hospital risk management plan by MHM

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Slide 1: 

RISK MANAGEMENT PLAN Guided By: Dr.Bhupinder Chaudhary Presented By: Ms.Dipti Manvar Dr.Anuj Mistry Dr.Rajnikant Darji Ms.Pooja Chaturvedi Dr.Dhara Patel Dr.Sahista Bhatt & Dr.Ankur Mehta

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"Forty-five women reported psychological harassment, 41 verbal harassment, 27 unwanted touch and 16 sexual gestures and exhibitionism," Kolkata, Nov 08 The study conducted by leading NGO 'population council' on 'sexual harassment in workplace' said. Employee & Security Zee Survey

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Surjan Singh carries the body of his newborn grandson at the state-run Rajendra hospital in Patiala, India, Saturday, Jan. 31, 2009. Electric fire in NICU

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Three-day old baby boy was allegedly stolen from the Sion Hospital, Mumbai. Wednesday, Mar 31, 2010 Tuesday, April 13, 2010 USG Clinic of Dr.Rohit Patel banned as caught for sex determination, Vijapur ,Pooja Hospita,N.G. Law & Theft Guj samachar Indian Express

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OBJECTIVE: Identification and prevention of risk exposures within the organization that could: Cause injury to patients, visitors and employees & Jeopardize the safety and security of the environment Result in costly claims and lawsuits with subsequent financial loss to the organization

Organization: : 

Organization: CEO- Ex-officio Director of Risk Management Security Manager Disaster & Fire safety officer Legal maters officer Infection control Head (Microbiologist) Finance Manager Inventory Manager Quality Manager HR Manager

Plan : 

Plan Risk Management

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Risk Management Disaster/Fire Mgt Security Mgt Infection Control Legal Issues Mgt HR Mgt Finance Mgt Materials Mgt Quality Mgt Patient rights Pregnancy act MLC Committee BMWM Preventive Technology Theft Pilferage Terrorism Plan Coding Race Pass Labor laws Nursing College Conflict Staff security Analysis Insurance Accreditation Audits Tool application Fire Safe storage insurance

Risk Tolerated Last Yr. : 

Risk Tolerated Last Yr.

Rs.2,66,500 Loss

Strategy : 


Slide 12: 

Of the 25 most costly insured world catastrophes in the past 40 years, 2/3rd have occurred since 2001. The Taj was insured by Tata AIG, received an interim claim of Rs.130 cr,as of Dec,2009. Terror insurance premium 15 lack/yr. Source:insurance chronicle

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Leading Causes of Fire & Property Loss %(2003-2007) Source:insurance chronicle

Disaster Risk Management Plan : 

Disaster Risk Management Plan

Risk Identification : 

Risk Identification Natural disaster risk: Earthquakes Cyclones Typhoons Hurricanes Tornados Epidemics Man-made disaster risk: Caused by warfare NBC Building collapse Explosions Fires Poisons Infection outbreaks Swine flue Hepatitis B

Risk Mitigation : 

Risk Mitigation To identify response time To justified appropriateness of the method

Risk Monitoring and Control : 

Risk Reassessment  Status Meetings Risk Audits  Variance and Trend Analysis  Technical Performance Measurement  Reserve Analysis Risk Monitoring and Control

Risk Strategy : 

Risk Strategy

Fire Management Plan : 

Properties that are prime importance to access the risk Commodity Combustibility Physical properties of the substances Heat release rate Heat of combustion (Btu/lb or Kg)*burning rate (lb/min or kg/s) Exposed surface for burning Fire Management Plan

Types of Fire : 

Types of Fire

Fire Prevention Methodology : 

Structural fire protection is achieved by: Passive fire protection Use of integral , fire resistant rated wall Active fire protection Manual and automatic detection and suppression of fires Education Building owner and operator have understanding of the applicable building and fire codes. Fire Prevention Methodology

Sprinkler System Flow Rates : 

Sprinkler System Flow Rates

Risk Inspection : 

Occupancy Building size, number of fire compartment Fire certificate information Sprinkler installation or not The construction of the building frame, combustibility of sandwich panel cores Potential for rapid spread of fire and flashover Water supply and water pressure Use and type of smoke ventilation equipments Risk Inspection

Risk management planning related to HR Department in Hospital : 

Risk management planning related to HR Department in Hospital

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Introduction Most valuable assets. Maximize the productivity of an organisation by optimizing the effectiveness of its employee. Hiring the right people and training them well. What are the “Risk” in HR? Conflict between employees Lack of staff Job security Strike Accidents HAI Contamination of infection

How to Prevent risk? : 

How to Prevent risk? Training and development programme Alertness about the hospital related risk Security and safety environment for all employees Try to avoid before occurrence. Performance and appraisal management.

