WorldWideScience

Sample records for care risk management

  1. Risk Management for Point-of-Care Testing

    OpenAIRE

    James, H. Nichols

    2014-01-01

    Point-of-care testing (POCT) is growing in popularity, and with this growth comes an increased chance of errors. Risk management is a way to reduce errors. Originally developed for the manufacturing industry, risk management principles have application for improving the quality of test results in the clinical laboratory. The Clinical and Laboratory Standards Institute (CLSI), EP23-A Laboratory Quality Control based on Risk Management guideline, introduces risk management to the clinical labor...

  2. Telephone Care Management of Fall Risk:: A Feasibility Study.

    Science.gov (United States)

    Phelan, Elizabeth A; Pence, Maureen; Williams, Barbara; MacCornack, Frederick A

    2017-03-01

    Care management has been found to be more effective than usual care for some chronic conditions, but few studies have tested care management for prevention of elder falls. This study aimed to assess the feasibility and preliminary efficacy of telephone care management of older adults presenting for medical attention due to a fall. The setting was an independent practice association in western Washington serving 1,300 Medicare Advantage-insured patients. Patients aged ≥65 years treated for a fall in an emergency department or their primary care provider's office were contacted via telephone by a care manager within 48 hours of their fall-related visit and invited to participate in a telephone-administered interview to identify modifiable fall risk factors and receive recommendations and follow-up to address identified risk factors. Data from care manager records, patient medical records, and healthcare claims for the first 6 months (November 2009-April 2010) of program implementation were analyzed in 2011. The feasibility of screening and management of fall risk factors over the telephone and the effect on medically attended falls were assessed. Twenty-two patients eligible for fall care management were reached and administered the protocol. Administration took 15-20 minutes and integrated easily with the care manager's other responsibilities. Follow-through on recommendations varied, from 45% for those for whom exercise participation was recommended to 100% for other recommendations. No medically attended falls occurred over 6 months of follow-up. Telephone care management of fall risk appears feasible and may reduce falls requiring medical attention. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  3. Assessment and management of suicide risk in primary care.

    Science.gov (United States)

    Saini, Pooja; While, David; Chantler, Khatidja; Windfuhr, Kirsten; Kapur, Navneet

    2014-01-01

    Risk assessment and management of suicidal patients is emphasized as a key component of care in specialist mental health services, but these issues are relatively unexplored in primary care services. To examine risk assessment and management in primary and secondary care in a clinical sample of individuals who were in contact with mental health services and died by suicide. Data collection from clinical proformas, case records, and semistructured face-to-face interviews with general practitioners. Primary and secondary care data were available for 198 of the 336 cases (59%). The overall agreement in the rating of risk between services was poor (overall κ = .127, p = .10). Depression, care setting (after discharge), suicidal ideation at last contact, and a history of self-harm were associated with a rating of higher risk. Suicide prevention policies were available in 25% of primary care practices, and 33% of staff received training in suicide risk assessments. Risk is difficult to predict, but the variation in risk assessment between professional groups may reflect poor communication. Further research is required to understand this. There appears to be a relative lack of suicide risk assessment training in primary care.

  4. Managing corporate governance risks in a nonprofit health care organization.

    Science.gov (United States)

    Troyer, Glenn T; Brashear, Andrea D; Green, Kelly J

    2005-01-01

    Triggered by corporate scandals, there is increased oversight by governmental bodies and in part by the Sarbanes-Oxley Act of 2002. Corporations are developing corporate governance compliance initiatives to respond to the scrutiny of regulators, legislators, the general public and constituency groups such as investors. Due to state attorney general initiatives, new legislation and heightened oversight from the Internal Revenue Service, nonprofit entities are starting to share the media spotlight with their for-profit counterparts. These developments are changing nonprofit health care organizations as well as the traditional role of the risk manager. No longer is the risk manager focused solely on patients' welfare and safe passage through a complex delivery system. The risk manager must be aware of corporate practices within the organization that could allow the personal objectives of a few individuals to override the greater good of the community in which the nonprofit organization serves.

  5. Medical Assistant-based care management for high risk patients in small primary care practices

    DEFF Research Database (Denmark)

    Freund, Tobias; Peters-Klimm, Frank; Boyd, Cynthia M.

    2016-01-01

    Background: Patients with multiple chronic conditions are at high risk of potentially avoidable hospital admissions, which may be reduced by care coordination and self-management support. Medical assistants are an increasingly available resource for patient care in primary care practices. Objective......: To determine whether protocol-based care management delivered by medical assistants improves patient care in patients at high risk of future hospitalization in primary care. Design: Two-year cluster randomized clinical trial. Setting: 115 primary care practices in Germany. Patients: 2,076 patients with type 2......, and monitoring delivered by medical assistants with usual care. Measurements: All-cause hospitalizations at 12 months (primary outcome) and quality of life scores (Short Form 12 Health Questionnaire [SF-12] and the Euroqol instrument [EQ-5D]). Results: Included patients had, on average, four co-occurring chronic...

  6. [Outsourcing in long-term care: a risk management approach].

    Science.gov (United States)

    Guimarães, Cristina Machado; Carvalho, José Crespo de

    2012-05-01

    This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Long-term Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change) and a risk evaluation matrix was created for outsourcing activities in order to define and implement a performance monitoring process. This study seeks to understand how to evaluate and assess the risks of an outsourcing strategy and proposes a monitoring model using risk management tools. It was shown that the risk management approach can be a solution for monitoring outsourcing in the organizational start-up phase. Conclusions concerning dissatisfaction with the results of outsourcing strategies adopted are also presented.

  7. Safe patient care - safety culture and risk management in otorhinolaryngology.

    Science.gov (United States)

    St Pierre, Michael

    2013-12-13

    Safety culture is positioned at the heart of an organization's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organization's maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organization's safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality. Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate stimulation based team trainings into their

  8. [Safe patient care: safety culture and risk management in otorhinolaryngology].

    Science.gov (United States)

    St Pierre, M

    2013-04-01

    Safety culture is positioned at the heart of an organisation's vulnerability to error because of its role in framing organizational awareness to risk and in providing and sustaining effective strategies of risk management. Safety related attitudes of leadership and management play a crucial role in the development of a mature safety culture ("top-down process"). A type marker for organizational culture and thus a predictor for an organizations maturity in respect to safety is information flow and in particular an organization's general way of coping with information that suggests anomaly. As all values and beliefs, relationships, learning, and other aspects of organizational safety culture are about sharing and processing information, safety culture has been termed "informed culture". An informed culture is free of blame and open for information provided by incidents. "Incident reporting systems" are the backbone of a reporting culture, where good information flow is likely to support and encourage other kinds of cooperative behavior, such as problem solving, innovation, and inter-departmental bridging. Another facet of an informed culture is the free flow of information during perioperative patient care. The World Health Organisation's "safe surgery checklist" is the most prevalent example of a standardized information exchange aimed at preventing patient harm due to information deficit. In routine tasks mandatory standard operating procedures have gained widespread acceptance in guaranteeing the highest possible process quality.Technical and non-technical skills of healthcare professionals are the decisive human resource for an efficient and safe delivery of patient care and the avoidance of errors. The systematic enhancement of staff qualification by providing training opportunities can be a major investment in patient safety. In recent years several otorhinolaryngology departments have started to incorporate simulation based team trainings into their curriculum

  9. Care home manager attitudes to balancing risk and autonomy for residents with dementia.

    Science.gov (United States)

    Evans, Elizabeth A; Perkins, Elizabeth; Clarke, Pam; Haines, Alina; Baldwin, Ashley; Whittington, Richard

    2018-02-01

    To determine how care home managers negotiate the conflict between maintaining a safe environment while enabling the autonomy of residents with dementia. This is important because there is limited research with care home managers; yet, they are key agents in the implementation of national policies. Semi-structured interviews were conducted with 18 managers from care homes offering dementia care in the Northwest of England. Data were analysed using a thematic analysis approach. There were three areas in which care home staff reported balancing safety and risk against the individual needs of residents. First, the physical environment created a tension between safety and accessibility to the outside world, which meant that care homes provided highly structured or limited access to outdoor space. Second, care home managers reflected a balancing act between an individual's autonomy and the need to protect their residents' dignity. Finally, care home managers highlighted the ways in which an individual's needs were framed by the needs of other residents to the extent that on some occasions an individual's needs were subjugated to the needs of the general population of a home. There was a strong, even dominant, ethos of risk management and keeping people safe. Managing individual needs while maintaining a safe care home environment clearly is a constant dynamic interpersonal process of negotiating and balancing competing interests for care home managers.

