Creating a Risk-Aware Culture

The foundation of the University of California's enterprise risk management program is to have people actively manage their various risks – everyone is a risk manager! One key to creating a culture where everyone is a risk manager is to give them tools that meet their specific needs. That means developing different tools, work groups, and initiatives, but delivering them in a cohesive and integrated manner. Also, how can we create personal ownership for identifying, managing, and monitoring risk? A group of forward-thinking people at UC Davis came up with a solution, and the My Managed Risk portal was bom!

The My Managed Risk (MMR) portal was designed as an entry point to the services and resources provided by the Office of Risk Services. It serves as a centralized location for authorized users to access enterprise risk management-related tools and information. The portal allows users direct access to their authorized ERM applications, as well as the ability to view content related to the ERM Solution Set, and at the same time to stay informed of up-to-date news and articles directly related to enterprise risk management. The streamlined design also provides an efficient way for users to search within the MMR portal in order to retrieve contents of interest quickly. (See Exhibit 5.3.)

Health System Specialized Programs

The UC Health System participates in and benefits from all of the tools and programs that come under the umbrella of ERM, but, in keeping with delivering the right tools to the right people, UC continues to develop programs specific to health care.

Exhibit 5.2 ERMIS Dashboard Samples

Dashboard Name


CFO Division AIM: Actionable Information for Managers

Promote positive administrative behavior at the campus level via campus-by-campus comparisons. Results are indicative of business/operational performance and are within Chancellor's realm of control.

Financial Accounting

Count of hand-postings, direct deposits, electronic W-2 and payments, CFR reports, and percentage of transaction not cleared.

Financial Services and Controls

Connexxus participation, travel spend, and savings. Purchase card expenditures, administrative efficiency, and incentives.

Procurement Services

Systemwide procurement savings, procurement spend under management, and percentage of transactions processed electronically by location.

External Finance, UC Bond Debt

Provides visibility and trending on UC bond debt by location.

Medical Quality

Extends medical quality reporting data to support risk management activities.

Travel Incidents, Calls, Claims

To correlate and report data from all travel insurance and travel agencies for UC students and staff traveling throughout the United States and world (anticipated).

UCSF PD Early Warning System Report

Provides UCSF PD leadership the ability to track and identify patterns of multiple staff complaints/investigations/incidents.

UC Travel Dashboard – Connexxus

Tracks campus adoption of the Connexxus travel system and actual savings for campuses that utilize Connexxus.

Waste Diversion

Contains results of the annual waste diversion campus survey. Allows for comparison of recycling/waste diversion between campuses.

Human Capital Dashboard

Provides human resources-related correlations by department and reason description by utilizing enrollment, FTEs, head count, hours, EPL claims, employee separation/retirement, OSHA rates, and harassment prevention training.

Safety Index Dashboard

Provides safety-related loss and exposure correlations by department and cause description by utilizing the following elements: WC claims, FTEs, hours, head count, vehicles, GL, student population, acres, property losses, and OSHA rates.

Safety Index ROI Enhancements

Illustrates the direct and indirect costs of safety risks at UC locations and enterprise-wide.

UC Ready

Provides mission (business) continuity plan completion counts for all locations at the department level.

UC Ready Department-Level Enhancements

Systemwide continuity plan completion and activity metrics at department level.

Reputational Risk (CDPH)

Provides aggregated counts and trends for medical center-related complaints and penalties as reported by California Department of Public Health.

Reputational Risk (OSHA Cube)

Allows visibility in OSHA claims against UC locations that may cause reputational risk to UC.

Office of General Counsel (OGC)

Provides visibility to legal cost by locations.

Medical Center

Provides Medical Center loss and exposure trends and correlations.

Medical Center PL Cube

Provides users the ability to create ad hoc reports utilizing selected Medical Center claims data.

Exhibit 5.3 UC My Managed Risk Portal

Integrating Traditional Risk Management into ERM

Are traditional risk management and ERM two separate programs, concepts, and disciplines? The short answer is "No." Rather, the traditional risk management practices are critical components that make up the ERM portfolio. To get at the big enterprise picture for incidents, events, and claims arising out of the medical centers and hospitals, UC developed an approach to the evaluation of medical incidents, events, and claims. (See Exhibit 5.4.)

Trending, monitoring, and reporting of adverse clinical events and their root cause(s) are done as part of ERM:

• Each University of California Medical Center uses a web-based clinical incident reporting system that permits any staff member to report an event or near miss. The university medical centers are moving to a commercial incident reporting platform that will be consistent across all facilities and permit comparison reporting.

• Each of the UC medical centers has individuals (category managers) who are responsible for the monitoring and evaluation of certain types of events and taking action on them. The Office of Risk Services has access to this system and receives notice of significant events through the system.

• Trend reports are prepared for facility patient safety and quality committees and forwarded through the facility committee structure to the facility governing body – typically the dean of the School of Medicine.

• Adverse event incidents are monitored, and serious events that may require reporting to the state are reviewed weekly; any that are sentinel events result in a root cause analysis.