Ideal plan for HR risk management in Hospital : 

Ideal plan for HR risk management in Hospital Hospital manager and HR manager are followed such plan. Inform about probability of risk Identify the risks in hospital Meeting with each HOD of diff. departments Make a plans and accept the right plan to handle the risk Implementation

Risk Mitigation : 

Risk Mitigation Activity or group activity that add to project schedule if certain event occur. Take feed back from each employee Ask and solve their queries. Improvement to handle the risk. Regular updated plan and meeting.

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Legal Aspects and Risk Management

Overview of the Legal System : 

Overview of the Legal System In the current health care environment, an increasing number of patients who believe they have sustained physical or psychological harm (a "bodily injury") as a result of the hospital's or a health care provider's negligence bring claims or lawsuits to recover damages. Factors contribute to patients' decision to sue Experiencing of an unexpected or less than perfect result, Feeling that they have been treated in an uncaring, rude, unsympathetic and/or less than professional manner. The most important factor that causes a patient to resort to litigation is a breakdown in the patient-physician relationship.

Legal Issues In Hospital : 

Legal Issues In Hospital Consumer Protection Act - Patient’s Right - Doctor-patient Relationship - Informed Consent No Smoking Act Prenatal Sex Determination Act Medical Termination of Pregnancy Act Drug & Cosmetic Act Bio-medical Waste (management & handling) Act

Consumer Protection Act,1986 : 

Consumer Protection Act,1986 Patients’ Rights: The hospital is ensuring that the rights of all patients are respected during their hospital stay & given all the information regarding treatment. From risk mgt perspective, all health care providers are encouraged to contact the patient representative for assistance because patients’ representative.

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Doctor Patient Relationship: Since the passing of the Consumer Protection Act in 1986, litigation against doctors is on the increase. The medical profession is definitely perturbed by this and a rethink is necessary on standards of medical practice or ‘defensive medicine’. Informed Consent: ‘Consent ‘ is when two or more persons agree upon the same thing in the same sense as per the definition given in section 13 of Indian Contract Act, 1872.

No Smoking Act,1970 : 

No Smoking Act,1970 These Regulations cited as the No-Smoking Premises Regulations 2007 and subject to section 23 of the Act, come into operation at 04.00 hours on the 30th March 2008. “No-smoking notice” means a notice displayed in accordance with section15(1) of the Act; “no-smoking symbol” consists solely of a graphic representation of a single burning cigarette enclosed in a red circle of at least 70 mm in diameter with a red bar across it.

Pre-natal Sex Determination Act,1996 : 

Pre-natal Sex Determination Act,1996 The Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act,1994, was enacted and brought into operation from 1st January, 1996. The Act prohibits determination and disclosure of the sex of foetus. For the risk mgt perspective, at USG department & Gynaec & Obstetric clinic prenatal determination of sex is punishable under this act.

Medical Termination of Pregnancy,1971 : 

Medical Termination of Pregnancy,1971 A registered medical practitioner shall not be guilty of any offence under Indian Penal Code or under any other law for the time being in force, if any pregnancy is terminated by him in accordance with the provisions of this Act. Under Sub-section 4, the same could be done.

Bio-medical Waste (management & handling) Act,1998 : 

Bio-medical Waste (management & handling) Act,1998 These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose, or handle bio medical waste in any form. Under this act, take all steps to ensure that such waste is handled without any adverse effect to human health and the environment. Bio-medical waste is treated and disposed of in accordance with Schedule I, and in compliance with the standards prescribed in Schedule V.

Drug & Cosmetic Act,1940 : 

Under this act, there is prohibition of import & sale of certain drugs or cosmetics Schedule H & L drugs are sold only on prescription. Drug & Cosmetic Act,1940

Risk management plan in Hospital Acquired infection : 

Risk management plan in Hospital Acquired infection

Introduction : 

Introduction HAIs are Infections that are acquired by the patient while he/she is in the hospital either from other patients, the hospital environment or members of the hospital staff.

Recognition/identification of risk : 

Recognition/identification of risk High risk procedures(key results area) like injections, surgical procedures ,dressing of wounds, investigation procedure, laboratory investigations, dialysis, organ transplantation unit, OT etc. In the service departments like house keeping, dietary and laundry services, CSSD,.

