk management systems would be another way of learning. Magazines, brochures and pamphlet circulation to staff on current issues in patient safety are other important educational tools. The primary objective was to educate all health care workers to define the underlying principles and concepts of risk management system, its associated values and the value of culture-building program. However, despite numerous efforts in planning, support of staff was poor. This may have been due to lots of work or poor organizational culture. Recommendations to senior management level of the hospital were to incorporate patient safety education into work programs of the team and to consider participation in such programs as a basis of performance appraisal (Adibi et al., 2012). Reactive Approach In this research, a voluntary system of reporting was established in the hospital. The reporting system, unfavorable event reporting, was conducted in two ways. The first way was to report such incidents using forms. Alternatively, the event was recorded in a patient safety log alongside the likely consequences of the incident. Further, delicate and critical issues were to be reported to patient’s safety department and clinical governance by the head nurse which later would be followed up closely. The filed reports would then be ranked according to priorities and intervention measures are undertaken either through personal interviews with the affected or by reviewing and inspecting of records. After in-depth analysis of the incident, strategies to counteract inherent deficiencies would be proposed. Actively reporting would be possible if and only if, the management would issue each team radio devices to promote a culture of reporting. Finally, a cause analysis (RCA) was conducted followed by appropriate action. Members of RCA group comprised of nursing staff, clinical health care teams, patient safety workers and managers of the hospital. CA of frequently reported incidents was carried out regularly with the intent of unmasking human, organizational or any technical factors creating the systems failure. The ultimate goal of RCA was to obtain necessary and sufficient information to facilitate redesign of the system to reduce future likelihoods of patient injuries. The main setbacks to this approach were: limitation of resources, high turnover rate for medical staff, and resistance of hospital management amongst others. The degree of staff participation across different wards varied depending on the work load, attitude and cultural issues in the wards. Possible solution to these challenges is to introduce patient safety issues in the school curriculum of health students (Adibi et al., 2012). Proactive Approach The above approach was a technique whose main purpose was to establish potential errors in service delivery, in health care institutions. It attempts to identify all possible sources of errors using different methods. In the exercise, several interactions and functionalities of health care facilities were ranked according to their value. Systematic study was then conducted to identify causes of failure, their impacts and later the contributory factors. Members of this group were tasked with predicting errors and controlling the effects of such errors. This strategy is thus an ongoing process necessary for quality improvement. Implementation of this group in each ward is fundamental to the success of risk management of a hospital. Results Number of patients Maternity wards Male wards Surgical wards Intensive care unit wards total Wrong blood fusion 3 21 9 37 70 Risky transport of patients 4 10 1 6 21 Falling accidents 4 24 8 0 36 Bedridden in hospital 131 503 245 66 945 The above are the findings of the above research. The results, however, represents roughly 3.6% incident rate of the hospitalized patients. Due to low reporting, the reported events do not form a good sample to represent the general population. Analyzing reported events, only 0.2% of such cases eventually led to the death of patients. A survey on the patient survey culture in the hospital above was considerably low (46.2%).An additional 44.3% of health workers rated the hospital safety performance program to be very good. However, 57% of the target group failed to report on any events (Adibi et al., 2012). Discussion Health facilities organizations ideally and in practice ought to create a suitable environment for not only it patients but staff, as well. Studies show that the risk management is the foundation for patient safety in hospitals as well as minimizing medical errors. Perception, attitudes and culture in respect of risk management in hospitals differ from one locality to another. Thus, clinical governance policies and programs should be the basis of patient safety culture. Various measures and strategies maybe setup to improve such a culture. Training of health staff will have a tremendous effect on patient safety improvement. Senior management level has a major role in the achievement of the set targets. The program’s success is dependent on the managers’ direct involvement and commitment in risk management systems (Adibi et al., 2012). Poor organizational culture is the cause of low staff participation in adverse event reporting and analysis. Health staff due to fear of blame oft fail to document and consequently report on incidents that concern patient safety. Another reason for staff non-participation in reporting is fear of submitting irrelevant data or information. Structures and policies should be put in place by management to encourage active participation of all the staff in patient safety improvement. The policies should be such that they will overcome fear of blame among staff and lack of confidentiality. Walk rounds have also proved to be an instrumental tool in hospitals’ risk management. They help educate the staff on patient safety and oft bring about organizational change. However, implementation of the devices requires a strong will from the management of the health facility (Adibi et al., 2012). Great importance should be placed on risk management systems in the medical subdivision as well as health institutions in order to improve the quality of service delivery to patients. Top management levels of hospitals should invest heavily in terms of human and financial resources, effective leadership styles and a strong value based system. A special committee should be setup if possible to monitor the performance of the program periodically and provide reports to the management. The report should give details of strengths and weaknesses of the current risk management system in the organization. The committee will also be responsible in coming up with possible solutions to overcome the limitations of the existing risk management system. Other measures such as rewarding staff for exemplary and active performance in patient safety programs will go a long way in encouraging other staff to follow suit. In conclusion, a fruitful risk management system will majorly be based on education, its systems and affirmative culture progression in a hospital. Reference Adibi Hossein, Khalesi Nader, Ravaghi Hamid, Jafari Mahdi & Jeddian Ali. Development of an effective risk management system in a teaching hospital.2012: pg 1-7 Read More