risk and the quality business dr peter kirker manager health risks victorian managed insurance...
TRANSCRIPT
![Page 1: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/1.jpg)
![Page 2: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/2.jpg)
Risk and the Quality BusinessRisk and the Quality Business
Dr Peter Kirker
Manager Health Risks
Victorian Managed Insurance Authority
![Page 3: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/3.jpg)
Victorian Managed Insurance AuthorityVictorian Managed Insurance Authority
•Established under Act in 1996
•Covers the public hospital system for medical malpractice
•Costs community approximately $50m per year to manage
•Covers all of government risk
•Charged with identifying and insuring the State of Victoria’s assets (asset register)
![Page 4: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/4.jpg)
The Rule of 72The Rule of 72
5% rise in numbers per annum7% rise in costs p.a.
![Page 5: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/5.jpg)
Claims processClaims process
90 000 APEs reported annually10 000 require further action (more
information)4 500 filed (no further action)5 000 – 6 000 claims notification files1 500 claims files established and
managed
![Page 6: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/6.jpg)
APEs in AustraliaAPEs in Australia
Quality in Australian Healthcare Study (QAHCS), MJA, 6 Nov 95. Wilson et al
Reviewed >14 000 admissions (NSW & SA) 16.6% associated with adverse event
resulting in disability / longer hospital stay (Harvard study only 4%)
51% of these considered preventable 13.7% had permanent disability 4.9% patient death
![Page 7: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/7.jpg)
APE rate
Permanent Disability rate
Death rate
High pre-ventability rate
Emergency Medicine
1.5% 9% 6% 82%
Internal Medicine
6.5% 41% 20% 73%
Cardiology 5.1% 25% 8% 58%
General surgery
13.8% 15% 3% 53%
Anaesthesia 2% 4% 2% 38%
QAHCS Study - APEs in AustraliaQAHCS Study - APEs in Australia
![Page 8: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/8.jpg)
QAHCS revisitedQAHCS revisited
Causes of adverse events:-– Technical performance failure /
complication (34.6%)– Information mismanagement (15.8%)– Follow up / follow on failure (11.8%)– Sub optimal care and attention (10.9%)
• Medical Journal of Australia• 1999, 170
![Page 9: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/9.jpg)
Tackling medical errorsTackling medical errors
Active failure – active mistakes with people directly involved in patient care (wrong syringe; memory lapse)
Latent failure – caused by people not directly involved with patient care (heavy workloads, inadequate experience or supervision, inadequate maintenance etc)
![Page 10: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/10.jpg)
Adverse Outcomes Leading to LitigationAdverse Outcomes Leading to Litigation
The Victorian Experience
![Page 11: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/11.jpg)
Statewide Data 1993-2001Statewide Data 1993-2001Specialty Number
(n=3474)% by no % by cost
Anaesthetics 189 3.0% 1.1%
Cardio-thoracic 69 1.4% 1.3%
ENT 90 1.5% 0.3%
Emergency 557 9.0% 11.4%
Gen Surg. 598 9.6% 7.7%
Neurosurgery 99 1.6% 1.5%
O&G
Orthopaedic
Ophthalmology
Plastic surgery
Psychiatry
Urology
Vascular Surg
1163
445
86
61
206
112
5
18.8%
7.2%
1.39%
1%
3.3%
1.81%
0.08%
42.2%
5.2%
0.73%
0.4%
2.6%
0.98%
0.05%
![Page 12: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/12.jpg)
St Elsewhere’s – Anaesthesia $265kSt Elsewhere’s – Anaesthesia $265k
Elsewhere Somewhere Aware
Phys. injury 4 1 2
Breech of policy 1
Damaged teeth 5 1 1
Other 1 1
Incorrect Δ
Cardiac arrest 1
Awareness 5
Airway related 2
IV related 1
Lack of care 1
![Page 13: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/13.jpg)
Orthopaedics -$800kOrthopaedics -$800k
EW SW AW
Complication 32 4 1
Incorrect Δ 4
Breach of policy 1 1
Delayed Δ 1
FB left in situ 2
Consent 4
Procedural issues 5 1
Lack of care 1
![Page 14: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/14.jpg)
Emergency Medicine - $1.8mEmergency Medicine - $1.8mEW SW AW
Delayed Δ 9 5
Incorrect Δ 18 12
Lack of care 1