  10. Managing high-risk patients: the Mass General care management programme

    Directory of Open Access Journals (Sweden)

    Dennis L Kodner

    2015-09-01

    Full Text Available The Massachusetts General Care Management Program (Mass General CMP or CMP was designed as a federally supported demonstration to test the impact of intensive, practice-based care management on high-cost Medicare fee-for-service (FFS beneficiaries—primarily older persons—with multiple hospitalisations and multiple chronic conditions. The Massachusetts General Care Management Program operated over a 6-year period in two phases (3 years each. It started during the first phase at Massachusetts General Hospital, a major academic medical centre in Boston, Massachusetts in collaboration with Massachusetts General Physicians Organisation. During the second phase, the programme expanded to two more affiliated sites in and around the Boston area, including a community hospital, as well as incorporated several modifications primarily focused on the management of transitions to post-acute care in skilled nursing facilities. At the close of the demonstration in July 2012, Mass General Massachusetts General Care Management Program became a component of a new Pioneer accountable care organisation (ACO. The Massachusetts General Care Management Program is focused on individuals meeting defined eligibility criteria who are offered care that is integrated by a case manager embedded in a primary care practice. The demonstration project showed substantial cost savings compared to fee-for-service patients served in the traditional Medicare system but no impact on hospital readmissions. The Massachusetts General Care Management Program does not rest upon a “whole systems” approach to integrated care. It is an excellent example of how an innovative care co-ordination programme can be implemented in an existing health-care organisation without making fundamental changes in its underlying structure or the way in which direct patient care services are paid for. The accountable care organisation version of the Massachusetts General Care Management Program

  11. Managing care.

    Science.gov (United States)

    Sandifer, Q D

    1997-09-01

    The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.

  12. Risk management

    OpenAIRE

    Mcmanus, John

    2009-01-01

    Few projects are completed on time, on budget, and to their original requirement or specifications. Focusing on what project managers need to know about risk in the pursuit of delivering projects, Risk Management covers key components of the risk management process and the software development process, as well as best practices for risk identification, risk planning, and risk analysis. The book examines risk planning, risk analysis responses to risk, the tracking and modelling of risks, intel...

  13. Challenges Associated With Managing Suicide Risk in Long-Term Care Facilities.

    Science.gov (United States)

    O'Riley, Alisa; Nadorff, Michael R; Conwell, Yeates; Edelstein, Barry

    2013-06-01

    Little information about suicidal ideation and behavior in long-term care (LTC) facilities is available. Nonetheless, the implementation of the Minimum Data Set 3.0 requires that LTC facilities screen their residents for suicide risk and have protocols in place to effectively manage residents' responses. In this article, the authors briefly discuss the risk factors of suicide in the elderly and the problems that suicidal ideation and behavior pose in the LTC environment. The authors explain issues that arise when trying to manage suicide risk in the elderly LTC population with general, traditional approaches. These inherent issues make it difficult to develop an effective protocol for managing suicide risk in LTC facilities, leading the authors to propose their own framework for assessing and managing suicide risk in the LTC setting.

  14. [Endorsement of risk management and patient safety by certification of conformity in health care quality assessment].

    Science.gov (United States)

    Waßmuth, Ralf

    2015-01-01

    Certification of conformity in health care should provide assurance of compliance with quality standards. This also includes risk management and patient safety. Based on a comprehensive definition of quality, beneficial effects on the management of risks and the enhancement of patient safety can be expected from certification of conformity. While these effects have strong face validity, they are currently not sufficiently supported by evidence from health care research. Whether this relates to a lack of evidence or a lack of investigation remains open. Advancing safety culture and "climate", as well as learning from adverse events rely in part on quality management and are at least in part reflected in the certification of healthcare quality. However, again, evidence of the effectiveness of such measures is limited. Moreover, additional factors related to personality, attitude and proactive action of healthcare professionals are crucial factors in advancing risk management and patient safety which are currently not adequately reflected in certification of conformity programs.

  15. Identifying Primary Care Skills and Competencies in Opioid Risk Management

    Science.gov (United States)

    Chiauzzi, Emil; Trudeau, Kimberlee J.; Zacharoff, Kevin; Bond, Kathleen

    2011-01-01

    Introduction: Primary care physicians (PCPs) treat a high proportion of chronic pain patients but often lack training about how to assess and address issues associated with prescribing opioids when they are an appropriate component of therapy. The result may be that they may avoid treating these patients, which can lead to an undertreatment of…

  16. What Do High-Risk Patients Value? Perspectives on a Care Management Program.

    Science.gov (United States)

    Ganguli, Ishani; Orav, E John; Weil, Eric; Ferris, Timothy G; Vogeli, Christine

    2018-01-01

    There is growing interest in coordinating care for high-risk patients through care management programs despite inconsistent results on cost reduction. Early evidence suggests patient-centered benefits, but we know little about how participants engage with the programs and what aspects they value. To explore care management program participants' awareness and perceived utility of program offerings. Cross-sectional telephone survey administered December 2015-January 2016. Patients enrolled in a Boston-area primary care-based care management program. Our main outcome was the number of topics in which patients reported having "very helpful" interactions with their care team in the past year. We analyzed awareness of one's care manager as an intermediate outcome, and then as a primary predictor of the main outcome, along with patient demographics, years in the program, attitudes, and worries as secondary predictors. The survey response rate was 45.8% (n = 1220); non-respondents were similar to respondents. More respondents reported worrying about family (72.8%) or financial issues (52.5%) than about their own health (41.6%). Seventy-four percent reported care manager awareness, particularly women (OR 1.33, 95% CI 1.01-1.77) and those with more years in the program (OR 1.16, 95% CI 1.03-1.30). While interaction rates ranged from 19.8% to 72.4% across topics, 81.3% rated at least one interaction as very helpful. Those who were aware of their care manager reported very helpful interactions on more topics (OR 2.77, 95% CI 2.15-3.56), as did women (OR 1.25, 95% CI 1.00-1.55), younger respondents (OR 0.98 for older age, 95% CI 0.97-0.99), and those with higher risk scores (OR 1.04, 95% CI 1.02-1.06), preference for deferring treatment decisions to doctors (OR 2.00, 95% CI 1.60-2.50), and reported control over their health (OR 1.67, 95% CI 1.33-2.10). High-risk patients reported helpful interactions with their care team around medical and social determinants of health

  17. Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice.

    Science.gov (United States)

    Slemon, Allie; Jenkins, Emily; Bungay, Vicky

    2017-10-01

    The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.

  18. Differences in cardiovascular disease risk factor management in primary care by sex of physician and patient.

    Science.gov (United States)

    Tabenkin, Hava; Eaton, Charles B; Roberts, Mary B; Parker, Donna R; McMurray, Jerome H; Borkan, Jeffrey

    2010-01-01

    The purpose of this study was to evaluate differences in the management of cardiovascular disease (CVD) risk factors based upon the sex of the patient and physician and their interaction in primary care practice. We evaluated CVD risk factor management in 4,195 patients cared for by 39 male and 16 female primary care physicians in 30 practices in southeastern New England. Many of the sex-based differences in CVD risk factor management on crude analysis are lost once adjusted for confounding factors found at the level of the patient, physician, and practice. In multilevel adjusted analyses, styles of CVD risk factor management differed by the sex of the physician, with more female physicians documenting diet and weight loss counseling for hypertension (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.12-4.40) and obesity (OR = 2.14; 95% CI, 1.30-3.51) and more physical activity counseling for obesity (OR = 2.03; 95% CI, 1.30-3.18) and diabetes (OR = 6.55; 95% CI, 2.01-21.33). Diabetes management differed by the sex of the patient, with fewer women receiving glucose-lowering medications (OR = 0.49; 95% CI, 0.25-0.94), angiotensin-converting enzyme inhibitor therapy (OR = 0.39; 95% CI, 0.22-0.72), and aspirin prophylaxis (OR = 0.30; 95% CI, 0.15-0.58). Quality of care as measured by patients meeting CVD risk factors treatment goals was similar regardless of the sex of the patient or physician. Selected differences were found in the style of CVD risk factor management by sex of physician and patient.

  19. Perceptions of health and risk management among home care workers in Sweden.

    Science.gov (United States)

    Larsson, A; Karlqvist, L; Westerberg, M; Gard, G

    2013-10-01

    Municipal home care workers provide high-quality services to an increasing proportion of elderly people living in private homes. The work environments and working conditions of these workers vary to a great extent, implying rapid priority-making among both employers and employees to ensure that the work can be performed in a safe way. This study aims to examine home care workers' perceptions of health, risks, working conditions, and risk management within their organization. The study was based on cross-sectional data collected from home care service staff in a municipality in the north of Sweden. Nursing assistants and care aides ( n  = 133) replied to a self-administered questionnaire. Descriptive statistics and between-group differences were analysed. Home care work was perceived to require high levels of professional skill and ingenuity, a good psychosocial work situation, but required a high physical workload. The general health, the capacity and self-efficacy of the staff in relation to work were good. Difficulty in performing risk assessments and following safety regulations due to lack of time, equipment, and information were identified. There is a need to increase participation in risk assessments among the staff, improve management support, structures, and cooperation with other divisions of the social services and the medical care organizations.

  20. A cooperative building up of care security: patient participation to risk management in radiotherapy

    International Nuclear Information System (INIS)

    Pernet, A.; Mollo, V.; Giraud, P.

