Risk culture in the hospital sector

The venue for the annual conference of the Risk Management Network was the Inselspital Bern. The 70 or so participants were eagerly awaiting a programme entitled "Integrated risk management at the Inselspital Bern", which dealt with the many 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 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 the risk management of 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.

Clinical quality and safety management
Stumbling blocks and success factors in clinical safety management (which deals with the risks emanating from the hospital, as opposed to security management, which deals with the risks acting on the hospital) were the focus of the presentation by Helmut Paula, Head of Clinical Quality and Safety Management at the Insel Group. He notes that the correlation 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 conditions 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 and costly error culture. Cultural changes must be implemented at various levels, with the focus on appropriate rules. Systematic and rule-based work processes are already a matter of course in the safety management of medical technology, 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 bio-banks, the (currently non-mandatory) standard on "Application of risk management for IT networks containing medical devices" (EN 80001-1) is also becoming increasingly important.

Clinic management at the Inselspital Bern
Following the interesting information film about the emergency centre of the Inselspital Bern, Peter Burkhardt, Head of Clinic Management/Kataplan, states 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 number 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.

Prof. Dr. Bruno Brühwiler, owner of the consulting firm EuroRisik Ltd., concludes that the Swiss healthcare system is only in the middle of the pack in terms of safety in an international comparison (see also p. 28 in this issue).

Innosuisse" pioneering project
The Insel Group is tackling a pioneering project with the federal innovation promotion agency "Innosuisse" under the premises of clinical quality and safety management. 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.