Full document - International Hospital Federation

Innovation and strategy: risk management
efficient integration of the two Sub-Programmes when they
already exist. This Committee will have to decide on key issues
such as: management structure of the CREMP and of the two
Sub-Programmes; the level of integration of the two Sub-
Programmes; common information management systems;
methods and tools to be used for assessing risks (even if there
are already methods and tools in use; integration would call for a
new approach), etc. It is important that all key stakeholders of the
two Sub-Programmes are represented in the Committee, either
as permanent members or as temporary advisers when
necessary. Cross-fertilised participation by managerial and clinical
staff is necessary.
Management structure and systems
Many hospitals already have a RMP and an ERP. These
Programmes, where they exist, have their own management
structure although some key functions (such as the director of the
hospital: chief of security, etc.) are members of both structures.
The challenge here is to integrate as much as possible the
“management structure for all risks” (including the risk arising from
disasters) into one single “command structure”. Both Programmes
require the technical expertise of different stakeholders in parallel
to the presence of a common “core management group”.
Therefore it is necessary to consider running two Sub-
Programmes as complementary and in synergy and to integrate
them into one single command structure of the CREMP.
Depending on the size of the hospital and the services it provides,
the complexity of the two Sub-Programmes will vary and therefore
the composition of the management board of each of them.
Hospitals should consider the appointment of a “Hospital Risk
Manager” (highly qualified; adequately trained; having a high
position in the hierarchy; appropriate authority).
Methodology for assessing vulnerabilities
There are many different methods for assessing the vulnerabilities
of communities, hospitals and systems, areas in which private
companies, for many years, have been very active. It is necessary
that hospitals desiring to develop a CREMP, select the methods
that best suit their facilities’ needs. Selection must be done also in
coordination with the local community, other hospitals that are
members of the local network, and in accordance with the policy
of the MoH (when available). The use of simple techniques
(qualitative) for the first estimate, is recommended for small-sized
hospitals. Very sophisticated computerized quantitative
techniques do not add much in terms of programme development
and in effectiveness of the whole process of risk management.
However, computerization of data is of paramount importance
(see information management). WHO has published a system for
assessing hospital vulnerabilities 52 . Nevertheless, it is
recommended that external vulnerabilities (present in the
surrounding community or in the system in which the hospital is a
member) that can impact on hospital activities, be included. When
selecting a method, the Planning Committee must consider the
resources that will be necessary as well as the competencies of
staff involved.
Methodology for identifying the hazards and threats
Selection of the methods that can be used must be done
according to validated pre-established criteria.
Methodology for assessing risks and ranking risks
It is vital that all hospitals in one country use the same
methodology. Training activities must be considered for those in
charge of contributing to either identification or treatment of risks.
Roles, functions, responsibilities and composition of the
Incident Command Group –ICG– (the “brain” of the two Sub-
Programmes); activation; resources; location of the
Command Room
These issues are usually discussed during the development of the
ERP. But is is necessary to identify the specific components and
the systems pertaining to a CREMP.
Administrative support
The support from and direct involvement of Administration
(including HR, Finance, etc.) is necessary as in any major project
in hospitals. The clear identification of the roles of the various
stakeholders is necessary (especially in Administration).
Logistic support
The two Sub-Programmes require resources (from back-up
systems and equipment to sophisticated technology). The
rationalization of the acquisition, mobilization, monitoring of
resources must be a continuous effort, including necessary
training of staff.
Information management
The management of information in both Sub-Programmes is a
complex issue as it involves different systems. For integration of
these systems the following issues need to be discussed:
i. data: selection, processing, reporting;
ii. software and IT;
iii. ongoing surveillance activities and special surveillance
during health crisis (e.g. syndromic based, active reporting);
iv. links with the national “observatory for hospital risks”;
v. links with national policy making;
vi. links with quality assurance and accreditation.
Management of information also includes sharing of information
with the MoH (health system and its management). This includes
the mechanisms for sharing the information and development of
new structures 53 at national level, to enable management of the
information gathered by hospitals. Development of a CREMP will
involve many stakeholders from different programmes (quality
assurance; blood safety, etc..) and therefore require integration of
all efforts and existing systems into a cohesive whole. This does
not mean that the various existing programmes are no longer
necessary. They need to be complementary and coordinated. The
development of a more comprehensive and more coordinated
policy on all these issues will contribute to the development of
CREMP by hospitals.
Monitoring process
Monitoring will consist of a complex set of activities in this new
concept of CREMP. The main elements that would need
addressing are:
✚ assessment of implemented risk treatment options (in both
Sub-Programmes)
✚ assessment of the Programme, involving
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