    2010-01-01

    Based on observations of radiotherapy consultations, interviews of professionals (physicians and operators), of ex-patients and patients under treatment, and on analysis of questionnaires sent to patients, this study aimed at understanding how, and to which levels, participation of patients can optimize risk management. It outlines the major role of therapeutic information and education of patients, but also of health professionals, in order to reach a shared cooperative management of cares. Short communication

  1. TeamSTEPPS for health care risk managers: Improving teamwork and communication.

    Science.gov (United States)

    Cooke, Marcia

    2016-07-01

    Ineffective communication among the health care team is a leading cause of errors in the patient care setting. Studies assessing training related to communication and teamwork in the clinical team are prevalent, however, teamwork training at the administrative level is lacking. This includes individuals in leadership positions such as health care risk managers. The purpose was to determine the impact of an educational intervention on the knowledge and attitudes related to communication and teamwork in the health care risk management population. The educational intervention was an adaptation of a national teamwork training program and incorporated didactic content as well as video vignettes and small group activities. Measurement of knowledge and attitudes were used to determine the impact of the education program. Knowledge and attitudes were assessed pre- and postcourse. Findings indicate that teamwork education tailored to the needs of the specific audience resulted in knowledge gained and improved attitudes toward the components of teamwork. The attitudes that most significantly improved were related to team structure and situation monitoring. There was no improvement in participants' attitudes toward leadership, mutual support, and communication. Team training has been shown to improve safety culture, patient satisfaction, and clinical outcomes. Including risk managers in training on teamwork, communication, and collaboration can serve to foster a common language among clinicians and management. In addition, a measurement related to implementation in the health care setting may yield insight into the impact of training. Qualitative measurement may allow the researcher to delve deeper into how these health care facilities are using team training interventions. © 2016 American Society for Healthcare Risk Management of the American Hospital Association.

  2. Supporting the information domains of fall-risk management in home care via health information technology.

    Science.gov (United States)

    Alhuwail, Dari; Koru, Güneş; Mills, Mary Etta

    2016-01-01

    In the United States, home care clinicians often start the episode of care devoid of relevant fall-risk information. By collecting and analyzing qualitative data from 30 clinicians in one home health agency, this case study aimed to understand how the currently adopted information technology solutions supported the clinicians' fall-risk management (FRM) information domains, and explored opportunities to adopt other solutions to better support FRM. The currently adopted electronic health record system and fall-reporting application served only some information domains with a limited capacity. Substantial improvement in addressing the FRM information domains is possible by effectively modifying the existing solutions and purposefully adopting new solutions.

  3. Nursing involvement in risk and patient safety management in Primary Care.

    Science.gov (United States)

    Coronado-Vázquez, Valle; García-López, Ana; López-Sauras, Susana; Turón Alcaine, José María

    Patient safety and quality of care in a highly complex healthcare system depends not only on the actions of professionals at an individual level, but also on interaction with the environment. Proactive risk management in the system to prevent incidents and activities targeting healthcare teams is crucial in establishing a culture of safety in centres. Nurses commonly lead these safety strategies. Even though safety incidents are relatively infrequent in primary care, since the majority are preventable, actions at this level of care are highly effective. Certification of services according to ISO standard 9001:2008 focuses on risk management in the system and its use in certifying healthcare centres is helping to build a safety culture amongst professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  4. Managing Occupational Risks for Hepatitis C Transmission in the Health Care Setting

    OpenAIRE

    Henderson, David K.

    2003-01-01

    Hepatitis C virus (HCV) infection is a significant contemporary health problem in the United States and elsewhere. Because it is primarily transmitted via blood, hepatitis C infection presents risks for both nosocomial transmission to patients and occupational spread to health care workers. Recent insights into the pathogenesis, immunopathogenesis, natural history, and treatment of infection caused by this unique flavivirus provide a rationale for the use of new strategies for managing occupa...

  5. Development and pilot of an internationally standardized measure of cardiovascular risk management in European primary care

    Directory of Open Access Journals (Sweden)

    Szecsenyi Joachim

    2011-04-01

    Full Text Available Abstract Background Primary care can play an important role in providing cardiovascular risk management in patients with established Cardiovascular Diseases (CVD, patients with a known high risk of developing CVD, and potentially for individuals with a low risk of developing CVD, but who have unhealthy lifestyles. To describe and compare cardiovascular risk management, internationally valid quality indicators and standardized measures are needed. As part of a large project in 9 European countries (EPA-Cardio, we have developed and tested a set of standardized measures, linked to previously developed quality indicators. Methods A structured stepwise procedure was followed to develop measures. First, the research team allocated 106 validated quality indicators to one of the three target populations (established CVD, at high risk, at low risk and to different data-collection methods (data abstraction from the medical records, a patient survey, an interview with lead practice GP/a practice survey. Secondly, we selected a number of other validated measures to enrich the assessment. A pilot study was performed to test the feasibility. Finally, we revised the measures based on the findings. Results The EPA-Cardio measures consisted of abstraction forms from the medical-records data of established Coronary Heart Disease (CHD-patients - and high-risk groups, a patient questionnaire for each of the 3 groups, an interview questionnaire for the lead GP and a questionnaire for practice teams. The measures were feasible and accepted by general practices from different countries. Conclusions An internationally standardized measure of cardiovascular risk management, linked to validated quality indicators and tested for feasibility in general practice, is now available. Careful development and pilot testing of the measures are crucial in international studies of quality of healthcare.

  6. Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management

    Directory of Open Access Journals (Sweden)

    Monica Zolezzi

    2017-02-01

    Full Text Available Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM is best approached by teamwork across health care professionals. This study aimed at assessing health care students’ (HCSs knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorst achieved similar knowledge scores, less than half (n = 38, 47% were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32% were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3. Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as major by nursing students. Future integration of interprofessional educational (IPE activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

  7. Perceived Preparedness of Health Care Students for Providing Cardiovascular Disease Risk Assessment and Management.

    Science.gov (United States)

    Zolezzi, Monica; Abdallah, Oraib; Aden, Suad; Major, Stella; White, Diana; El-Awaisi, Alla

    2017-02-21

    Early assessment and management of risk factors is known to have significant impact in preventing cardiovascular disease (CVD) and its associated burden. Cardiovascular disease risk assessment and management (CVDRAM) is best approached by teamwork across health care professionals. This study aimed at assessing health care students' (HCSs) knowledge about the parameters needed for estimating CVD risk, their self-assessed preparedness/confidence and perceived barriers for the provision of CVDRAM services through a survey administered to third and fourth year pharmacy, medical, and nursing students in Qatar. Although all student cohorts achieved similar knowledge scores, less than half ( n = 38, 47%) were able to identify all of the six main risk factors necessary to estimate absolute CVD risk, and a third (32%) were unable to identify total cholesterol as an independent risk factor necessary to estimate CVD risk. Training on the use of CVD risk assessment tools differed among the three student cohorts. All student cohorts also perceived similar levels of preparedness in CVDRAM. However, pharmacy students reported the highest preparedness/confidence with the use of the latest CVDRAM guidelines. The majority of statements listed under the barriers scale were perceived by the students as being moderate (median score = 3). Poor public acceptance or unawareness of importance of estimating CVD risk was the only barrier perceived as a major by nursing students. Future integration of interprofessional educational (IPE) activities in the CVDRAM curricula of HCSs may be a suitable strategy to minimize barriers and foster collaborative practice for the provision of CVDRAM services in Qatar.

  8. Rethinking risk management

    International Nuclear Information System (INIS)

    Kloman, H.F.

    1992-01-01

    The purpose of this paper is to bring together the ideas of those who currently practice the many different forms of risk management on a global basis. These forms include guidance of public policy on macro risks, risk financing and insurance for many larger commercial organizations, managing credit, currency and interest rate risks for financial institutions, plus other extensions of risk management including security, quality control, and quality assurance in a health-care environment

  9. Risk management.

    Science.gov (United States)

    Chambers, David W

    2010-01-01

    Every plan contains risk. To proceed without planning some means of managing that risk is to court failure. The basic logic of risk is explained. It consists in identifying a threshold where some corrective action is necessary, the probability of exceeding that threshold, and the attendant cost should the undesired outcome occur. This is the probable cost of failure. Various risk categories in dentistry are identified, including lack of liquidity; poor quality; equipment or procedure failures; employee slips; competitive environments; new regulations; unreliable suppliers, partners, and patients; and threats to one's reputation. It is prudent to make investments in risk management to the extent that the cost of managing the risk is less than the probable loss due to risk failure and when risk management strategies can be matched to type of risk. Four risk management strategies are discussed: insurance, reducing the probability of failure, reducing the costs of failure, and learning. A risk management accounting of the financial meltdown of October 2008 is provided.

  10. Sustainable improvement of animal health care by systematic quality risk management according to the HACCP concept.

    Science.gov (United States)

    Noordhuizen, J P; Welpelo, H J

    1996-12-01

    This paper addresses the principles of the Hazard Analysis Critical Control Point (HACCP) concept as applied to animal health management strategy. Characteristics of the concept were analysed and compared with those of current animal health care strategies for disease risk identification and herd health management, insurance, and certification. HACCP is a hybrid strategy of quality control at both production process and product level. Animal health is considered a particular quality feature. We show that process control (expressed in terms of controlling both general and specific disease risk factors) and product control (expressed in terms of testing animals or animal products for specific disease agents) could form the basis for improving animal health. We conclude that HACCP provides ample opportunity for preventive health action and risk management at a relatively low cost in terms of labour, finance and documentation expenditure, at both the farm and sector level. Epidemiological field studies are currently needed to identify critical control points and to design HACCP procedures for livestock producers. In the long run, HACCP based animal health care can be further developed into a quality control systems approach to cover all aspects that are related, either directly or indirectly, to animal health.