UC's Enterprise Risk Management Approach to the Evaluation of Incidents, Events, and Claims

Exhibit 5.4 UC's Enterprise Risk Management Approach to the Evaluation of Incidents, Events, and Claims

'Serious events are identified and reported to location Quality of Care Steering Committee for review. This committee is multidisciplinary and includes key individuals of the Quality & Safety Committee (e.g., the chief medical officer, other physician staff members, the chief nursing officer, legal, quality, risk, and compliance).

• In addition, the medical centers measure and review data on a number of metrics from patient complaints to infection rates, patient falls, and so on.

• Hospital-level data is compared with national benchmarks, United Healthcare (UHC) data, and so on.

Individual adverse events may result in claims and lawsuits:

• Risk Services manages the Third Party Claims Administrator to ensure that the claims are promptly investigated and appropriately resolved. As part of this process, Risk Services monitors the Third Party Administrator (TPA) performance against developed performance expectations.

• Risk Services in conjunction with the Office of General Counsel (OGC) and medical center risk management staff collaborate to ensure that the cases are well managed throughout the claims and litigation process. A select panel of defense attorneys is assigned cases.

• Risk Services through Legalbill monitors law firm billing compliance with university guidelines to ensure that the university benefits from a cost- efficient and cost-effective legal defense.

• Medical Staff Risk Management Committee at each facility reviews claims and lawsuits and makes evaluations regarding the quality of care and corrective action that is needed internally; the committee monitors the action through to resolution by the responsible departments. The Risk Services director attends the committee meetings at the locations periodically.

• There are also facilities (allocation committees) that review settled claims and lawsuits and attribute responsibility to individual practitioners or to system issues. If individuals are identified as responsible, they are reported to the external state licensing boards. Risk Services and OGC are responsible to ensure that cases are appropriately reported to both the state licensing boards and the federal National Practitioner Data Bank, and work with the locations to advise them on reporting. Both the Risk Services director and an OGC representative participate with a facility medical director to review the reporting recommendations of the local facility.

• If cases result in costs to the university, inclusive of defense and indemnity, each location has to identify the risk issues involved and the corrective action taken or planned; this action is reviewed by the Risk Services professional liability (PL) program director and the CRO; for cases of certain value, the actions are also reviewed by the senior vice president for health sciences and service.

• Additionally, the General Counsel and the Board of Regents review the corrective action that is reported.

• In addition, Risk Services has developed and implemented a monitoring system to ensure that corrective actions on cases costing the university more than $50,000 are tracked through resolution through the UC Action process. UC Action is a software tool that permits the capture of events, the causes of loss, and the corrective action that was implemented across the UC System. It permits the assignment of controls to ensure that loss prevention actions are implemented and monitored to avoid recurrence of identified issues. Developed in conjunction with UC Davis, this tool supports the Risk Services and campus loss prevention efforts. All Risk Services program managers periodically review and assess the actions being taken for appropriateness.

The role and activities of UC's Risk Services in adverse event clinical audit (quality assurance) include the following:

• The Risk Services director for professional liability manages the systemwide incident report (IR) system and receives reports of certain types of events via e-mail as well as being able to evaluate trend reports.

• The Risk Services director periodically provides reports of individual events and trends to the facility chief medical directors at their systemwide meetings. In addition, each medical director typically brings events to discuss to these meetings so that locations can learn from each other.

• In addition to the IR system, the Risk Services director is often called by the facility risk managers and alerted to serious events. The Risk Services director also serves as a resource for questions from the facilities.

• The Risk Services PL director implemented a program to ensure that all of the university's claims and lawsuits are coded for loss prevention and trended. This was accomplished through using the Controlled Risk Insurance Company (CRICO[1]) Comprehensive Risk Intelligence Tool (CRIT). This program permits the university to identify the areas of greatest frequency and cost and the underlying contributing factors in a reliable manner. The university facilities have access to the system and are able to compare their trends against the other UC system and non-UC entities.

• The Risk Services director hosts monthly conference calls with medical center risk management staff to discuss matters of interest and loss prevention opportunities.

• Risk Services funds loss prevention activities for the medical centers and student health facilities targeted at reducing university liability. Examples include the prescription rebate program, which provided grant funds for loss prevention activities; ELM Exchange,[2] which provides online risk education; EMMI Solutions information consent program, which helps ensure patient understanding of their clinical options to improve satisfaction; the Vanderbilt Patient Advocacy Reporting System (PARS) to identify and assist physicians who are outliers in terms of patient complaints; disclosure education; and operating room technology aimed at reducing retained foreign bodies.

• In addition, the senior vice president for health sciences and services collects and reviews data from multiple sources regarding hospital performance in clinical areas other than adverse clinical events.

• UC Action summary reports regarding corrective action are shared with the Regents on high-dollar-value litigated cases in the form of reports from the Office of General Counsel.

  • [1] CRICO is the patient safety and medical liability company that serves the Harvard University medical community. It is a leader in evidence-based risk management.
  • [2] Education in Legal Medicine.
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