MFK PERTEMUAN 6 ASESMEN RISIKO

RISK ASSESSMENT Proses untuk membantu organisasi menilai tentang luasnya risiko yg dihadapi ,kemampuan mengontrol frekuensi dan dampak risiko. Harus dilakukan oleh seluruh staf dan semua pihak yg terlibat termasuk Pasien dan Publik dapat terlibat bila memungkinkan.

AREAS TO ASSES : A - OPERATIONAL B - FINANCIAL C - HUMAN CAPITAL RISK ASSESSMENT….. AREAS TO ASSES : A - OPERATIONAL B - FINANCIAL C - HUMAN CAPITAL D - STRATEGIC E - LEGAL/REGULATORY F - TECHNOLOGY

A. OPERATIONAL 1. CREDENTIALING AND STAFFING : - INITIAL APPOINTMENT - REAPPOINTMENT - AFFILIATED STAFF 2. CLINICAL : - PATIENT COMMUNICATION - PATIENT CARE RECORDS - CONFIDENTIALITY - INFORMED DECISION MAKING - TELEPHON PROTOCOLS - TRACKING DIAGNOSTIC INFORMATION

- PRIMARY CARE SCREENING AND MONITORING - SUPERVISION - PATIENT SATISFACTION/COMPLAINTS - COVERAGE ISSUES - INFECTION CONTROL - MEDICATION SAFETY - EMERGENCY RESPONSE - PATIENT AND STAFF EDUCATION 3. GENERAL LIABILITY ASSESSMENT TOPICS : - SAFETY PROGRAM - SECURITY PROGRAM - FACILITY MANAGEMENT 4. PARKING ( LIGHTING, LOCATION, SECURITY ) : - VISITOR CONTROL PROCEDURES - VALUABLES

B. FINANCIAL 1. RISK FINANCING TREATMENTS : - INSURANCE - SELF-INSURANCE 2. ABILITY TO RAISE CAPITAL 3. REIMBURSEMENT 4. BILLING AND COLLECTION 5. CONTRACT ADMINISTRATION : - SCOPE OF SERVICE AND METHODE OF PAYMENT - CONTRACTUAL TERMS - RISK-SHARING AGREEMENT - REMEDIES FOR BREACH

C. HUMAN CAPITAL 1. EMPLOYMENT PRACTICES/HUMAN RESOURCES TOPICS : - WORKER’S COMPENSATION - HARASSMENT - NEGLIGENT FIRING - DISCRIMINATION - CONFIDENTIALITY - EDUCATION - EMPLOYEE HEALTH - STAFF RIGHTS AND STAFF COMPETENCY 2. ENVIRONMENTAL ISSUES RELATED TO EMPLOYEES : - SAFETY - SECURITY - OCCUPATIONAL HAZARDS - ENVIRONMENTAL HAZARDS

D. STRATEGIC STRATEGIC PLAN AND MISSION BUSINESS VENTURES : - MERGER - JOINT VENTURES 3. COMPETITION’S STATUS 4. ADVERTISING LIABILITY 5. REPUTATIONAL RISKS : - PATIENT & COMMUNITY RELATIONS - MEDIA RELATIONS - MARKETING & SALES

6. NEW PROJECTS & SERVICES TOPICS : - IDENTIFICATION OF INSURANCE NEEDS - STAFF REQUIREMENTS - CONTRACT NEEDS - COMPETITIVE IMPACTS 7. CONSTRUCTION/RENOVATION : - LICENCES/PERMITS - CONTRACTS - DISRUPTION OF SERVICES - HAZARDS (AIR QUALITY,SAFETY DESIGN) - APPROVALS

1. STATUTES,STANDARDS & REGULATIONS : E. LEGAL AND REGULATORY 1. STATUTES,STANDARDS & REGULATIONS : - REGIONAL,STATE AND LOCAL IMPACTS 2. LICENSURE 3. ACCREDITATION 4. CORPORATE COMPLIANCE PROGRAM : - IDENTIFICATION OF RELATED COMPLIANCE FACTORS - PROGRAM COMPONENTS : -EDUCATION,REPORTING, DATA MAINTENANCE,REVIEW, MONITORING - RELATIONSHIPS

F. TECHNOLOGY 1. INFORMATION SYSTEMS 2. TELEMEDICINE 3. EQUIPMENT 4. NEW TECHNOLOGIES 5.INVENTORY CONTROL

RISK MANAGEMENT TECHNIQUES/TREATMENTS RISK CONTROL : - EXPOSURE AVOIDANCE - LOSS PREVENTION ( RCA ) - LOSS REDUCTION ( FMEA ) - SEGREGATION (SEPARATION OR DUPLICATION) - CONTRACTUAL TRANSFER FOR RISK CONTROL RISK FINANCING : - RISK RETENTION - RISK TRANSFER

Hazardous Substances Risk Management

Hazardous Substances Risk Management There are many hazards which could result in loss. In order to eliminate or minimise the hazards and therefore the potential for injury, illness or damage to plant or property, hazards need to be identified, and risks need to be assessed and controlled. Identification of hazards Hazard identification is the process of identifying situations or events that could give rise to the potential for injury, illness or damage to plant or property.

