Opening Of NHG's Inaugural Conference On Enterprise Risk Management In Healthcare

03 Sep 2007

By Heng Chee How

Venue: Grand Copthorne Waterfront Singapore

I am delighted to be with you at this opening of the Enterprise Risk Management in Healthcare Conference.  To our overseas delegates, I warmly welcome you to Singapore and wish you a most pleasant stay here.

Risk management is a rational approach toward achieving prudence without paranoia, and confidence without complacency.  By managing risks well, we make it more possible to be bold in a sensible way. 

What constitutes a risk is not fixed, and neither is the significance of a risk.  Some risks are inherent in the nature of the activity. Others may be present or be accentuated because of the context or the operating environment, and may therefore vary depending on circumstances.  Hence, there is no set or static answer to how best to manage risks, even if we ask that question only of hospitals. Each organisation has to review its activities, processes and circumstances, and decide what are the risks to be managed, to what extents to manage them and how to do it. And then, from time to time, review these decisions to take into account changes.

In terms of operating context, there are internal organizational factors, societal characteristics and value factors. For example, Singapore, as an international business hub and tourist city attracts a high volume and fast flow of passing-through traffic and business and tourist traffic.  At the same time, the fairly open labour market and education and health systems mean that there are significant foreign working populations, student populations and patient populations.  A hospital that operates in such an inter-connected setting obviously faces a different range and depth of opportunities, challenges and risks compared to one that serves a stable domestic population.  Then, depending on value factors such as the extent to which a society is litigious, the risks of a particular act or omission would again vary.

ENHANCING QUALITY OF CARE THROUGH BETTER MANAGEMENT OF RISK

How have these concepts been adapted in healthcare? Let me share with you some examples of clinical risk management that have been adopted by our healthcare institutions. 

In a typical hospital, you have a group of trained professionals – namely doctors, nurses,  pharmacists and therapists – coming together as an interdisciplinary team to exercise their skill and judgment to care for individuals who are injured, sick, disabled, or infirm. It is not uncommon these days to find in a local hospital, a doctor from Singapore, a nurse from China, a pharmacist from Malaysia and a therapist from Australia working as a team. Despite their professional training, there is still a risk that a medical error may occur due to miscommunication and misunderstanding arising from their different cultural backgrounds.  

NHG has sought to mitigate this risk by introducing the SBAR (which stands for Situation, Background, Assessment and Recommendation) card. This card helps improve the communication processes among staff during complex patient care situations and thereby reduce the risk of committing an error. The use of the SBAR card locally was initiated by a group of Patient Safety Officers.  These clinicians also underwent the Clinical Practice Improvement Programme (CPIP), a quality improvement programme spearheaded by NHG since March 2002.  The CPIP focuses on improvement in 3 areas, namely, clinical outcome, cost outcome and patient satisfaction. It is currently in its 16th run and has helped train 611 healthcare staff in Singapore, including personnel from the SingHealth cluster and private hospitals. To date, the CPIP has yielded 199 completed projects, of which 50 have been highlighted as having potential for cluster wide implementation.

Other clinical risk management measures include the Medication Reconciliation project which was undertaken by Alexandra Hospital and funded by the Ministry of Health under its Healthcare Quality Improvement Fund. The project succeeded in improving medication safety and reducing potential harm to patients.  It highlighted the importance of effective communication between healthcare providers and patients. The project prevented 48% of potential medication errors and 5.2% of potential Adverse Drug Events (ADE), and resulted in indirect cost savings. Plans are underway to extend this practice to the other hospitals. 

Another project funded by the Ministry and carried out at the National University Hospital showed that with a pharmacist accompanying doctors’ rounds at the Intensive Care Unit, ADEs were reduced by 84% as the pharmacist plays a pivotal role in ensuring prescriptions are verified real time. This spared patients from undue suffering and also helped avoid prolonged hospitalization.

WHAT MAKES ERM EFFECTIVE IN HEALTHCARE 

Risk management should be an integral part of planning and operations, and not an ‘add on’ after the fact.  Effective risk management is also not just a matter of procedures, rules and SOPs. Every system is ultimately as strong and as weak as the people who run it.  For example introducing clinical risk management measures such as the SBAR card and medication reconciliation exercise on their own would not be adequate if the hospitals’ human resource processes are weak. Hence, personnel selection, training, discipline is crucial.  Furthermore, the example set by leaders at all levels, and how they exercise judgment and good sense are paramount.

CONCLUSION

This conference has successfully brought together many international thought leaders and distinguished delegates and practitioners.  It promises to be a valuable platform to exchange ideas and share experiences.  I wish you all an enriching and stimulating time of deliberation and learning. 

Thank you.