  11. Quality of Disease Management and Risk of Mortality in English Primary Care Practices.

    Science.gov (United States)

    Dusheiko, Mark; Gravelle, Hugh; Martin, Stephen; Smith, Peter C

    2015-10-01

    To investigate whether better management of chronic conditions by family practices reduces mortality risk. Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions. © Health Research and Educational Trust.

  12. Care Management to Promote Treatment Adherence in Patients with Cognitive Impairment and Vascular Risk Factors: A Demonstration Project.

    Science.gov (United States)

    Bonner, L M; Hanson, A; Robinson, G; Lowy, E; Craft, S

    2018-01-01

    Dementia prevention is highly important. Improved control of vascular risk factors has the potential to decrease dementia risk, but may be difficult. Therefore, we developed and piloted a care management protocol for Veterans at risk for dementia. We enrolled 32 Veterans with diabetes and hypertension, at least one of which was poorly controlled, and cognitive impairment. Participants were randomly assigned to a 6-month care management intervention or to usual care. At enrollment, 6-months and 12-months, we assessed cognitive performance, mood, and diabetes and hypertension control. At follow-up, diastolic blood pressure was lower in intervention participants at 6 months (p=.041) and 12 months (p=.022); hemoglobin A1c, global mental status and mood did not differ between groups. Recall of a distractor list (p=.006) and logical memory long-delay recall (p=.036) were better at 6 months in the intervention group (p=.006). Care management may contribute to improved control of dementia risk factors.

  13. Risk management in providing specialized care for people living with AIDS.

    Science.gov (United States)

    Leadebal, Oriana Deyze Correia Paiva; Medeiros, Leidyanny Barbosa de; Morais, Kalline Silva de; Nascimento, João Agnaldo do; Monroe, Aline Aparecida; Nogueira, Jordana de Almeida

    2016-01-01

    Analyzing the provision of actions related to managing clinical risk in managing specialized care for people living with AIDS. A cross-sectional study carried out in a reference outpatient clinic in Paraíba, with a sample of 150 adults with AIDS. Data were collected through primary and secondary sources using a structured questionnaire, analyzed using descriptive statistics, multiple correspondence analysis and logistic regression model to determine the association between "providing care" and "clinical risk." Actions with satisfactory provision express a biological care focus; the dimensions that most contributed to a satisfactory assessment of care provision were "clinical and laboratory evaluations" and "prevention and self-care incentivization"; 45.3% of participants were categorized into high clinical risk, 34% into average clinical risk, and 20.7% into low clinical risk; a positive association between providing care and clinical risk was found. The need to use risk classification technologies to direct the planning of local care provision became evident considering its requirements, and thus qualifying the care provided in these areas. Analisar a oferta de ações relacionadas ao manejo de risco clínico na gestão do cuidado especializado a pessoas vivendo com aids. Estudo transversal realizado em ambulatório de referência na Paraíba, com amostra de 150 adultos com aids. Os dados foram coletados por meio de fontes primárias e secundárias utilizando-se de formulário estruturado, e analisados através de estatística descritiva, análise de correspondência múltipla e modelo de regressão logística para averiguar a associação entre "oferta" e "risco clínico". As ações de oferta satisfatória expressam foco biologicista do cuidado; as dimensões que mais contribuíram para o julgamento satisfatório da oferta foram "avaliação clínica e laboratorial" e "prevenção e estímulo ao autocuidado"; 45,3% dos participantes foram categorizados em risco

  14. Tensions of difference: reconciling organisational imperatives for risk management with consumer-focused care from the perspectives of clinicians and managers.

    Science.gov (United States)

    Clancy, Leonie; Happell, Brenda

    2014-11-01

    To understand the impact of risk management and assessment on the delivery of mental health care from the perspectives of managers and clinicians. The concept of risk is now embedded in contemporary mental health services. A focus on risk has been identified as a barrier to the provision of consumer-focused care; however, there is a paucity of research in this area, particularly being drawn from key stakeholders in the field. Qualitative exploratory methods. In-depth interviews were conducted with managers and clinicians from a large metropolitan aged-care mental health service in Australia. The participants represented a range of disciplines and expertise across practice settings (community, inpatient and residential). The theme tensions of difference emerged from this research. This theme referred to the tensions between accountability and attending to risk issues and consumer-centred care, with concerns being raised that procedural and bureaucratic accountability influence (often negatively) the provision of care. Differences in the perspectives of clinicians and managers were also evident in the perceived contribution of evidence-based practice in relation to risk. Prioritising risk management may be interfering with the capacity of clinicians and managers to provide quality and consumer-focused mental health care. A deeper examination and reconceptualisation of the role and importance of risk in mental health care are needed to ensure the focus of service delivery remains consumer-focused.

  15. An agent based architecture for high-risk neonate management at neonatal intensive care unit.

    Science.gov (United States)

    Malak, Jaleh Shoshtarian; Safdari, Reza; Zeraati, Hojjat; Nayeri, Fatemeh Sadat; Mohammadzadeh, Niloofar; Farajollah, Seide Sedighe Seied

    2018-01-01

    In recent years, the use of new tools and technologies has decreased the neonatal mortality rate. Despite the positive effect of using these technologies, the decisions are complex and uncertain in critical conditions when the neonate is preterm or has a low birth weight or malformations. There is a need to automate the high-risk neonate management process by creating real-time and more precise decision support tools. To create a collaborative and real-time environment to manage neonates with critical conditions at the NICU (Neonatal Intensive Care Unit) and to overcome high-risk neonate management weaknesses by applying a multi agent based analysis and design methodology as a new solution for NICU management. This study was a basic research for medical informatics method development that was carried out in 2017. The requirement analysis was done by reviewing articles on NICU Decision Support Systems. PubMed, Science Direct, and IEEE databases were searched. Only English articles published after 1990 were included; also, a needs assessment was done by reviewing the extracted features and current processes at the NICU environment where the research was conducted. We analyzed the requirements and identified the main system roles (agents) and interactions by a comparative study of existing NICU decision support systems. The Universal Multi Agent Platform (UMAP) was applied to implement a prototype of our multi agent based high-risk neonate management architecture. Local environment agents interacted inside a container and each container interacted with external resources, including other NICU systems and consultation centers. In the NICU container, the main identified agents were reception, monitoring, NICU registry, and outcome prediction, which interacted with human agents including nurses and physicians. Managing patients at the NICU units requires online data collection, real-time collaboration, and management of many components. Multi agent systems are applied as

  16. Primary care physician management, referral, and relations with specialists concerning patients at risk for cancer due to family history.

    Science.gov (United States)

    Wood, M E; Flynn, B S; Stockdale, A

    2013-01-01

    Risk stratification based on family history is a feature of screening guidelines for a number of cancers and referral guidelines for genetic counseling/testing for cancer risk. Our aim was to describe primary care physician perceptions of their role in managing cancer risk based on family history. Structured interviews were conducted by a medical anthropologist with primary care physicians in 3 settings in 2 north-eastern states. Transcripts were systematically analyzed by a research team to identify major themes expressed by participants. Forty interviews were conducted from May 2003 through May 2006. Physicians provided a diversity of views on roles in management of cancer risk based on family history, management practices and patient responses to risk information. They also provided a wide range of perspectives on criteria used for referral to specialists, types of specialists referred to and expected management roles for referred patients. Some primary care physicians appeared to make effective use of family history information for cancer risk management, but many in this sample did not. Increased focus on efficient assessment tools based on recognized guidelines, accessible guides to management options, and patient education and decision aids may be useful directions to facilitate broader use of family history information for cancer risk management. Copyright © 2013 S. Karger AG, Basel.

  17. Proactive safety management in health care : towards a broader view of risk analysis, error recovery, and safety culture

    NARCIS (Netherlands)

    Habraken, M.M.P.

    2010-01-01

    Medical errors occur frequently. The harm and additional costs associated with those errors ask for effective safety management. According to the objective of minimal patient harm, safety management in health care should be proactive; that is, risks should be anticipated and reduced before patients

  18. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

    OpenAIRE

    Enrique Jiménez-Rodríguez; José Manuel Feria-Domínguez; Alonso Sebastián-Lacave

    2018-01-01

    Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identificati...

  19. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care.

    Science.gov (United States)

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-02-01

    The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1). errors inevitably occur and usually derive from faulty system design, not from negligence; (2). accident prevention should be an ongoing process based on open and full reporting; (3). major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff.