Assessment of Risks Assessment of the risks is the process of determining the likelihood of an injury, illness or damage to plant or property happening. This generally involves consideration of the nature of exposure to the hazard such as: - How likely is it someone will be hurt or something damaged (eg. will or could happen etc.) - Frequency of exposure - Level of exposure (eg. No. of people, amount/degree/extent of exposure to noise, chemicals etc.) - Pattern of exposure (eg. continuous, intermittent etc.) - Adequacy of any existing control measures

Control of hazards - Hazard control is the process of determining and implementing appropriate measures to control risks and their consequences associated with that hazard. - The control process must follow the control hierarchy : . Elimination, . substitution, . engineering, . administrative (procedures) and . protective equipment type controls. - Protective equipment should always be the last control option.

A combination of controls may be appropriate however the solution must follow the control hierarchy. - It is always important that any control measure does not introduce new hazards, and that on going effectiveness of the control is monitored.

RISK MANAGEMENT PROCESS The basic steps of the risk management process are shown in the flow chart

PROSES MANAJEMEN RISIKO KOMITMEN : - PIMPINAN RS - TIM K3RS - SELURUH KARYAWAN RS IDENTIFIKASI RISIKO : - APA YANG DAPAT TERJADI - BAGAIMANA HAL ITU TERJADI PENILAIAN RISIKO : - BAGAIMANA RISIKO BISA TERJADI - APA DAMPAKNYA BILA SUDAH TERJADI - BAGAIMANA HAL ITU BISA DIKURANGI EVALUASI DAN PERINGKAT: - EVALUASI PILIHAN UNTUK MENGURANGI RISIKO - HITUNG BEAYA UNTUK MENGURANGI RISIKO - IDENTIFIKASI KEGIATAN YANG DAPAT MENGURANG BEAYA RISIKO - BANDINGKAN BEAYA DENGAN BENEFIT

PROSES MANAJEMEN RISIKO …………. PENGENDALIAN RISIKO : - ELIMINASI - SUBSTITUSI - ENGENEERING - PROSEDUR - PPE MONITOR DAN REVIEW : - MONITOR DAMPAK RISIKO - DIKAJI KEMBALI/REVIEW EFEKTIFITAS KEGIATAN - PERUBAHAN PRIORITAS RISIKO DIKOMUNIKASIKAN DAN DIKONSULTASIKAN : -SIAPA SAJA YANG PERLU TAHU (INTERNAL/EKSTERNAL ) - SIAPA SAJA YANG TERLIBAT

STEP 1 Hazard Identification Department Head / Supervisor or their delegated staff shall identify all hazards associated with processing plant and plant related systems of work using the most relevant methods chosen from the following list: - a visual inspection - auditing - testing - technical or scientific evaluation - an analysis of injury or near miss data - discussions with designers, manufactures, suppliers, importers, employers, employees or relevant parties. Hazards are to be recorded on The Risk Management Worksheet

STEP 2 Risk Assessment The risks arising from the hazards are to be assessed and rated by using the following factors : - Likelihood - the chance of the hazard or event actually occurring during the life of the plant. - Consequences - the extent of the harm (injury or ill health) should it actually occur. Once the likelihood and consequence of each hazardous event or situation has been decided, the risk is to be rated

PROBABILITY / LIKELIHOOD Level DESKRIPSI 1 Very low 0–5% – extremely unlikely or virtually impossible HAMPIR TIDAK MUNGKIN TERJADI 2 Low 6–20% – low but not impossible JARANG TAPI BUKAN TIDAK MUNGKIN TERJADI 3 Medium 21–50% – fairly likely to occur MUNGKIN TERJADI / BISA TERJADI 4 High 51–80% – more likely to occur than not SANGAT MUNGKIN 5 Very high 81–100% – almost certainly will occur HAMPIR PASTI AKAN TERJADI

1 2 3 4 5 SKOR DAMPAK Kematian Tidak ada cedera INSGNIFICANT MINOR MODERATE MAJOR CATASTROPHIC CIDERA PASIEN Tidak ada cedera Dapat diatasi dengan pertolongan pertama Berkurangnya fungsi motorik / sensorik Setiap kasus yang memperpanjang perawatan Cedera luas Kehilangan fungsi utama permanent Kematian PELAYANAN/OPERASIO NAL TERHENTI LEBIH DARI 1 JAM TERHENTI LEBIH DARI 8 JAM TERHENTI LEBIH DARI 1 HARI TERHENTI LEBIH DARI 1 MINGGU TERHENTI PERMANEN BIAYA / KEUANGAN KERUGIAN KECIL KERUGIAN LEBIH DARI 0,1% ANGGARAN KERUGIAN LEBIH DARI 0,25 % ANGGARAN KERUGIAN LEBIH DARI 0,5% ANGGARAN KERUGIAN LEBIH DARI 1% ANGGARAN PUBLIKASI RUMOR - MEDIA LOKAL - WAKTU SINGKAT MEDIA LOKAL WAKTU LAMA MEDIA NASIONAL KURANG DARI 3 HARI MEDIA NASIONAL LEBIH DARI 3 HARI REPUTASI DAMPAK KECIL THD MORIL KARYAWAN DAN KEPERCAYAAN MASYARAKAT DAMPAK BERMAKNA THD MORIL KARYAWAN DAN KEPERCAYAAN MASYARAKAT DAMPAK SERIUS THD MORIL KARYAWAN DAN KEPERCAYAAN MASYARAKAT MENJADI MASALAH BERAT BAGI PR

