Full document - International Hospital Federation

Innovation and strategy: risk management
A comprehensive risk and emergency
management programme for
hospitals: a new approach
ARTICLE BY MARCEL R DUBOULOZ
Senior Medical Consultant, Health Development Counseling and Audit (HDCA) – Geneva
This article looks at risk management in hospitals and the management of emergencies and disasters. It
considers the models and policies that exist in private companies and the core components of a risk
management strategy for hospitals. Building on this knowledge the author puts forward a new plan for
hospitals called the Comprehensive Risk and Emergency Management Programme (CREMP) and explains the
advantages of this approach.
The World Health Organization (WHO) has, over the years,
advocated adoption, by all Members States, laws and
regulations for safer hospitals during major crisis and
disasters. The United Nations International Strategy for Disaster
Reduction (UNISDR) and WHO launched the 2008-2009
campaign for “safe hospitals”, the primary focus of which is the
reduction in “vulnerabilities” 1 , that result in major loss of life,
services in hospitals. Global indicators show that lack or weak
management of vulnerabilities in hospitals lead to catastrophic
loss in services in both high and low-income countries. The 2009
World Health Day was dedicated to “safe hospitals”. Besides
providing care, hospitals also have a major role to play in
management of public health programmes during disasters and
health crisis. With hospitals acting as key sources of information in
the surveillance system 2 , priority is now increasingly being given to
development of the concepts of continuity of delivery of essential
services and surge capacity. Hospitals are not isolated islands:
therefore the objective should be to develop a global health
system, prepared for disasters and major emergencies. There
must be a continuum between the concept of “safer hospitals”
(focus on reducing vulnerabilities) and mass casualty
management. Management of hospital vulnerabilities is best
addressed and controlled when brought into the broader concept
of hospital risk management.
Risk management in hospitals
Many countries, over the years, have developed complex laws and
regulations to regulate and control medical and other healthrelated
activities 3 , such as medical practice, blood safety, quality
assurance, safety and security, and accreditation. Ministries of
Health (MoH) and/or specialized governmental institutions are
often the bodies mandated to monitor compliance 4 . The majority
of countries, however, have yet to develop exhaustive
administrative and technical guidelines for full implementation of
such policies as well as to identify and produce documentation on
best practices.
Management of emergencies and disasters
Many countries have developed national multi-sectoral policies on
management of emergencies 5 , particularly for mass casualty
management (MCM) – also referred as Comprehensive
Emergency Management Programme 6 (CEMP). The Ministry of
Interior or a special Unit in the office of the Prime Minister is usually
entrusted with the responsibility of developing and implementing
the policies, from conception of plans to response management 7 .
Some countries or States in USA have also adopted similar
CEMPs for major governmental Institutions 8 . The trend is more
and more to decentralize the response capacity 9 for MCMs. In
these countries usually the MoHs have also developed their
respective MCM policies, Emergency Medical Services (EMS)
policies, and Hospital Emergency Response Plans 10 . The
increasing trend is towards development of management of
emergencies in hospitals within the framework of CEMPs 11 .
Risk management in hospitals
In parallel to development of the emergency (disaster)
management strategies, many hospitals have introduced risk
management approaches usually under the umbrella of
Comprehensive 12 Risk Management Programmes 13 ”, the targets of
which are regulated risks 14,15 , with the creation of specific
committees for the different regulated risks. Many countries have
national policies on risk management in hospitals, with technical
guidelines for implementation 16 . The risks incorporated in these
policies are primarily routine medical and clinical risks and the
regulated risks. Disasters are not included in these programmes.
Hospital accreditation is also a risk management-related
regulatory tool applied in many countries. The prerequisite,
however, for accreditation is the existence of a risk management
programme as well as the existence of a hospital disaster plan.
Often the process of accreditation is linked to the concept of
quality assurance. Various methods (including checklists 17 ) are
used to assess and monitor. Development of quality improvement
strategies is gaining in importance with MoHs and hospitals. There
Hospital and Healthcare Innovation Book 2009/2010 17