Risk Management Process and Enterprise Risk Management (ERM)

Risk

Management

Process

and

Enterprise

Risk

Management

(ERM)

Dr

Arjaty

Daud

MARS

Disampaikan

pada

Kuliah

Program

Magister

Administrasi

RS

Tujuan

1.

Mahasiswa dapat menyebutkan tujuan

mata ajar risk management process and

enterprise risk management

2.

Mahasiswa dapat menguraikan topik- topik

dan jadwal mata ajar risk management

process and enterprise risk management

3.

Mahasiswa dapat menggambarkan sistem

evaluasi pembelajaran dan buku wajib

The

Five

Steps

In

The

Risk

Management

Process

(ARM)

1.

Identify

loss

exposures

2.Examine

potential

risk

management

technique(s)

3.Select

risk

management

technique(s)

4.Implement

technique(s)

5.Monitor

results

The

Risk

Management

Process

Loss

Prevention

(frequency)

Net

Incom

e

Liab

ility

Pers

onnel

Contractua

l

Transfer

(nonins

urance)

Prop

erty

Active

Non-insuran

ce

&

Self-insuran

ce

Lo

ss

Risk

Analysis

+

Loss

Frequenc

y:

Howlikely

is

it

that

a

loss

will

happen?

+

Loss

Severity:

Howseriou

s

will

the

loss

be?

Ins

urer

A

carri

er

Pass

ive

Not

reco

gnize

Non-Insure

r

Hold

harmle

ss

agree

ments

Risk

Identific

ation

+

Identify

the

loss

Segre

gation

Loss

Reduction

(severity)

Tran

sfer

Risk

Financin

g

Rete

ntion

Treat

the

Exposure

Through

RM

Techniques

Identify/

Analyze

Exposure

Risk

Avoidan

ce

Risk

Contro

l

Risk

Management

Process

Arjaty

Daud/2017

5

1. Risk

Identification

–

Mengkategorikan

dan

mencatat

sumber2

kemungkinan

kerugian

1. Risk

Analysis

• Menetapkan

Frequency

of

Occurrence

/

Loss

Risk

Treatment

3.Risk

control

techniques

:

3. Risk

Avoidance

4. Loss

Prevention

5. Loss

Reduction

6. Segregation

of

Exposure

Units

7. Non-Insurance

Transfer

4.Risk

financing

•Risk

Transfer

•Risk

retention

RISK

CONTROL

Arjaty

Daud/2017

8

1. Risk

Avoidance

•Menghindari

/

tidak

terlibat

dalam Kegiatan

risiko

terkait

2.

Loss

Prevention

Arjaty

Daud/2017

9



Reduksi

/

Eliminasi

kemungkinan

Loss



Contoh

:



Surgical

Instrument

Counts



Infection

Control

Procedures



Safety

Programs



Credentialing

3.

Loss

Reduction

Arjaty

Daud/2017

10

• Reduksi

potensial

dampak

Loss

/

Reduksi

potensial

Severity

Loss

• Examples

– Team

to

Respond

to

Cardiac

or

Respiratory

Distressed

Patients

/

Code

Blue)

– Sprinkler

System

4.

Segregation

of

Exposure

Units

Arjaty

Daud/2017

11

• Pemisahan

(Separation):

–

Membagi

Aset

/

kegiatan

menjadi

dua

atau

lebih

di

lokasi

yang

terpisah

(Mengurangi

Risiko

Rugi

dalam

satu

kejadian)

•

Contractual

Transfer

(Non-Insurance)

• Membuat

Kontrak

dan

Pergeseran

Saat

ini perkembangan

RM

menjadi

lebih

sentralisasi

(ERM)

karena

:

•

Globalisasi

keuangan

&

bisnis

•

Integrasi

industri

asuransi

•

Meningkatnya

regulasi

•

Lebih

fokus

pada

tata

kelola

korporasi

•

Clinical

governance

&

keselamatan

pasien

The

traditional

six-step

RM

process

:

1.