  20. From aviation to medicine: applying concepts of aviation safety to risk management in ambulatory care

    Science.gov (United States)

    Wilf-Miron, R; Lewenhoff, I; Benyamini, Z; Aviram, A

    2003-01-01

    

 The development of a medical risk management programme based on the aviation safety approach and its implementation in a large ambulatory healthcare organisation is described. The following key safety principles were applied: (1) errors inevitably occur and usually derive from faulty system design, not from negligence; (2) accident prevention should be an ongoing process based on open and full reporting; (3) major accidents are only the "tip of the iceberg" of processes that indicate possibilities for organisational learning. Reporting physicians were granted immunity, which encouraged open reporting of errors. A telephone "hotline" served the medical staff for direct reporting and receipt of emotional support and medical guidance. Any adverse event which had learning potential was debriefed, while focusing on the human cause of error within a systemic context. Specific recommendations were formulated to rectify processes conducive to error when failures were identified. During the first 5 years of implementation, the aviation safety concept and tools were successfully adapted to ambulatory care, fostering a culture of greater concern for patient safety through risk management while providing support to the medical staff. PMID:12571343

  1. Risk management and security services interaction--a must in today's health care environment.

    Science.gov (United States)

    Stultz, M S

    1990-01-01

    The author shows why risk managers and security directors are natural partners in the effort of a hospital to reduce risks from such occurrences as baby kidnappings, serial killers, thefts, and rapes/sexual assaults.

  2. Knowledge and attitudes of primary care physicians in the management of patients at risk for cardiovascular events

    Directory of Open Access Journals (Sweden)

    Turakhia Mintu P

    2008-07-01

    Full Text Available Abstract Background Adherence to clinical practice guidelines for management of cardiovascular disease (CVD is suboptimal. The purposes of this study were to identify practice patterns and barriers among U.S. general internists and family physicians in regard to cardiovascular risk management, and examine the association between physician characteristics and cardiovascular risk management. Methods A case vignette survey focused on cardiovascular disease risk management was distributed to a random sample of 12,000 U.S. family physicians and general internists between November and December 2006. Results Responses from a total of 888 practicing primary care physicians who see 60 patients per week were used for analysis. In an asymptomatic patient at low risk for cardiovascular event, 28% of family physicians and 37% of general internists made guideline-based preventive choices for no antiplatelet therapy (p Conclusion Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations. Innovative educational approaches that address barriers may facilitate the implementation of guideline-based recommendations in CVD risk management.

  3. The Care Manager's Dilemma: Balancing Human Rights with Risk Management under the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003

    Science.gov (United States)

    Prebble, Kate; Diesfeld, Kate; Frey, Rosemary; Sutton, Daniel; Honey, Michelle; Vickery, Russell; McKenna, Brian

    2013-01-01

    In New Zealand, the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003 provides diversion for persons with an intellectual disability who have been charged with, or convicted of, a criminal offence. This unique Act moves the responsibility for such "care recipients" from the criminal justice system to a disability…

  4. Managers' practices related to work-family balance predict employee cardiovascular risk and sleep duration in extended care settings.

    Science.gov (United States)

    Berkman, Lisa F; Buxton, Orfeu; Ertel, Karen; Okechukwu, Cassandra

    2010-07-01

    An increasing proportion of U.S. workers have family caregiving responsibilities. The purpose of this study was to determine whether employees in extended care settings whose managers are supportive, open, and creative about work-family needs, such as flexibility with work schedules, have lower cardiovascular disease (CVD) risk and longer sleep than their less supported counterparts. From semistructured interviews with managers, we constructed a work-family balance score of manager openness and creativity in dealing with employee work-family needs. Trained interviewers collected survey and physiologic outcome data from 393 employees whose managers had a work-family score. Employee outcomes are sleep duration (actigraphy) and CVD risk assessed by blood cholesterol, high glycosylated hemoglobin/diabetes, blood pressure/hypertension, body-mass index, and tobacco consumption. Employees whose managers were less supportive slept less (29 min/day) and were over twice as likely to have 2 or more CVD risk factors (ORs = 2.1 and 2.03 for low and middle manager work-family scores, respectively) than employees whose managers were most open and creative. Employees who provide direct patient care exhibited particularly elevated CVD risk associated with low manager work-family score. Managers' attitudes and practices may affect employee health, including sleep duration and CVD risk.

  5. Coordinating resources for prospective medication risk management of older home care clients in primary care: procedure development and RCT study design for demonstrating its effectiveness.

    Science.gov (United States)

    Toivo, Terhi; Dimitrow, Maarit; Puustinen, Juha; Savela, Eeva; Pelkonen, Katariina; Kiuru, Valtteri; Suominen, Tuula; Kinnunen, Sirkka; Uunimäki, Mira; Kivelä, Sirkka-Liisa; Leikola, Saija; Airaksinen, Marja

    2018-03-16

    The magnitude of safety risks related to medications of the older adults has been evidenced by numerous studies, but less is known of how to manage and prevent these risks in different health care settings. The aim of this study was to coordinate resources for prospective medication risk management of home care clients ≥ 65 years in primary care and to develop a study design for demonstrating effectiveness of the procedure. Health care units involved in the study are from primary care in Lohja, Southern Finland: home care (191 consented clients), the public healthcare center, and a private community pharmacy. System based risk management theory and action research method was applied to construct the collaborative procedure utilizing each profession's existing resources in medication risk management of older home care clients. An inventory of clinical measures in usual clinical practice and systematic review of rigorous study designs was utilized in effectiveness study design. The new coordinated medication management model (CoMM) has the following 5 stages: 1) practical nurses are trained to identify clinically significant drug-related problems (DRPs) during home visits and report those to the clinical pharmacist. Clinical pharmacist prepares the cases for 2) an interprofessional triage meeting (50-70 cases/meeting of 2 h) where decisions are made on further action, e.g., more detailed medication reviews, 3) community pharmacists conduct necessary medication reviews and each patients' physician makes final decisions on medication changes needed. The final stages concern 4) implementation and 5) follow-up of medication changes. Randomized controlled trial (RCT) was developed to demonstrate the effectiveness of the procedure. The developed procedure is feasible for screening and reviewing medications of a high number of older home care clients to identify clients with severe DRPs and provide interventions to solve them utilizing existing primary care resources

  6. A Practical Risk Stratification Approach for Implementing a Primary Care Chronic Disease Management Program in an Underserved Community.

    Science.gov (United States)

    Xu, Junjun; Williams-Livingston, Arletha; Gaglioti, Anne; McAllister, Calvin; Rust, George

    2018-01-01

    The use of value metrics is often dependent on payer-initiated health care management incentives. There is a need for practices to define and manage their own patient panels regardless of payer to participate effectively in population health management. A key step is to define a panel of primary care patients with high comorbidity profiles. Our sample included all patients seen in an urban academic family medicine clinic over a two-year period. The simplified risk stratification was built using internal electronic health record and billing system data based on ICD-9 codes. There were 347 patients classified as high-risk out of the 5,364 patient panel. Average age was 59 years (SD 15). Hypertension (90%), hyperlipidemia (62%), and depression (55%) were the most common conditions among high-risk patients. Simplified risk stratification provides a feasible option for our team to understand and respond to the nuances of population health in our underserved community.

  7. Case management for at-risk elderly patients in the English integrated care pilots: observational study of staff and patient experience and secondary care utilisation

    Directory of Open Access Journals (Sweden)

    Martin Roland

    2012-07-01

    Full Text Available Introduction: In 2009, the English Department of Health appointed 16 integrated care pilots which aimed to provide better integrated care. We report the quantitative results from a multi-method evaluation of six of the demonstration projects which used risk profiling tools to identify older people at risk of emergency hospital admission, combined with intensive case management for people identified as at risk. The interventions focused mainly on delivery system redesign and improved clinical information systems, two key elements of Wagner's Chronic Care Model.Methods: Questionnaires to staff and patients. Difference-in-differences analysis of secondary care utilisation using data on 3,646 patients and 17,311 matched controls, and changes in overall secondary care utilisation.Results: Most staff thought that care for their patients had improved. More patients reported having a care plan but they found it significantly harder to see a doctor or nurse of their choice and felt less involved in decisions about their care. Case management interventions were associated with a 9% increase in emergency admissions. We found some evidence of imbalance between cases and controls which could have biased this estimate, but simulations of the possible effect of unobserved confounders showed that it was very unlikely that the sites achieved their goal of reducing emergency admissions. However, we found significant reductions of 21% and 22% in elective admissions and outpatient attendance in the six months following an intervention, and overall inpatient and outpatient costs were significantly reduced by 9% during this period. Area level analyses of whole practice populations suggested that overall outpatient attendances were significantly reduced by 5% two years after the start of the case management schemes.Conclusion: Case management may result in improvements in some aspects of care and has the potential to reduce secondary care costs. However, to improve

  8. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

    Science.gov (United States)

    Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

    2015-12-15

    Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

  9. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

    Directory of Open Access Journals (Sweden)

    Jonathan Stokes

    Full Text Available An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis.We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group. Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately, and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14. A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36 and long-term (0.35, 0.04 to 0.66. Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care.This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and

  10. Effectiveness of Case Management for 'At Risk' Patients in Primary Care: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Stokes, Jonathan; Panagioti, Maria; Alam, Rahul; Checkland, Kath; Cheraghi-Sohi, Sudeh; Bower, Peter