RISK RATING NUMBER (RRN) RRN = Kemungkinan (Likelihood) X Dampak (Consequences) Kemungkinan / Probability (Likelihood) Dampak (Consequences) Hampir Tdk mungkin 1 jarang 2 Mungkin 3 Sangat mungkin 4 pasti 5 Sangat rendah Rendah 6 8 10 Sedang 9 12 15 Besar 16 20 Katastropik 25 Sangat rendah 1-4 Ringan 5-10 Sedang 11-15 Berat 16-25 26

Potencial Concequences / Impact Can be manage by procedure MATRIX ASSESSMENT Likelihood / Probability Potencial Concequences / Impact Insignificant 1 Minor 2 Moderate 3 Major 4 Catastropic 5 Almost certain (Tiap mgg /bln) High Extreme Likely (Bebrp x /thn) Posible (1-2 thn/x) Low Unlikely (2-5 thn/x) Rare (>5 thn/x) high ACTION : Can be manage by procedure Clinical Manager / Lead Clinician should assess the consequences againts cost of treating the risk Detailed review & urgent treatment should be undertaken by senior management Immediate review & action required at Board level. Director must be informed

Ratings for each factor and the risk rating are to be recorded in the appropriate columns on the Risk Management Worksheet. When developing risk control strategies, HIGH ratings shall receive first priority.

STEP 3 Risk Control Where a risk to health and safety has been identified, controls must be introduced to eliminate or minimise it. The following ‘hierarchy’ of controls is a guide to controlling risks. In many cases a combination of controls will be necessary to reduce the risk to the level required.

Level 1 Eliminate the risk Level 2 Minimise the risk - substitute with something safer - modify the plant - isolate the plant or hazardous aspect - introduce engineering controls Level 3 ‘Back up’ controls - implement administrative controls & safe work practices - require personal protective equipment Actions taken to eliminate or control the risks are to be actioned and recorded consistent with existing procedures. e.g. Safe Operating Procedures (SOP’s),Job Safe Instructions

STEP 4 Review Review the hazards and control measures to ensure that no new hazards have been introduced and that the process is working effectively to identify the risks and control the hazards

CONSULTATION Department Head / Supervisor or their staff will carry out risk assessments for work for which they are responsible. They will be responsible for employee involvement in the identification and control of hazards and advising employees of any identified hazards and the means of eliminating or controlling them.

RISK MANAGEMENT WORKSHEET   Hospital : Location: ___________________________________ Date:___/___/___ Compiled By: _____________ HAZARD IDENTIFIED LIKELIHOOD Rare Unlikely Posible Likely Almost certain CONSEQUENCE Insignificant Minor Moderate Major Cathastropic RISK RATING Sangat rendah Ringan Sedang Berat CONTROL ACTION 1. Initiated 2. Implemented 3. Reviewed 1 2 3

Risk Assessment – Hazard Guidelines The potential hazards listed below are to be used as a guideline, it is not intended to act as a comprehensive checklist. Friction Entanglement Fire Access / Egress Shearing Environmental dust, noise, weather Manual Handling weight Ergonomics design, repetition, restriction, lighting, behaviour Electrical shock, burn, isolation, leads, cables, switches Slipping Tripping & Falling surfaces, spills, obstacles, guard rails, ladders, collapse Temperature air, surfaces, stability Vibration Emergency Switches/Guarding Confined Spaces High Pressure Fluid Fumes or emissions Hazardous substances chemicals, asbestos Biological human, plant and animal Crushing falling, collapsing, trapping Cutting, Stabbing & Puncturing ejected, falling, disintegration Striking disintegrating, ejecting Suffocation low oxygen, high contaminsation, fumes

Hazard Control - Guidelines Step 1 - List applicable hazards (refer Hazard Guidelines for assistance) .......................................................................................................................................

Step 2 - The following is a flowchart of the process to be Step 2 - The following is a flowchart of the process to be used in controlling the risk for each of the hazards listed in Step 1 in order to complete JobSafety Analysis worksheet

OH&S Obligations Legislative requirements Consultation Job procedures Communication Training

POLICY Department Head / Supervisors shall be responsible for hazard identification and risk assessment in their areas of responsibility: a. before the introduction of any plant or substance; b. before significantly changing a work practice or procedure; or c. before changing any activity or process, where the change may give rise to a risk to health or safety, and, d. ensure that any risks to health or safety at work are eliminated, or if this impracticable at least minimised.

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