Risk and the Quality Business

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Risk and the Quality Business

• Dr Peter Kirker
• Manager Health Risks
• Victorian Managed Insurance Authority

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Victorian 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 Victorias assets (asset register)
  

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The Rule of 72

• 5 rise in numbers per annum
• 7 rise in costs p.a.

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Claims process

• 90 000 APEs reported annually
• 10 000 require further action (more information)
• 4 500 filed (no further action)
• 5 000 6 000 claims notification files
• 1 500 claims files established and managed

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APEs in Australia

• Quality in Australian Healthcare Study (QAHCS),
  MJA, 6 Nov 95. Wilson et al
• Reviewed gt14 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

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QAHCS Study - APEs in Australia
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QAHCS 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

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Tackling 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)

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Adverse Outcomes Leading to Litigation

• The Victorian Experience

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Statewide Data 1993-2001
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St Elsewheres Anaesthesia 265k
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Orthopaedics -800k
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Emergency Medicine - 1.8m
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General Surgery 1.22m
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Obs and Gynae - 940k
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Psychiatry - 180k
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Neurosurgery - 750k
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• 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

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VMIA STRATEGY

• Risk Management Focus
• AS4360 Risk Management Standard
• Risk Identification
• Risk Evaluation
• Risk Treatment
• Monitor Review

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HOW TO MAKE IT HAPPEN

• Create a Risk Management culture endorsed by CEO,
  Board and driven from top down.
• Identify a Risk Management Champion
• Establish Risk Management Committee
• Monitor and review Risk Management Program
• Risk is everyones responsibility

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ASSISTANCE 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

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BENEFICIAL OUTCOMES

• Assists Corporate Governance
• Reduction of exposures to loss
• Compliance with relevant legislation
• Undesirable risks identified and Managed
• Ultimate reduction in Premium costs
• Reduced adverse patient incidents

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BASE PREMIUM FUNDED BY DHS

• Base includes loadings for high risk practices
• Obstetrics
• Emergency

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BONUS 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

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CLAIMS PERFORMANCE POOL CLAIMS RATIOS
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Dr Peter Kirker Dr Jack Bergman Managers of
Health Risks Victorian Managed Insurance
Authority Ph. 03 8601-5900 Email
p.kirker_at_vmia.vic. gov.au
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