    2015-01-01

    An ageing population with multimorbidity is putting pressure on health systems. A popular method of managing this pressure is identification of patients in primary care 'at-risk' of hospitalisation, and delivering case management to improve outcomes and avoid admissions. However, the effectiveness of this model has not been subjected to rigorous quantitative synthesis. We carried out a systematic review and meta-analysis of the effectiveness of case management for 'at-risk' patients in primary care. Six bibliographic databases were searched using terms for 'case management', 'primary care', and a methodology filter (Cochrane EPOC group). Effectiveness compared to usual care was measured across a number of relevant outcomes: Health--self-assessed health status, mortality; Cost--total cost of care, healthcare utilisation (primary and non-specialist care and secondary care separately), and; Satisfaction--patient satisfaction. We conducted secondary subgroup analyses to assess whether effectiveness was moderated by the particular model of case management, context, and study design. A total of 15,327 titles and abstracts were screened, 36 unique studies were included. Meta-analyses showed no significant differences in total cost, mortality, utilisation of primary or secondary care. A very small significant effect favouring case management was found for self-reported health status in the short-term (0.07, 95% CI 0.00 to 0.14). A small significant effect favouring case management was found for patient satisfaction in the short- (0.26, 0.16 to 0.36) and long-term (0.35, 0.04 to 0.66). Secondary subgroup analyses suggested the effectiveness of case management may be increased when delivered by a multidisciplinary team, when a social worker was involved, and when delivered in a setting rated as low in initial 'strength' of primary care. This was the first meta-analytic review which examined the effects of case management on a wide range of outcomes and considered also the

  11. Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program.

    Science.gov (United States)

    Lawn, Sharon; Zabeen, Sara; Smith, David; Wilson, Ellen; Miller, Cathie; Battersby, Malcolm; Masman, Kevin

    2017-08-24

    Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health's Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P=0.037) and complex needs (Pmanage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia's health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management

  12. Managing risks

    International Nuclear Information System (INIS)

    Nathwani, J.S.

    1993-01-01

    The three principles to guide regulating authorities are: Risks shall be managed to maximize the total expected net benefit to society; The safety benefit to be promoted is quality-adjusted life expectancy; Decisions for the public in regard to health and safety must be open and apply across the entire range of hazards to life and health. Based on the principle that excessive spending on health and safety, or lack of necessary development, may cause poverty and thereby actually decrease (adjusted) life expectancy, the author has developed a Life Product Index which gives comparable results to the Human Development Index promoted by the United Nations Development Program. These two social indicators can be used for purposes such as project evaluation, choosing between alternative technologies, or evaluation of health and safety programs

  13. Fall-Risk Evaluation and Management: Challenges in Adopting Geriatric Care Practices

    Science.gov (United States)

    Tinetti, Mary E.; Gordon, Catherine; Sogolow, Ellen; Lapin, Pauline; Bradley, Elizabeth H.

    2006-01-01

    One third of older adults fall each year, placing them at risk for serious injury, functional decline, and health care utilization. Despite the availability of effective preventive approaches, policy and clinical efforts at preventing falls among older adults have been limited. In this article we present the burden of falls, review evidence…

  14. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management.

    Science.gov (United States)

    Jiménez-Rodríguez, Enrique; Feria-Domínguez, José Manuel; Sebastián-Lacave, Alonso

    2018-03-30

    Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData ® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

  15. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

    Directory of Open Access Journals (Sweden)

    Enrique Jiménez-Rodríguez

    2018-03-01

    Full Text Available Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE. The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs. Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR concept in combination to the Loss Distribution Approach (LDA is proved to be a proactive tool, within the frame of balanced scorecard (BSC, in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls.

  16. Assessing the Health-Care Risk: The Clinical-VaR, a Key Indicator for Sound Management

    Science.gov (United States)

    Jiménez-Rodríguez, Enrique; Sebastián-Lacave, Alonso

    2018-01-01

    Clinical risk includes any undesirable situation or operational factor that may have negative consequences for patient safety or capable of causing an adverse event (AE). The AE, intentional or unintentionally, may be related to the human factor, that is, medical errors (MEs). Therefore, the importance of the health-care risk management is a current and relevant issue on the agenda of many public and private institutions. The objective of the management has been evolving from the identification of AE to the assessment of cost-effective and efficient measures that improve the quality control through monitoring. Consequently, the goal of this paper is to propose a Key Risk Indicator (KRI) that enhances the advancement of the health-care management system. Thus, the application of the Value at Risk (VaR) concept in combination to the Loss Distribution Approach (LDA) is proved to be a proactive tool, within the frame of balanced scorecard (BSC), in health organizations. For this purpose, the historical events recorded in the Algo-OpData® database (Algorithmics Inc., Toronto, ON, Canada, IBM, Armonk, NY, USA) have been used. The analysis highlights the importance of risk in the financials outcomes of the sector. The results of paper show the usefulness of the Clinical-VaR to identify and monitor the risk and sustainability of the implemented controls. PMID:29601529

  17. European Practice Assessment of Cardiovascular risk management (EPA Cardio: protocol of an international observational study in primary care

    Directory of Open Access Journals (Sweden)

    van Lieshout Jan

    2009-01-01

    Full Text Available Abstract Background Despite important improvements in available prevention and treatment, cardiovascular diseases (CVD remain an important cause of morbidity and mortality. Not all high-risk patients and patients with CVD have healthy lifestyles and receive the best possible healthcare. Internationally comparative data are needed to compare cardiovascular risk management in different countries, and to examine the impact of improvement programs and others factors. Objectives This study aims to provide internationally comparative data on cardiovascular risk management provided in primary care and on health-related lifestyles of patients in Europe. The study will also explore the views of doctors and patients on innovative preventive services for CVDs. Design and methods An observational cross-sectional study is planned. In 10 European countries, stratified samples of 36 practices per country will be recruited. In each practice, three samples of 15 patients each will be sampled: patients with coronary heart disease, patients at high risk for CVD, and healthy adult patients. The quality of cardiovascular risk management has been specified in terms of 44 performance indicators that resulted from an international Delphi-procedure with general practitioners. Most indicators are based on medical records, and some on a structured interview with a contact person of the practice. Lifestyle (smoking, physical exercise, diet will be measured with previously validated questionnaires that are completed by patients. Additional measures include practice characteristics and exposure to programs to improve cardiovascular care.

  18. Cost-effectiveness of cardiovascular risk management by practice nurses in primary care

    NARCIS (Netherlands)

    Tiessen, Ans H.; Vermeulen, Karin M.; Broer, Jan; Smit, Andries J.; van der Meer, Klaas

    2013-01-01

    Background: Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases

  19. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30- and 60-Day Hospitalization: The Depression Care for Patients at Home Cluster-Randomized Trial.

    Science.gov (United States)

    Bruce, Martha L; Lohman, Matthew C; Greenberg, Rebecca L; Bao, Yuhua; Raue, Patrick J

    2016-11-01

    To determine whether a depression care management intervention in Medicare home health recipients decreases risk of hospitalization. Cluster-randomized trial. Nurse teams were randomized to intervention (12 teams) or enhanced usual care (EUC; 9 teams). Six home health agencies from distinct geographic regions. Home health recipients were interviewed at home and over the telephone. Individuals aged 65 and older who screened positive for depression on nurse assessments (N = 755) and a subset who consented to interviews (n = 306). The Depression CARE for PATients at Home (CAREPATH) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted telephone conferences with team supervisors every 2 weeks. Hospitalization while receiving home health services was assessed using data from the home health record. Hospitalization within 30 days of starting home health, regardless of how long recipients received home health services, was assessed using data from the home care record and research assessments. The relative hazard of being admitted to the hospital directly from home health was 35% lower within 30 days of starting home health care (hazard ratio (HR) = 0.65, P = .01) and 28% lower within 60 days (HR = 0.72, P = .03) for CAREPATH participants than for participants receiving EUC. In participants referred to home health directly from the hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, P = .001) for CAREPATH participants. Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk in older adults receiving Medicare home health nursing services. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  20. Understanding and managing risk attitude

    National Research Council Canada - National Science Library

    Hillson, David; Murray-Webster, Ruth

    2007-01-01

    ... This book highlights how risk attitude factors influence the human psyche, and carefully explains the impacts. Organisations seeking to dramatically improve the effectiveness of their risk management process will want to use this book's insights. Craig Peterson, President, PMI Risk Management SIG This book has prompted me to think more deeply as a change d...

  1. Risk management

    International Nuclear Information System (INIS)

    Magne, L.

    1999-01-01

    There is always a risk of an accident occurring at a nuclear power plant, however small. The problem lies in estimating the probability of it occurring. The method of probabilistic safety assessment provides this estimate, and by identifying the sources of potential risk, makes it possible to prevent them from occurring. It is not, however, a substitute for other decision-making processes. (author)

  2. NASA's Risk Management System

    Science.gov (United States)

    Perera, Jeevan S.

    2011-01-01

    Leadership is key to success. Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks -- risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  3. Health care operations management

    NARCIS (Netherlands)

    Carter, M.W.; Hans, Elias W.; Kolisch, R.

