Cedric Stephens | Hospital hazard management

ADVISORY COLUMN: RISKS & INSURANCE

Recent reports in this newspaper about non-compliance with fire-safety rules by public hospitals and government ministries are very alarming.

The reporting by Jovan Johnson about the decade-long problems at The University Hospital of the West Indies, UHWI, is particularly scary when viewed against the deteriorating conditions that occurred at the Cornwall Regional Hospital in St James over many years.

Billions of dollars are now being spent to fix the many problems. Is the UHWI and ministries’ failure to comply with basic fire-safety rules a symptom of a deeper set of problems? How safe are our hospitals?

UHWI’s chief executive officer, Kevin Allen, did not provide any definitive answers to the two questions. Also, he failed to offer any reassurance that the problems relating to fire safety were on his ‘to do’ list. One can, to some extent, understand this given the “financial problem and old infrastructure had frustrated efforts to get the hospital up to standard”. Missing from his list were the COVID-19 impacts, which will lead to other problems.

The January to March 2020 issue of the Indian Journal of Community Medicine provides insights into the fire hazards that public hospitals face. One out of every five hospital fires that occurred in 2017 took place in India.

The authors of the article wrote that “hospital fires can be devastating in terms of loss of life, injuries to patients, staff, and loss of property and equipment, more so because hospitals house many vulnerable people … on life support and incapable of moving. People losing lives at the altar of cure is a saddening tragedy leading to several health, economic, and social ramifications”.

The latter sentence sparked a painful memory: the ‘dead babies scandal’, which occurred five years ago. Nearly 20 infants died as a result of bacterial infections in the Neonatal Special Care and Intensive Care Units at the UHWI and Cornwall Regional Hospital.

The non-compliance with fire-safety rules and infant deaths caused by bacterial infections are connected. The bridge is risk management.

“Risk management is defined as the systematic process of identifying, evaluating, and addressing potential and actual risk. It is the process to protect the assets and minimize financial loss to the organisation. Managing risk is a proactive function. It is taking action to reduce the frequency and severity of unexpected incidents, reduce the impact of legal claims, and promote high-reliability performance system design,” the Indian journal reported. The key word is proactive.

The UHWI CEO did not identify the institution’s non-compliance as a risk management failure or say whether it employed or was planning to recruit a risk manager or had a structure in place to manage the many risks to which the hospital is exposed.

The essentials of a risk management programme in a hospital like the UHWI or CRH include, according to Balbir Singh and M. Habeeb Ghatala in their 2012 article “Risk Management in Hospitals”:

• The appointment of a risk manager who will have the support of the governing board, CEO, medical staff, and other segments of the hospital community;

• The risk manager making the rounds and meeting department heads to acquaint each of them with their responsibilities.

• The implementation of a six-step programme with the cooperation of the risk-management committee to ensure the following:

a) Identification of situations that could produce an incident that would result in financial loss;

b) Evaluation of incident reports and comparing available data on incidents in other hospitals to be able to identify those situations that are likely to yield an incident;

c) Elimination of dangerous procedures that are performed on the premises, sale of equipment that can result in negligence claims;

d) Reduction of risks so that the hospital can feel comfortable in instituting an internally funded and operated insurance mechanism;

e) Transfer of liability by having "hold harmless" agreement with drug and equipment manufacturers; and

f) Developing and implementing strategies for transferring risks.

The risk management committee would be chaired by the administrator responsible for quality control and would have representatives from quality assurance, the blood bank, medical audit, infection control, safety and security, accreditation, education, physicians, nurses, legal counsel, tissue committee, professional liability committee, professional practices committee, medical discipline, medical-legal committee, antibiotic use, therapeutics, pharmacy, medical records, and the utilisation review committee.

The purpose of the risk management committee will be to assist the risk manager in fulfilling the responsibilities of the position to minimise injuries to patients, visitors, and employees, and financial loss to the hospital.

Top-performing companies, according to McKinsey & Company, “deem risk management as a strategic asset, which can sustain significant value over the long term”. This statement applies to public and private entities.

The educational institution to which the hospital is attached offers a postgraduate degree in this discipline. In this context, the statements that were attributed to the hospital’s CEO in this newspaper on October 15 and in this article, require a more detailed response from him on the broader risk management implications of non-compliance with fire safety rules.

Cedric E. Stephens provides independent information and advice about the management of risks and insurance. For free information or counsel, write to aegis@flowja.com.