Identifkasi

risiko

2.Analisa

risiko

3.Mengembangkan

teknik

pengelolaan

risiko

(treat

risks)

4.Memilih

teknik

kelola

risiko

yang

terbaik

(selection

of

best

risk-treatment

techniques),

5.Implementasi

teknik

yang

dipilih

6.Monev

efektivitas

manajemen

risiko

Enterprise

Risk

Management

:

2.lebih

mengintegrasikan

manajemen

risiko

kedalam

struktur

organisasi

3.pendekatan

interaktif

untuk

identifkasi

risiko,

analisa

&

kelola

melalui

prinsip

manajemen

risiko

kedalam

operasional

korporasi

&

Renstra

Definisi

Enterprise

Risk

Management

(ERM):

Arjaty

Daud/Esa

Unggul

2016

14

•

Suatu

Proses

yg dilakukan

oleh

BOD dan manajemen

di

semua level unit

yang

dirancang

dalam suatu

strategi

Institusi

untuk

mengidentifikasi kejadian

potensial yang dapat mempengaruhi Institusi dan

mengelola risiko tersebut

untuk

pencapaian

tujuan

institusi

•

ERM

menggunakan

pendekatan

fungsi

silang

untuk

ases,

evaluasi,

dan

mengukur

semua

risiko

institusi,

tidak

hanya

yang

terkait

dengan

risiko

yang

bisa

The

ERM

Framework

4

KATEGORI

8

KOMPONENi

4

LEVEL

Tujuan

•Dalam

konteks

menetapkan

misi

atau

visi

korporasi,

manajemen

menetapkan

tujuan

strategi,

memilih

strategi,

dan

menentukan

tujuan

yang

sejalan

dengan

korporasi

Arjaty

Daud/Esa

Unggul

2016

16

•Framework

ERM

diarahkan

untuk

mencapai

tujuan

korporasi.

EMPAT

KATEGORI

:

•Strategic

–

tujuan

sesuai

dengan

misi

•Operations

–

effective

and

efficient

use

of

its

resources

•Reporting

–

reliability

of

reporting

Delapan

Komponen

ERM

Arjaty

Daud/Esa

Unggul

2016

17

ERM

terdiri

dari

DELAPAN

KOMPONEN

saling

terkait

yang

diperoleh

dari

cara

manajemen

mengelola

korporasi

dan

integrasikannya

dalam

proses

manajemen

•

Internal

Environment

Lingkungan

internal

meliputi

“Tone”

organisasi,

dan

menetapkan bagaimana

risiko

diidentifikasi

dan

ditangani

Manajemen

termasuk

filosofi

manajemen

risiko,

integritas

dan

nilai2

etika,

dan

lingkungan

di

mana

mereka

bekerja

•

Objective

Setting

Tujuan

harus

dibuat

sebelum

manajemen

mengidentifkasi

potensial

event.

ERM

memastikan

bahwa

organisasi

dijalankan

3. Event

Identification

Kejadian

internal

&

eksternal

yg

mempengaruhi

pencapaian

tujuan

korporasi

harus

diidentifikasi,

bedakan

antara

risiko

dan

peluang.

Peluang (lihat

kembali Renstra

dalam

menentukan

tujuan)

4.Risk

Assessment

Risiko

dianalisa,

dihitung

peluang

dan

dampak,

sebagai

dasar

mengelola

risiko

•

Risk

Response

Manajemen

memilih

respon

terhadap

risiko

:

17

a. tolak,

b. terima,

c. reduksi,

6. Control

Activities

Kebijakan

&

prosedur

ditetapkan

&

diimplementasi

untuk

memastikan

respon

riisko

dilaksanakan

dengan

efektif

•

Information

and

Communication

Informasi

yang

relevan

diidentifkasi,

dikomunikasikan

dalam

bentuk

&

jnagkawaktu

yang

membuat

individu

melaksanakan

tanggungjawabnya.

Komunikasi

efektif

juga

terjadi

sangat

luas

diseluruh

korporasi

(kebawah,

kesamping

dan

keatas)

•

Monitoring

ERM

dimonitor

&

dimodifkasi

jika

diperlukan.

Monitoring

dicapai

melalui

aktiiftas

manajemen.

ERM

dilakukan

disetiap

level

orgsnisasi

:

EMPAT

LEVEL

:

•Entity-level

•Division

•Business

unit

processes

•Subsidiary

Areas

to

Assess

Definitions of Risk. (ERM

)

1.Definisi

pertama

:

event

atau

aksi

yang

bisa

berdampak

pada

kinerja

keuangan

atau

operasional

RS.