    2012-01-01

    Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

  4. Managing obesity in primary care.

    Science.gov (United States)

    Goldie, Christine; Brown, Jenny

    Obesity is a complex problem and often difficult to tackle in primary care. A year-long pilot of a practice nurse-led scheme that used a holistic approach towards self-care in obesity management was set up to reduce the cardiovascular risk of patients who were obese and improve their quality of life. This person-centred approach may offer an important tool in the management of these patients in the GP surgery.

  5. Failure mode and effect analysis: improving intensive care unit risk management processes.

    Science.gov (United States)

    Askari, Roohollah; Shafii, Milad; Rafiei, Sima; Abolhassani, Mohammad Sadegh; Salarikhah, Elaheh

    2017-04-18

    Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services - their frequency and severity - were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.

  6. Palliative care - managing pain

    Science.gov (United States)

    ... page, please enable JavaScript. Palliative care is a holistic approach to care that focuses on treating pain ... stressful for you and your family. But with treatment, pain can be managed. How Pain is Measured ...

  7. Audit of co-management and critical care outreach for high risk postoperative patients (The POST audit).

    Science.gov (United States)

    Story, D A; Shelton, A; Jones, D; Heland, M; Belomo, R

    2013-11-01

    Co-management and critical care outreach for high risk surgical patients have been proposed to decrease postoperative complications and mortality. We proposed that a clinical project with postoperative comanagement and critical care outreach, the Post Operative Surveillance Team: (POST), would be associated with decreased hospital length of stay. We conducted a retrospective before (control group) and after (POST group) audit of this hospital program. POST was staffed for four months in 2010 by two intensive care nurses and two senior registrars who conducted daily ward rounds for the first five postoperative days on high risk patients undergoing inpatient general or urological surgery. The primary endpoint was length of hospital stay and secondary endpoints were Medical Emergency Team (MET) calls, cardiac arrests and in-hospital mortality. There were 194 patients in the POST group and 1,185 in the control group. The length of stay in the POST group, median nine days (Inter-quartile range [IQR]: 5 to 17 days), was longer than the control group, median seven days (IQR: 4 to 13 days): difference two days longer (95.0% confidence interval [95.0% CI]: 1 to 3 days longer, P audit found that the POST service was not associated with reduced length of stay. Models of co-management, different to POST, or with different performance metrics, could be tested.

  8. NASA's Risk Management System

    Science.gov (United States)

    Perera, Jeevan S.

    2013-01-01

    Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks - not just risk office personnel. Each group/department is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk informed decision making should be introduced to all levels of management. ? Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner. Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  9. Health care engineering management.

    Science.gov (United States)

    Jarzembski, W B

    1980-01-01

    Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.

  10. Comparison of Cardiovascular Risk Screening Methods and Mortality Data among Hungarian Primary Care Population: Preliminary Results of the First Government-Financed Managed Care Program.

    Science.gov (United States)

    Móczár, Csaba; Rurik, Imre

    2015-09-01

    Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the characteristics of individual primary care practices and doctors' screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.

  11. [Risk management in health care systems: the new legislative orientations in medical civil responsibility].

    Science.gov (United States)

    Tomassini, A; Signorelli, C; Colzani, E

    2004-01-01

    The recent radical change in the relationships between physicians and patients has increased the frequency of malpractice. Consequently, on one hand, many physicians got used to avoiding any possible risk of denunciation by applying the so called "defensive medicine", while on the other hand, the insurance companies raised the prices of their premiums for policies concerning civil responsibility of health operators. In order to avoid this "vicious circle", some health structures created Units for the Risk Management related to malpractice, while others took advantage of the collaboration of Associations for Patients' Rights to create database about the most frequent medical mistakes. The need for a legislative change has been accepted by the Parliament which expects with the proposal n.108 (approved in spring 2002 by the Commission for Hygiene and Health of the Senate) to attribute the civil responsibility of the physicians to the hospitals (both private and public) for which they work, to constitute a Register of experts and to accelerate the legal disputes. The problem is complex and still to be solved, but it seems that time for a strong intervention in order to improve the situation has to come.

  12. Two books on dementia care: Risk Assessment and management for living well with dementia, and Key issues in evolving dementia care

    Directory of Open Access Journals (Sweden)

    Gillian Manthorpe

    2013-05-01

    Full Text Available Risk Assessment and Management for Living Well with Dementia. Charlotte L. Clarke, Heather Wilkinson, John Keady and Catherine E. Gibb. Foreword by Murna Downs. Part of the Bradford Dementia Group Good Practice Guides series. London: Jessica Kingsley Publishers, 2011, pp. 128, ISBN: 978-1-84905-005-0Key Issues in Evolving Dementia Care. International Theory-based Policy and Practice. Edited by Anthea Innes, Fiona Kelly and Louise McCabe. Foreword by Professor June Andrews. London: Jessica Kingsley Publishers, 2012, pp. 264, ISBN: 978-1-84905-242-9

  13. Gout and rheumatoid arthritis, both to keep in mind in cardiovascular risk management: A primary care retrospective cohort study.

    Science.gov (United States)

    Janssens, Hein J E M; Arts, Paul G J; Schalk, Bianca W M; Biermans, Marion C J

    2017-01-01

    To assess in one time window cardiovascular risks for both patients with gout and patients with rheumatoid arthritis in a Dutch primary care population. Retrospective matched cohort study with data from the electronic health records of 51 Dutch general practices. Participants were patients aged 30 years or older with an incident diagnosis of gout (n=2655) or rheumatoid arthritis (n=513), and matched non-disease controls (n=7891 and n=1850 respectively). At disease incidence date, patients and controls were compared for prevalence of hypertension, diabetes mellitus, hypercholesterolemia, and prior cardiovascular diseases. Patients without prior cardiovascular disease were followed for a first cardiovascular disease, and compared to controls using Kaplan-Meier survival curves and Cox proportional hazard analyses. Compared to controls, gout patients suffered more from hypertension (44.8%), diabetes (20.1%), hypercholesterolemia (13.7%), and prior cardiovascular disease (30%) (P0.05). After adjustment, both gout and rheumatoid arthritis patients without prior cardiovascular disease were more likely to get a cardiovascular disease: hazard ratio (95% confidence interval) 1.44 (1.18 to 1.76), and 2.06 (1.34 to 3.16) respectively. This primary care study indicates that gout and rheumatoid arthritis are both independent risk factors for cardiovascular diseases, rheumatoid arthritis to some greater extent, whereas gout patients at first diagnosis had already an increased cardiovascular risk profile. It gives strong arguments for implementation of both rheumatic diseases in primary care guidelines on cardiovascular risk management. Copyright © 2016 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  14. Enterprise risk management

    Energy Technology Data Exchange (ETDEWEB)

    Eaton, C. [Enbridge, Calgary, AB (Canada)

    2015-07-01

    Enterprise risk management (ERM) is a relative new, holistic and strategic approach for managing risks in modern organizations. ERM builds on and extends traditional risk management (RM). Risk is the effect of uncertainty on objectives - positive and/or negative. Risk management is a set of practices used to understand and address risk. ERM is a form of RM that emphasizes risk aggregation and integration. Risk aggregation is combining individual risks into categories ({sup r}olled up{sup )}. risk integration is embedding RM into organizational contexts ({sup b}uilt in{sup )}.

  15. Innovations in Quantitative Risk Management

    CERN Document Server

    Scherer, Matthias; Zagst, Rudi

    2015-01-01

    Quantitative models are omnipresent –but often controversially discussed– in todays risk management practice. New regulations, innovative financial products, and advances in valuation techniques provide a continuous flow of challenging problems for financial engineers and risk managers alike. Designing a sound stochastic model requires finding a careful balance between parsimonious model assumptions, mathematical viability, and interpretability of the output. Moreover, data requirements and the end-user training are to be considered as well. The KPMG Center of Excellence in Risk Management conference Risk Management Reloaded and this proceedings volume contribute to bridging the gap between academia –providing methodological advances– and practice –having a firm understanding of the economic conditions in which a given model is used. Discussed fields of application range from asset management, credit risk, and energy to risk management issues in insurance. Methodologically, dependence modeling...

  16. Project Risk Management

    Science.gov (United States)

    Jr., R. F. Miles

    1995-01-01

    Project risk management is primarily concerned with performance, reliability, cost, and schedule. Environmental risk management is primarily concerned with human health and ecological hazards and likelihoods. This paper discusses project risk management and compares it to environmental risk management, both with respect to goals and implementation. The approach of the Jet Propulsion Laboratory to risk management is presented as an example of a project risk management approach that is an extension to NASA NHB 7120.5: Management of Major System Programs and Projects.

  17. Drug utilization research and risk management

    NARCIS (Netherlands)

    Mazzaglia, Giampiero; Mol, Peter G. M.; Elseviers, Monique; Wettermark, Björn; Almarsdóttir, Anna Birna; Andersen, Morten; Benko, Ria; Bennie, Marion; Eriksson, Irene; Godman, Brian; Krska, Janet; Poluzzi, Elisabetta; Taxis, Katja; Vlahovic-Palcevski, Vera; Stichele, Robert Vander

    2016-01-01

    Good risk management requires continuous evaluation and improvement of planned activities. The evaluation impact of risk management activities requires robust study designs and carefully selected outcome measures. Key learnings and caveats from drug utilization research should be applied to the

  18. Risk management and safety

    International Nuclear Information System (INIS)

    Niehaus, F.; Novegno, A.

