Full document - International Hospital Federation

Innovation and strategy: risk management
other “non-regulated” risks and emerging risks that occur more
frequently, with sometimes great potential for severe
consequences and substantial losses. Many HRMP do not
include the “non-regulated” risks and are limited to only the
“regulated risks” and the safety procedures that are necessary
for quality assurance and accreditation. The trend,
nevertheless, seems to be towards increasing consideration of
non-regulated risks as part of the business.
✚ Information management. This is a major component as
HRMP requires management of l many data. Several key
issues must be solved:
• selection of the necessary and useful data (what, when, who;
forms, use of computers; etc.);
• quality of data (from collection to processing and use in the
decision making process) and of the source of data;
• confidentiality of data (data concerning patients; sensitive
data concerning the hospital);
• reporting mechanisms of any event that has a link with the
Programme (especially critical events, sentinel and precursor
events 41 ).
Use of modern technology 42 . The use of modern technology for
managing information facilitates the management of data
pertaining to the HRMP and the data collected as routine activity.
It enhances early detection of emerging risks (detection of signals),
adverse events and precursor events (software intranet based or
internet based).
The emergency response plans of hospitals (disaster plans)
In many countries the MoH has defined its policy on Hospital
Emergency Response Plans (from preparation of the ERP to the
validation of the Plans). Contingency plans 43 (e.g. internal fire;
bomb threat; Avian Influenza Pandemic, chemical incidents, etc.)
are either included in the overall Hospital ERP as contingency
procedures (SOP and Supplemental Emergency Response Plans
of the various units and departments of the Hospital) or
developed as contingency plans. Unfortunately in many
countries the situation is chaotic: lack of national policy of the
MoH (only few hospitals develop an ERP); lack of validation of
the plans that are developed (no standardization; many plans are
only paper documents that will never survive a real emergency).
WHO has recommended a list of elements that must be included
in the ERP of hospitals 44 . WHO has also developed toolkits for
developing hospital ERP.
Comprehensive Risk and Emergency Management
Programme (CREMP) for Hospitals: the new approach 45 .
The rationale for the integration of hospital risk management
programmes (as a sub-programme) and hospital emergency
management (as a sub-programme) into a cohesive overall
Programme
Many elements of the conceptual framework of Comprehensive
Emergency Management used by communities (and
governmental institutions at national or sub-national levels) can
be applied to the management of hospitals during crisis and
major emergencies. The preparation, the activation, and the use
of the hospital ERP often mirror 46 the existing systems and
mechanisms used in the wider community or at sectoral level,
especially when focusing on special functions such as Incident
Management Systems; EOC; Incident Command Group; logistic
management; information management, etc. The adoption of a
CREMP by hospitals must be based on the assessment of
existing hazards (and threats) that could possibly affect the
activities of the hospital or the assets (either impacting on them or
requiring an important surge capacity in delivering essential 47
service). In the context of Comprehensive Emergency
Management in MCM, WHO advocates for capacity building at
community level and for decentralization. The safe and efficient
decentralization of the response capacity to sub-national levels
and to community levels requires a clear national policy (and its
application guidelines) and clear mechanism for transfer of
authority, resources and financial means. Hospitals are a major
assets to consider in MCM.
The systems and the structures of the CREMP
Clear rationale exists for integration of the Emergency
Management System, as described in the ERP of the hospital,
together with the various programmes dealing with risk
management into an overall comprehensive programme. The
general conceptual framework and the overall organization as
well as the links between the components of these different subprogrammes
are presented in the Figure 2. Emergency
Management Australia (Governmental Agency) has already paved
the way in this direction by combining together the subprogrammes
of quality assurance and emergency risk
management 48 . In this new conceptual framework, the notion of
critical infrastructure is defined as follows: “A service, facility or a
group of services or facilities, the loss of which will have severe
adverse effects on the physical, social, economic or
environmental well being or safety of the community”. It is
particularly interesting to note that this notion also includes “a
group of services or facilities”. Medical surge capacity largely
depends on the effectiveness of the networks (as recommended
by ADPC 49 ) that each hospital develops with the other
stakeholders 50 .
The main elements that of the various programmes (Quality
Assurance; Emergency Management/ ERP; Hospital Risk
Management Programme) are:
✚ hazard and threat identification and assessment;
✚ risk analysis (that requires also identification of vulnerabilities);
✚ development and implementation of risk treatment options
(which includes vulnerability reduction);
✚ monitoring mechanisms;
✚ coordination and management systems.
The advantages of the CREMP
The main advantages of adopting this integrated strategy in
hospitals are:
✚ Many management systems required for Emergency.
Management/ERP and Risk Management Programmes/Quality
Assurance are very similar. Indeed the management of severe
events in Risk Management Programmes and the
management of crisis during disasters require the mobilization
of a “Command Group” and the development of an Incident
Action Plan; the mobilization of resources (especially trained
staff); the activation of special procedures and SOP; the
management of information, etc. The pre-establishment of
such structures and systems for responding to both situations
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