—

Risiko

harus:

1.didefiniskan

secara

spesifik

2.terukur,

gunakan

standar

akunting

unit

seperti

revenue

atau

kunjungan

pasien

• bisa

diamati

sepanjang

waktu

2.Definisi

kedua:

risiko

tidak

terjadi

secara

terisolasi

namun

diidentiifkasi

secara

kelompok

Domain

risiko

1.

Operational

2.

Financial

3.

Human

Capital

4.

Strategic

DOMAIN

RISIKO

:

1.Risiko

operasional.

timbul

dari

praktik

bisnis

utama

organisasi.

Dalam

organisasi

kesehatan,

risiko

operasional

terkait

dengan

pelayanan

kesehatan.

•

Risiko

keuangan

.

berhubungan

dengan

kemampuan

organisasi

untuk

meningkatkan

dan

mempertahankan

akses

ke

modal,

masalah

kontrak,

biaya

risiko,

dan

evaluasi

dukungan

pemasok.

Domain

ini

termasuk

risiko

untuk

pembiayaan,

seperti

asuransi.

3. Risiko

modal

manusia.

kemampuan

organisasi

untuk

memperoleh,

mengelola,

dan

mempertahankan

pekerja.

Kompensasi

pekerja,

pekerjaan

dan

lingkungan

bahaya,

omset,

absensi,

kekerasan

di

tempat

kerja,

pelecehan,

dan

diskriminasi

masuk

dalam

domain

ini

4. Risiko

strategis.

Risiko yang

berdampak

pada

pertumbuhan

organisasi.

Risiko

strategis

termasuk

merger,

akuisisi,

usaha

patungan,

dan

kewajiban

iklan.

Juga

meliputi

risiko

reputasi

yang

terkait

dengan

hubungan

masyarakat

dan

ekspektasi

kinerja

bagi

organisasi

oleh

pasien

dan

pembayar.

5.

Hukum

dan

peraturan

risiko

. termasuk

risiko

yang

terkait

dengan

aturan

yang

diamanatkan,

peraturan,

UU

dan

standar.

Dalam

pelayanan

kesehatan,

peraturan

dan

standar2

ini

banyak

dan

rumit.

Contoh akreditasi

dan

privasi

dan

peraturan

keamanan.

6.

Risiko

teknologi

.

berhubungan

dengan

teknologi

baru.

Ini

adalah

domain

resiko

yang

tumbuh

dalam

pelayanan

kesehatan

dan

termasuk

perangkat

biomedis,

telemedicine,

obat

elektronik,

sistem

informasi

manajemen

risiko

dan

teknologi

informasi

lainnya,

usang

dan

peralatan

Domain Description/Example

1 Operational Thebusinessofhealthcareisthe deliveryofcarethatissafe,timely, effective,efficient,andpatient-centeredwithindiverse populations.Operationalrisksrelatetothoserisksresultingfrominadequate orfailedinternalprocesses, people,orsystemsthat affectbusinessoperations.Includedarerisksrelatedto:adverseeventmanagement,credentialingandstaffing,documentation, chainofcommand,anddeviationfrompractice.

Risksassociatedwiththedeliveryofcaretoresidents,patientsandotherhealthcarecustomers.Clinicalrisksinclude:failuretofollow evidencebasedpractice,mediationerrors,hospitalacquiredconditions(HAC),serioussafetyevents(SSE),andothers.

2 Strategic Risksassociatedwiththefocusanddirectionoftheorganization.Becausetherapidpaceofchangecancreateunpredictability,risks includedwithinthestrategicdomainareassociatedwithbrand,reputation,competition,failuretoadapttochangingtimes,health reformorcustomerpriorities.Managedcarerelationships/partnerships,conflictofinterest,marketingandsales,mediarelations, mergers,acquisitions,divestitures,jointventures,affiliationsandotherbusinessarrangements,contractadministration,and advertisingareotherareasgenerallyconsideredaspotentialstrategicrisks.

3 Financial Decisionsthataffectthefinancialsustainabilityoftheorganization,accesstocapitalorexternalfinancialratingsthroughbusiness relationshipsorthetimingandrecognitionofrevenueandexpensesmakeupthisdomain.Risksmightinclude:costsassociatedwith malpractice,litigation,andinsurance,capitalstructure,creditandinterestratefluctuations,foreignexchange,growthinprogramsand facilities,capitalequipment,corporatecompliance(fraud andabuse),accountsreceivable,daysofcashonhand,capitation

contracts,billingandcollection.

