Risk Management Network on Reliability in the Hospital Sector

The venue for the annual conference for the Risk Management Network was the Inselspital Bern. The work of a hospital closely combines human know-how and technical sophistication, it is complex and demanding, its core processes are usually time-critical and hardly allow any interruptions, and it is dangerous: mistakes can be fatal. In order for hospitals to preserve human life without putting it at additional risk, attentiveness is an indispensable element in professional action. Ensuring this attentiveness at all times in order to systematically gain safety and save costs is essentially the responsibility of risk management. The task is a demanding one.

The 70 or so participants were eagerly awaiting a programme entitled "Integrated Risk Management at Inselspital Bern", which dealt with the manifold challenges involved in the conception, practical implementation and further development of risk management in hospitals. Five presentations explored the following key questions: How is the Insel Group's risk management set up and where is there potential for optimisation? How can an open safety culture be achieved in everyday medical practice? Which problems have to be mastered with regard to reliable medical technology, and which in emergency and crisis preparation? And finally: What are the basic success factors underlying the "safe hospital"? Where does Switzerland stand in an international comparison?

Risks of a large hospital group

Patrick Egger, Head of Risk Management at the Insel Group, outlined the numerous dimensions and requirements that risk management at a group the size of the Insel Group with six different hospitals must take into account. While the business risk management is well established, the medical area still works largely ad hoc and situationally. Its further development, and in particular the integration of both systems into a holistic risk management system that serves as a dynamic management tool, is one of the major challenges. The Insel Group is tackling these as part of a pioneering project with the federal innovation promotion agency "Innosuisse". The fact that other large hospitals such as the University Hospital Zurich or the Cantonal Hospital St. Gallen are working on similar projects indicates the development potential in clinical risk management in the Swiss hospital landscape.

Clinical quality and safety management

Stumbling blocks and success factors in clinical safety management (dealing with the risks that emanate from the hospitalunlike security management, which is concerned with the affecting the hospital risks) were the focus of the presentation by Helmut Paula, Head of Clinical Quality and Safety Management at the Insel Group. As a special feature of clinical processes, he notes that the connection between critical errors and fatal events is less pronounced than in processes of primarily technical systems such as aviation. The reason for this is the different health constitutions of the patients. However, this should not be used as an excuse for clinical errors or even violations.

The fact that this still happens is an expression of an unhealthy error culture that is costly for everyone. Cultural changes must be implemented at various levels, with appropriate rules at the center.

Standard for medical devices (EN 80001-1)

Systematic and rule-based work processes are already a matter of course in medical technology safety management, says Dieter Egger, Head of Medical Technology at the Insel Group. How else could the life cycle of a fleet of over 13,000 devices and their safe and timely use be guaranteed in 40 clinics, and this in an environment of constant innovation and ongoing cost pressure? Important rules are derived not only from legal regulations, but also from the comprehensive risk inventory that is part of integrated risk management. In the age of digitalisation 2.0, Big Data, artificial intelligence or biobanks, the (currently non-mandatory) standard on "Application of risk management for IT networks containing medical devices". (EN 80001-1) is becoming increasingly important.

Clinic management at the Inselspital Bern 

In the aftermath of the interesting Info film about the emergency centre of the Inselspital Bern Peter Burkhardt, Head of Clinic Management/Kataplan, notes that the case numbers of the emergency centre have increased significantly in recent years and, with around 46,000 patients in 2016, are approaching the capacity limits of normal operations. In the event of an extraordinary incident such as a major accident, however, Kataplan has to work with significantly lower capacities, as seriously injured patients, for example, require a particularly large amount of resources. Special triage systems and networking with other hospitals are priority management measures here. The highest risks, however, include prolonged interruptions in the supply of electricity, water, telephony or ICT systems. This is due to the limited bridging capacities of the BCM for these vital resources.

Success factors in clinical risk management

From a comprehensive perspective, Prof. Dr. Bruno Brühwiler, Managing Director of Eurorisk Ltd. and founding member of the Risk Management Network, highlighted the success factors in clinical risk management. Based on his many years of experience in hospital consulting and his recent research for the book "Das sichere Krankenhaus" (Kohlhammer, ISBN 978-3-17-021611-2), which will be published in autumn 2018, he discussed the critical elements of reliable clinical processes.

Brühwiler paid particular attention to the safety and error culture. For risk managers, this is hardly surprising: the top medical executives play a formative role as managers, team leaders and role models. Switzerland's position in international comparisons of clinical risk and quality management, on the other hand, is astonishing: here, our healthcare system is only in the middle of the pack. Starting points for sustainable progress are, in addition to raising the awareness of medical hospital management and professional associations (arguments: increased patient safety, significant cost reduction, competitive advantages), in particular the institutional framework conditions, namely with regard to the application of the law.

However, as the Insel Group has demonstrated with its Innosuisse project, individual hospitals can also take steps towards innovation on their own initiative. Brühwiler notes that "establishing competencies in clinical risk management is not a walk for a few specialists, but a marathon for an entire organisation".

http://www.netzwerk-risikomanagement.ch

Another exciting article from the magazine "Management & Quality 04/2018" on the subject of The influence of humans, Risk: "Employees  you will find here.