Risk assessment : 

Risk assessment Rate of occurrence: Over 1.7million people worldwide suffer from HAI annually with cost ranging from4.5$billion to11$ billion. Due to HAI patients occupy beds for an average of 15 to 20 days. CIR=(NUMBER OF INFECTIONS/NUMBER OF ADMIDDIONS)*100 Statistical data of HAI; 1996- 6.7% 2001- 5.9% 2006-5.0%

Strategies to manage risk : 

Strategies to manage risk universal precautions. Personal protective equipment(cap, mask, apron, gloves, boots gloves) Use of disinfectants Sterilization of reusable equipments Cleaning floors air conditioning, nursing care,

Infection control committee : 

Infection control committee Ad Hoc Dietary Supervisor, House Keeping Supervisor, Central Supply Supervisor, Employee Health Director

Risk mitigation : 

Risk mitigation Training of nursing, medical technologist, radiology, respiratory therapy and other students. An action plan to control outbreaks of infection, disinfection/sterilization activities, Bio-medical Waste (BMW) management.

Cont… : 

Cont… Having a written document(manual) outlining the various infection control policies and procedures and updating periodically. Providing facilities to the hospital staff to maintain good infection control practices.

Spillage management : 

Spillage management mercury spillage Mercury spillage kit; Glows, forceps, hard paper, blue bag glass container with cover

Blood spillage kit;Cap, mask,glows forceps, news paper or tissue, yellow, red and blue bag, hypocloride solution ,mop : 

Blood spillage kit;Cap, mask,glows forceps, news paper or tissue, yellow, red and blue bag, hypocloride solution ,mop

Niddle prick injury : 

Niddle prick injury Procedure; Clean the finger with running water When blood stop coming out wash it with soap and clean with water inform sister in charge Note down in register Sister in charge will inform to the physician Physician will refer both staff and patient for test in ICTC After seeing reports physician will decide to give post exposure prophylaxis treatment

Risk management related to Material in Hospital : 

Risk management related to Material in Hospital

What is MATERIAL MANAGEMENT?What are the Risk for Materials? : 

What is MATERIAL MANAGEMENT?What are the Risk for Materials? Theft. Fire. Expiration of materials. Shortage and Surplus of materials. Purchase of Bad quality materials. Bad storage of materials etc.

Ideal plan for material risk management in hospital : 

Ideal plan for material risk management in hospital Identification of Risk Risk Assessment Development of strategies to manage it Risk Mitigation using Managerial Resources

Risk transfer- general insurance of equipment Risk transfer- Contract base system develop Risk reduction-Biomedical engineer appoint. Development of strategies to manage it

Risk Mitigation using Managerial Resources : 

Risk Mitigation using Managerial Resources Levels of decision making are well understood and do not over-lap, but are approached as a multidisciplinary team effort. Practical and applicable education and training policy for the staff. Equipment maintenance policies are in place and are adhered to.

Cont….. : 

Cont….. There is provision for documentation, archiving and timely retrieval of the records. There is adequate hand-over. All such incidents should also be maintained on a ‘risk register’ for periodical analysis.

Security - Risk Management Plans : 

Security - Risk Management Plans Risk Identification Risk Assessment Strategies Development Risk Mitigation

Recognition / Identification of Risk : 

Recognition / Identification of Risk

Risk Assessment : 

Risk Assessment Sources of Fraud in the hospital (2009 – 2010)

Development of Strategies : 

Development of Strategies

Strategies : 

Strategies Physical security – Control of human traffic Separate entry & exit points Identify and guide non-patient & non-visitor traffic Controlling and checking of vehicles Electronic surveillance of strategic & sensitive areas through CCTV cameras Install locking devices & Alarm system Issue visitors passes Locker and lockable cabinets for staff against personal property theft Provision to safe patients’ valuables Secured cabins for cashiers with a panic button

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B. Procedural Security – Establish service rules and communicate them to all employees. Establish policies & procedure manual for each department. Establish committees. Establish accountability & control over the flow of hospital supplies and materials. Establish inventory control procedures. Establish well-formulated procedures for purchase, supply & distribution. Conduct surprise checks of all departmental inventories.

Risk Mitigation : 

Risk Mitigation Equip security office with monitors for CCTV cameras Equip every entry / exit point by two guards round the clock Provide supervisors for every one or two floors Provide security drills to staff & have some percentage of female staff Place CCTV cameras at strategic locations Provide good communication system between security staff at various positions (walkie-talkie, mobiles, whistles)

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ONLY A PERSON WHO RISKS IS FREETo laugh is to risk appearing the fool.To weep is to risk appearing sentimental.To reach for another is to risk involvement.To expose your ideas, your dreams,before a crowd is to risk their loss.To love is to risk not being loved in return.To live is to risk dying.To believe is to risk despair.To try is to risk failure.But risks must be taken, because thegreatest hazard in life is to risk nothing.The people who risk nothing, do nothing,have nothing, are nothing.They may avoid suffering and sorrow,but they cannot learn, feel, change,grow, love, live.Chained by their attitudes they are slaves;they have forfeited their freedom.Only a person who risks is free.

Slide 68: 

Thank You…! “Ask Question on your Risk”

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