4 HumanCapital Thisdomainreferstotheorganization’sworkforce.Thisisanimportantissueintoday’stightlaborandeconomicmarkets.Included arerisksassociatedwithemployeeselection,retention,turnover,staffing,absenteeism,on-the-jobwork-relatedinjuries(workers’ compensation),workschedulesandfatigue,productivityandcompensation. Humancapitalassociatedrisksmaycoverrecruitment, retention,andterminationofmembersofthemedical-andallied-healthstaff.

6 Legal/Regulatory Riskwithinthisdomainincorporates thefailuretoidentify, manageandmonitorlegal,regulatory, andstatutorymandatesonalocal, stateandfederallevel.Suchrisksaregenerallyassociatedwithfraudandabuse,licensure,accreditation,productliability,

managementliability,CentersforMedicareandMedicaidServices(CMS)ConditionsofParticipation(CoPs)andConditionsfor Coverage(CfC),aswellasissuesrelatedtointellectualproperty.

6 Technology Thisdomaincoversmachines,hardware,equipment,devicesandtools,butcanalsoincludetechniques,systemsandmethodsof organization.Healthcarehasseenanexplosioninthe useoftechnologyforclinicaldiagnosisandtreatment,trainingandeducation, informationstorageandretrieval,andassetpreservation.ExamplesalsoincludeRiskManagementInformationSystems(RMIS), ElectronicHealthRecords(EHR)andMeaningful Use,socialnetworkingandcyberliability.

7 Hazard

SampleRiskList

Strategic / External Operational Human Capital Financial Legal & Compliance Technology Hazard • Competition

 Afliation, Mergers& Acquisitions

 Variabilityin Patient-Related Volume  Research Grant /Funding Availability  NewModels forCare Delivery  Diminished Market  Regulatory Change/ Healthcare Reform

 Confictof Interest  Decreased Capital Spending  Hospital/ Physician Relationship

 Availabilityof PublicData (HAI/HAC)

Business Management Discipline/Cost Management Equipment Maintenance Failureto Identify& FollowEBM Facility Maintenance

TimelyAccess toCare

FailuretoRefer

Failureto Diagnosis Clinical Continuity Insufcient Discharge Planning Inconsistent Clinical Competency Hiring& Retention Organizational Structure, Alignment& Direction Succession Planning Unionization Turnover Recruitment Aging Workforce Disruptive Behavior FlexStafng Workers’ Compensation Physician Shortage

Arjaty

Credit/ Collections Financial Performance Billing Accuracy /Compliance

PayerMix/ Reimburseme nts

Pension/ Retirement Obligations

Philanthropy/ Fundraising/ Capital

Campaign

FailuretoMeet Margin Uncompensat edCare Accessto Capital Contract Management Revenue Enhancement

Daud/Esa

Unggu

Confictsof Interest Fraud,Theft and Embezzlement Governance, Complianceand Oversight ACO HIPAAPrivacy &Security HealthReform Employment Practices

l

2016

Multiple Vendors Social Networking Information Breach

BarCoding

HybridEMR

IT

Infrastructure &Security

PaucityofIT Professionals

FailuretoActin aTimely Manner Incompatible Programs Natural Disaster FailuretoPlan FailuretoAct Timely

Inabilityto ManageaCrisis

Enterprise

Risk

Management

Operational

Human

Capital

Financia

l

Legal/

Regulatory

ASHRM

Handbook

Technolog

y

Assessment

Model

Technology

28

Arjaty

Daud/Esa

Unggul

2016

Financial

PATIENT

/

ORGANIZATION

Operational

Human

Capital

Legal/Regulatory

Enterprise

Risk

Management

Assessment

Areas

To

Assess:

Operational

Arjaty

Daud/Esa

Unggul

2016

29



Quality

initiatives

(Data

Indikator)



Adverse

event

management

(Data

IKP)



Board

governance



Credentialing

and

staffing

–

Initial

appointment

Areas

To

Assess:

A

Board

’

s Legal

Risks

Arjaty

Daud/Esa

Unggul

2016

30



Duty

to

supervise/

manage



Select

competent

physicians



Conflict

of

interests



Provide

adequate

facilities

and

equipment



Provide

adequate

insurance



Provide

satisfactory

patient

care



Select

competent

administrator



Require

competitive

bidding



Provide

safe

environment



Regulatory

and

Areas

To

Assess:

