By Kopiha Nathan and Ellen Gardner

Management of healthcare risks is a key function of healthcare organizations, but it is also one many struggle with. Risks often are managed independently as a patchwork of activities within horizontal or vertical silos. As a result, some risks receive attention and resources while other, often more important risks, go unacknowledged.

In its observation of patient safety incidents through medical-legal claims, HIROC (the Healthcare Insurance Reciprocal of Canada) sees the consequences of ineffective management of risks. These range from single adverse events to catastrophic multi-patient events. Integrated Risk Management (IRM) has been identified in Accreditation Canada’s Leadership and Governance standards as an important requirement in monitoring and improving quality and safety in healthcare.

A program to accelerate adoption of IRM

In response to requests from healthcare organizations for assistance with the implementation of IRM, HIROC brought together an IRM Steering Committee with national representation from acute and community/home health sectors. The aim of this Committee was to standardize and simplify the implementation of IRM and to provide a shared platform to track and manage key organizational risks.

The rationale behind the concerted effort to develop an IRM system is highlighted by the tragic case of the Mid Staffordshire NHS Foundation Trust in England, where it was determined that hundreds of patients needlessly died as a result of board and leadership’s focus on reaching targets and financial outcomes at the expense of delivering acceptable care.

Working with technology partner Datix, HIROC and the Advisory Committee developed a standardized risk taxonomy, and a secure and simplified evidence-based, online IRM Risk Register tool. The program was launched in January 2015 for use by all HIROC subscribers at no cost.

Patient care risks most frequently cited

Since the launch of HIROC’s IRM Risk Register, 93 subscribers have signed on and over 1,700 risks have been entered into the system. Mining the data captured in the IRM Risk Register shows that the category with the most risks relates to patient care and safety. The top five cited patient safety-related risks are: care communication/coordination; medication adverse events; patient falls; infection control; and care access.

“It’s only been just over a year and a half,” says HIROC VP Healthcare Risk Management Polly Stevens, “but the widespread organizational interest in the program shows a deep commitment to managing key risks, especially risks to patients – which we know leads to safer care.”

IRM is a challenge in many healthcare organizations, but those that are successful use a simplified approach and have the support of senior leadership. “Initial buy-in is important and we needed to be open to adopting categories of risk,” says Lori Borovoy, Director of Risk Management and Patient Safety at the Central CCAC, “but we’ve learned to approach ERM as a dynamic process that must have an impact on our day-to-day activities.”

As the number of participants and risks entered into the Risk Register system grows, a national database of healthcare risks is emerging. “This unique Canadian database will be extremely valuable both for those using the program and the health system in general, as we identify trends and share best practices in managing risks,” says Stevens.

In addition, creating an IRM community has aided in the uptake of IRM – connecting healthcare organizations that are just starting their IRM journey with those that have more experience.

Overcoming obstacles

A key part of HIROC’s IRM journey has been working with an Advisory Council – including representation from a wide range of healthcare organizations. Their input and feedback has been essential to developing the IRM Risk Register program.

The biggest barriers to successful implementation of IRM in healthcare organizations include uncertainty about best practices, how to rank risks, and overly complex IRM structures. Another challenge with implementing IRM in healthcare organizations is the lack of leadership and board support.

HIROC’s analysis of published and experiential knowledge on IRM shows that adoption is improved when organizations:

• Keep it simple;

• Ensure senior leadership and board ownership;
• Focus on risks to core objectives starting with safe patient care;
• Limit the number of risks to start.

The adoption of IRM in HIROC subscriber organizations has increased the focus by senior healthcare leaders on key organizational risks with patient safety and care-related issues at the top of the list. As the healthcare system reiterates its commitment to reducing the incidence of adverse events and ensuring high quality, safe care for patients, the time is now for efficient and effective IRM in all healthcare organizations.

Kopiha Nathan is Senior Healthcare Risk Management Specialist – Data Specialist at HIROC and Ellen Gardner is Manager, Communications and Marketing at HIROC.