Complications 3 1
Suicide 1
Complications of Rx 1
Medication error 1
Incorrect test interpretation
1
![Page 15: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/15.jpg)
General Surgery – 1.22mGeneral Surgery – 1.22mEW SW AW
Complications 34 4 1
Procedural issue 4 1
Lap. complications 6 3 1
Consent 2 1
FB left in situ 3
Incorrect Δ 4
Equipment issue 1
Waiting list issue 1
Delayed Δ 1
![Page 16: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/16.jpg)
Obs and Gynae - $940kObs and Gynae - $940kEW SW AW
Postpartum comps 3
Comps of delivery 6
Failed sterilisation 2
General comps 1
Delayed Δ 7 3 1
Un Δ stillbirth 1
Un Δ congenital anomalies 2
Equip. issue 1 1
Procedural issue 1
Consent 3
![Page 17: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/17.jpg)
Psychiatry - $180kPsychiatry - $180k
EW SW AW
Suicide 6
Incorrect Δ 2
Absconding 4
Lack of care 2
Breach of Admin rule/policy 7
Medication error 3
Delayed Δ 1
![Page 18: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/18.jpg)
Neurosurgery - $750kNeurosurgery - $750kEW SW AW
Complications 10
Delayed Δ 2
Incorrect Δ 4
Medication error 1
Waiting list issues 4
Consent 1
Suicide 1
Procedure 1
Equip. issue 2
![Page 19: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/19.jpg)
Present directions
•DHS initiatives ( LAOS and Sentinel Event reporting)
•Incident & complaint monitoring and tracking
•Infection control
•Credentialing of medical staff
•Documentation and medical records
•Medical staff education
![Page 20: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/20.jpg)
VMIA STRATEGYVMIA STRATEGYRisk Management FocusAS4360 Risk Management Standard
Risk IdentificationRisk EvaluationRisk TreatmentMonitor & Review
![Page 21: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/21.jpg)
HOW TO MAKE IT HOW TO MAKE IT HAPPENHAPPEN
Create a Risk Management culture endorsed by CEO, Board and driven from top down.
Identify a Risk Management “Champion”Establish Risk Management CommitteeMonitor and review Risk Management
ProgramRisk is everyone’s responsibility
![Page 22: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/22.jpg)
ASSISTANCE FROM VMIAASSISTANCE FROM VMIA Assist clients with the following:
Establish RM Committees Develop a Risk Profile Risk Management Performance Assessment Tool
(RIMPAT) Incident monitoring tool – uniformity - RiskMan Implement Incident Reporting Systems Site Risk Surveys Sponsoring of pilot CRM projects
![Page 23: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/23.jpg)
BENEFICIAL OUTCOMESBENEFICIAL OUTCOMESAssists Corporate GovernanceReduction of exposures to lossCompliance with relevant legislationUndesirable risks identified and
ManagedUltimate reduction in Premium costs
Reduced adverse patient incidents
![Page 24: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/24.jpg)
BASE PREMIUM – BASE PREMIUM – FUNDED BY DHSFUNDED BY DHS
Base includes loadings for high risk practices: ObstetricsEmergency
![Page 25: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/25.jpg)
BONUS & PENALTYBONUS & PENALTY
• Base Premium adjusted for good/poor claims performance; 3 years actuarially developed claims X 100
3 years premium cost 1
• Claims capped – Protects “Lightning Strikes”• Loss Ratio determines extent of Bonus or
Penalty
![Page 26: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/26.jpg)
CLAIMS PERFORMANCE POOL – CLAIMS RATIOS
Annual Premium Band for the Current Year of the Insured Agency
Loss Ratio Bands
0 – $25,000
$25,001 - $100,000
$100,001 - $200,000
$200,001 +
0 – 65% (25.0%) to (1.7%)
(17.5%) to (1.2%)
(12.5%) to (0.8%)
(10.0%) to – (0.7%)
65 – 85% 0.0% 0.0% 0.0% 0.0%
85% + +3.3% to + 50.0%
+ 1.7% to + 25.0%
1.0% to + 15.0% +0.7% to + 10.0%
![Page 27: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/27.jpg)
Dr Peter Kirker
Dr Jack Bergman
Managers of Health Risks
Victorian Managed Insurance Authority
Ph. 03 8601-5900
Email: [email protected]. gov.au
![Page 28: Risk and the Quality Business Dr Peter Kirker Manager Health Risks Victorian Managed Insurance Authority](https://reader035.vdocuments.net/reader035/viewer/2022070400/56649e605503460f94b5ab12/html5/thumbnails/28.jpg)