Operational

Arjaty

Daud/Esa

Unggul

2016

31



General

Liability

Assessment

Topics

–

Safety

program

–

Security

program

–

Facility

management



Parking

(lighting,

location,

security)

Areas

To

Assess:

Operational

Arjaty

Daud/Esa

Unggul

2016

32

●

Clinical

–

Patient

communication

–

Patient

care

records

–

Confidentiality

–

Informed

decision

making

–

Telephone

protocols

–

Tracking

diagnostic

information

–

Primary

care

screening

and

monitoring

–

Supervision

–

Patient

satisfaction/complaints

–

Coverage

issues

–

Infection

control

–

Medication

safety

–

Emergency

response

Areas

To

Assess:

Financial

Arjaty

Daud/Esa

Unggul

2016

33



Risk

Financing

Treatments

–

Insurance

–

Self-insurance



Ability

to

raise

capital



Reimbursement

Areas

To

Assess:

Financial

Arjaty

Daud/Esa

Unggul

2016

34



Contract Administration

–

Scope of service and method of payment /

ruanglingkup

layanan

dan

metode

pembayaran

–

Professional services provided

/

layanan

profesional

–

Quality expectations

/

ekspektasi

mutu

–

Contractual terms

–

Termination provisions

–

Risk-sharing agreements

–

Apparent agency liability

–

Hold harmless and indemnity agreements

Areas

To

Assess:

Human

Capital

Arjaty

Daud/Esa

Unggul

2016

35



Employment

Practices/

Human

Resources

Topics

–

Workers

’

compensation

–

Harassment

–

Negligent

firing

–

Discrimination

–

Testing

–

Background

checks

–

Grievance

procedures

Areas

To

Assess:

Human

Capital

Arjaty

Daud/Esa

Unggul

2016

36



Employment

Practices/Human

Resources

Topics

–

Education



orientation



continuing

education



CPR

–

Employee

health



exposures

–

Employee

assistance

programs

(EAPs)

–

Benefits

Areas

To

Assess:

Human

Capital

Arjaty

Daud/Esa

Unggul

2016

36



Environmental

issues

related

to

employees

–

Safety

–

Security

–

Occupational

hazards

Areas

To

Assess:

Strategic

Arjaty

Daud/Esa

Unggul

2016



Strategic

plan

and

mission

–

Immediate

goals

vs.

long

range

goals



Business

ventures

–

Mergers

–

Acquisitions

and

divestitures

–

Joint

ventures



Competition

’

s

status



Advertising

liability



Reputational

risks

–

Patient

and

community

relations

–

Media

relations

Areas

To

Assess:

Strategic

Arjaty

Daud/Esa

Unggul

2016

39



New

Projects

and

Services

Topics

–

䇾

Fit

䇾

with

existing

organization

structure

–

Identification

of

insurance

needs

–

Staff

requirements

–

Contract

needs

–

Competitive

impacts

–

Process

development



Policies/procedures

Areas

To

Assess:

Strategic

Arjaty

Daud/Esa

Unggul

2016

40



Construction/Renovation

–

Licenses/permits

–

Contracts

–

Disruption

of

services

–

Hazards



Air

quality



Interim

and

design

safety

–

Communication

issues

Areas

To

Assess:

Legal

and

Regulatory

Arjaty

Daud/Esa

Unggul

2016

40



Statutes,

standards

and

regulations

–

Federal,

state

and

local

impacts



Licensure

Areas

To

Assess:

Legal

and

Regulatory



Corporate

Compliance

Program/Interface

–

Identification

of

related

compliance

factors

/

identifikasi

faktor

terkait

kepatuhan

–

Compliance

assessment

results

/

hasil

asesmen

kepatuhan

–

Program

components

-

education,

reporting,

data

maintenance,

review,

monitoring

–

Relatio

A

n

rjat

s

y

D

h

au

i

d

p

/E

s

sa

Unggul

2016

Areas

To

Assess:

Technology

Arjaty

Daud/Esa

Unggul

2016

43



Information

systems



Telemedicine



Equipment

Areas

To

Assess

Arjaty

Daud/Esa

Unggul

2016

44



Setting

priorities

for

program

development

/

Buat

prioritas

untuk

pengembangan

program

–

Utilize

information

from

external

and

internal

assessment

sources

/

gunakan

informasi

dari

sumber

ekstrenal

&

internal

–

Goals

should

be:



Flexible



Short

and

long

term

–

Priorities

should

be: