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  • Inspiring Clinical Safety Excellence Owning and Accounting for Clinical Risk

    Across the Board to Influence Culture

  • Agenda

    2

    Introducing The Risk Authority Stanfords Advanced Risk Management System Workshop 1 Influence Culture & Duty of Candour Workshop 2

  • 3

    The Stanford University Medical Network

    The Risk Authority-Stanford

    The Stanford University Medical Network

  • What do we do?

    Value-Driven Enterprise Risk Management

    Medical Malpractice Patient Safety Clinical Risk Management Claims and Litigation Workers Compensation Risk Finance

    Total Risk Program Value

    Downside Risk

    Value Protection

    Upside Risk

    Value Creation

    4

  • Client Solutions

    5

    DART Stanford Risk Assessments

    PEARL Clinical Coding Risk in Residency Program

    VDERM Consulting

    Safe Patient Handling

    Physician Peer Support

    Loss Prevention Strategies

    Risk Education

  • Building on Traditional and Enterprise Risk Management

    6

    Using data and decision analytics in the risk process to create risk intelligence.

  • Agenda

    7

    Introducing The Risk Authority Stanfords Advanced Risk Management System Workshop 1 Influence Culture & Duty of Candour Workshop 2

  • Advanced Risk Management Five Critical Steps

    8

  • Value Protected & Value Created Figure out what types of

    future events might prevent or slow the achievement of objectives or enhance the prospects of success.

    Advanced Risk Management Step One - Identify

    9

  • The coding of medical malpractice claims is the center of our patient safety model.

    Prioritizes to focus resources Focuses on what needs to be fixed Identifies who is involved Supports resourcing solutions

    CODING

    Identify: The Model Methodology

    10 10

  • Identify: Clinical Coding

    11 11

  • Identify: Using an Accident Causation Taxonomy

    12 12

  • High Level Trended Data

    13 13

    0

    10

    20

    30

    40

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    60

    1998

    1999

    2000

    2001

    2002

    2003

    2004

    2005

    2006

    2007

    2008

    2009

    2010

    2011

    2012

    NU

    MB

    ER

    OF

    CA

    SE

    S Entity 1 Entity 2

    Cases by Loss Year

    The majority of cases in this analysis originate from events occurring within the last 6 years.

    LOSS YEAR

    247 cases | 21M total incurred

    Entity 1 N=214

    Entity 2 N=33

  • 14 14

    High Level Trended Comparison - Directional

    Entities have faced a larger proportion surgical-related cases than its AMC peers.

    45%

    19%

    11% 11% 9%

    7%

    31%

    22% 19%

    8% 6% 7% 0%

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    Entities AMCMajor Allegations

  • 15 15

    Comparison Between 2 Hospitals by Specialty

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    Top Responsible Services

    Surgical specialties are the most frequently identified responsible service for both entities.

    247 cases | 21M total incurred

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    10

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  • 16 16

    Drill Down by Sub-Specialty

    0200,000400,000600,000800,0001,000,0001,200,0001,400,0001,600,0001,800,000

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    S

    number of cases total incurred

    Top Responsible Surgical Services

    Neurosurgery and Orthopedics are the services most frequently identified in Entity cases.

    105 cases | 6.8M total incurred

  • 17 17

    Drill Down by Sub-Specialty

    0200,000400,000600,000800,0001,000,0001,200,0001,400,0001,600,0001,800,000

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    RR

    ED

    NU

    MB

    ER

    OF

    CA

    SE

    S

    number of cases total incurred

    Top Responsible Surgical Services

    Neurosurgery and Orthopedics are the services most frequently identified in Entity cases.

    105 cases | 6.8M total incurred

    Top Neurosurgery Procedures

    Laminectomy 6

    Spinal Fusion 4

    Craniotomy 3

  • 18 18

    Causality

    PERCENT OF CASES*

    37%

    62%

    26%

    22%

    13%

    15%

    AMC

    *A case will often have multiple factors identified.

    Entitys cases involve a larger proportion of technical skill factors versus peers.

    Top Contributing Factors

    FACTOR PERCENT

    OF CASES*

    Technical Skill 59%

    Clinical Judgment 56%

    Communication 43%

    Administrative 25%

    Clinical Systems 12%

    Behavior-related 11%

    Entities

  • 19 19

    Deep Dive into Causality

    Entitys surgical cases are driven by a larger proportion of intra-operative technical issues.

    Top Major Allegations

    ALLEGATION PERCENT OF CASES

    Surgical Treatment 87%

    improper performance of surgery 52%

    improper management of surgical patient 22%

    retained foreign body 8%

    surgery, other 4%

    delay in surgery 1%

    Diagnosis-related 4%

    Communication 4%

    Medication-related 2%

    Medical Treatment 1%

    AMC Entity

    PERCENT OF CASES

    72%

    40%

    19%

    7%

    3%

    3%

    8%

    3%

    2%

    11%

  • Determine which risks are most critical and how individual risks are related to each other.

    Value Protected & Value Created

    Advanced Risk Management Step Two - Assess

    20

  • Assess Risk Register

    21

    Value Protected & Value Created Identify

    Assess

  • Assess Heat Map

    22

    Value Protected & Value Created Identify

    Assess

    IMP

    AC

    T

    LIKELIHOOD

  • Value Protected & Value Created

    Advanced Risk Management Step Three - Evaluate

    Decide which risks need to be addressed and evaluate and compare outcomes

    23

  • Value and Risk Map

    Probability Assessments

    Quantified Value Model

    Waterfall of Value

    Tornado Diagram

    Strategic Decision Insights

    Dashboards/ Monitoring

    A B C D E F

    1

    2

    3

    4

    5

    uu uuuuu

    uuuuu uu

    Quantified Heat Maps

    VA

    LUE

    CR

    EATI

    ON

    VALUE PROTECTION

    Evaluate: Sampling of Decision Analysis Tools

    24

  • Evaluate - Risk & Value Map

    25

    Value Protected & Value Created Identify

    Assess

  • Evaluate S Curve

    26

    Value Protected & Value Created Identify

    Assess

  • Evaluate Tornado

    27

    Value Protected & Value Created Identify

    Assess

  • Evaluate Waterfall

    28

    Value Protected & Value Created Identify

    Assess

  • Value Protected & Value Created

    Advanced Risk Management Step Four - Mitigate

    This is where the action is. Develop and follow steps to reduce risks at the top of your list as well as steps to increase potential benefits.

    29

  • MITIGATE

    30

    The goal is to turn data into information, and information

    into insight.

    Carly Fiorina Former CEO of HP

    Data Coding Analytics Communication

    Data Analytics

    Risk Intelligence Risk Mitigation and Prevention Strategies

    Data

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