    1985-01-01

    Risk assessment, including probabilistic analyses, has made great progress over the past decade. In spite of the inherent uncertainties it has now become possible to utilize methods and results for decision making at various levels. This paper will, therefore, review risk management in industrial installations, risk management for energy safety policy and prospects of risk management in highly industrialized areas. (orig.) [de

  19. Usual care and management of fall risk increasing drugs in older dizzy patients in Dutch general practice

    Science.gov (United States)

    Stam, Hanneke; Harting, Thomas; van der Sluijs, Marjolijn; van Marum, Rob; van der Horst, Henriëtte; van der Wouden, Johannes C.; Maarsingh, Otto R.

    2016-01-01

    Objective For general practitioners (GPs) dizziness is a challenging condition to deal with. Data on the management of dizziness in older patients are mostly lacking. Furthermore, it is unknown whether GPs attempt to decrease Fall Risk Increasing Drugs (FRIDs) use in the management of dizziness in older patients. The aim of this study is to gain more insight into GP’s management of dizziness in older patients, including FRID evaluation and adjustment. Design Data were derived from electronic medical records, obtained over a 12-month period in 2013. Setting Forty-six Dutch general practices. Patients The study sample comprised of 2812 older dizzy patients of 65 years and over. Patients were identified using International Classification of Primary Care codes and free text. Main outcome measures Usual care was categorized into wait-and-see strategy (no treatment initiated); education and advice; additional testing; medication adjustment; and referral. Results Frequently applied treatments included a wait-and-see strategy (28.4%) and education and advice (28.0%). Additional testing was performed in 26.8%; 19.0% of the patients were referred. Of the patients 87.2% had at least one FRID prescription. During the observation period, GPs adjusted the use of one or more FRIDs for 11.7% of the patients. Conclusion This study revealed a wide variety in management strategies for dizziness in older adults. The referral rate for dizziness was high compared to prior research. Although many older dizzy patients use at least one FRID, FRID evaluation and adjustment is scarce. We expect that more FRID adjustments may reduce dizziness and dizziness-related impairment. Key PointsIt is important to know how general practitioners manage dizziness in older patients in order to assess potential cues for improvement.This study revealed a wide variety in management strategies for dizziness in older patients.There was a scarcity in Fall Risk Increasing Drug (FRID) evaluation and adjustment

  20. Contemporary Management and Control of Uncomplicated Hypertension in Canada: Insight From the Primary Care Audit of Global Risk Management (PARADIGM) Study.

    Science.gov (United States)

    Gupta, Milan; Szmitko, Paul; Singh, Narendra; Tsigoulis, Michelle; Kajil, Mahesh; Stone, James

    2015-05-01

    Although clinical practice guidelines for the management of hypertension exist in Canada, the rate of contemporary blood pressure (BP) control remains unclear. In the Primary Care Audit of Global Risk Management (PARADIGM) study, 3015 healthy, middle-aged Canadians, free of cardiovascular disease (CVD) or diabetes were evaluated. In this analysis, we characterized the CVD risk factors, treatment patterns, and BP control rates in subjects with uncomplicated hypertension. A total of 917 subjects (30.4%) had a diagnosis of hypertension. The median age was 59 ± 8 years. The mean treated systolic/diastolic BP were 134 ± 14 mm Hg/82 ± 9 mm Hg, respectively. CVD risk factors included past/current smoking (35.9%), abdominal obesity (62.5%), and dyslipidemia (59.4%). Using the Framingham Risk Score, 20.4%, 41.0%, and 38.5% of the subjects were at low, intermediate, and high risk, respectively. Of the 88% with treated hypertension, 46.9%, 38.7%, and 14.3% received 1, 2, or ≥3 drugs, respectively. The rate of BP control was 57.4% (systolic BP Risk Score, and was lower in patients with metabolic syndrome vs those without (P risk factors are prevalent in Canadians with uncomplicated hypertension. BP control was modest (57.4%) and was lowest in patients prescribed diuretic monotherapy and in those at highest CVD risk. Despite the success of national hypertension strategies, enhanced efforts are warranted to improve BP control in Canada. Copyright © 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  1. Risk factors, management and outcomes of patients admitted with near fatal asthma to a tertiary care hospital in Riyadh

    Directory of Open Access Journals (Sweden)

    Hasan M Al-Dorzi

    2014-01-01

    Conclusions: In our study, NFA risk factors were younger age and higher number of ED visits. NFA had significant morbidity. Reducing neuromuscular blockade duration during ventilator management may decrease neuromyopathy risk.

  2. Risk management at university

    OpenAIRE

    Ivanova, H.; Abramovich, S.

    2013-01-01

    This article observes the basic recommendations for the risk management system in higher education as an example Yanka Kupala State University of Grodno. Consider the risk-management standard that based in a process approach

  3. Management of business risks

    OpenAIRE

    BAZARBAY A.

    2015-01-01

    The article presents methodological ideas concerning the problem of risk management. Special attention is paid to increasing of enterprises' operating efficiency by means of risk-management system development in business organizations.

  4. Commodity risk management

    Directory of Open Access Journals (Sweden)

    Hilary Till

    2016-09-01

    Full Text Available This article discusses the practical issues involved in applying a disciplined risk management methodology to commodity futures trading. Accordingly, the paper shows how to apply methodologies derived from both conventional asset management and hedge fund management to futures trading. The article also discusses some of the risk management issues that are unique to leveraged futures trading.

  5. Certification and risk management

    International Nuclear Information System (INIS)

    Villanueva Fernandez, M.

    2015-01-01

    Nowadays more organizations are increasingly aware of the importance of properly managing the uncertainty of its activities and build competitive advantages through the identification, assessment and management of risks that they face. Risk management is also an aspect of great importance within the new version of ISO fact it is one of the most innovative and also the most laborious, because an appropriate risk management achieves expected results and customer satisfaction. In conclusion, risk management is a new field of business and can be considered a cross-cutting component for other relevant factors of organizational change management. (Author)

  6. Effectiveness of a tailored intervention to improve cardiovascular risk management in primary care: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Huntink, Elke; Heijmans, Naomi; Wensing, Michel; van Lieshout, Jan

    2013-12-17

    Cardiovascular disease (CVD) is an important worldwide cause of mortality. In The Netherlands, CVD is the leading cause of death for women and the second cause of death for men. Recommendations for diagnosis and treatment of CVD are not well implemented in primary care. In this study, we aim to examine the effectiveness of a tailored implementation program targeted at practice nurses to improve healthcare for patients with (high risk for) CVD. A two-arm cluster randomized trial is planned. We offer practice nurses a tailored program to improve adherence to six specific recommendations related to blood pressure and cholesterol target values, risk profiling and lifestyle advice. Practice nurses are offered training and feedback on their motivational interviewing technique and an e-learning program on cardiovascular risk management (CVRM). They are also advised to screen for the presence and severity of depressive symptoms in patients. We also advise practice nurses to use selected E-health options (selected websites and Twitter-consult) in patients without symptoms of depression. Patients with mild depressive symptoms are referred to a physical exercise group. We recommend referring patients with major depressive symptoms for assessment and treatment of depressive symptoms if appropriate before starting CVRM. Data from 900 patients at high risk of CVD or with established CVD will be collected in 30 general practices in several geographical areas in The Netherlands. The primary outcome measure is performance of practice nurses in CVRM and reflects application of recommendations for personalized counselling and education of CVRM patients. Patients' health-related lifestyles (physical exercise, diet and smoking status) will be measured with validated questionnaires and medical record audit will be performed to document estimated CVD risk. Additionally, we will survey and interview participating healthcare professionals for exploration of processes of change. The control

  7. [Global risk management].

    Science.gov (United States)

    Sghaier, W; Hergon, E; Desroches, A

    2015-08-01

    Risk management is a fundamental component of any successful company, whether it is in economic, societal or environmental aspect. Risk management is an especially important activity for companies that optimal security challenge of products and services is great. This is the case especially for the health sector institutions. Risk management is therefore a decision support tool and a means to ensure the sustainability of an organization. In this context, what methods and approaches implemented to manage the risks? Through this state of the art, we are interested in the concept of risk and risk management processes. Then we focus on the different methods of risk management and the criteria for choosing among these methods. Finally we highlight the need to supplement these methods by a systemic and global approach including through risk assessment by the audits. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  8. Jumping off and being careful: children's strategies of risk management in everyday life

    DEFF Research Database (Denmark)

    Christensen, Pia Haudrup; Mikkelsen, Miguel Romero

    2008-01-01

    and games and routine pushing and shoving at school. In looking after themselves, children negotiate rules of participation and they safeguard personal and collective interests. Gender differences in these processes are addressed and discussed. The article argues that risk engagement is an important...

  9. Agile risk management

    CERN Document Server

    Moran, Alan

    2014-01-01

    This work is the definitive guide for IT managers and agile practitioners. It elucidates the principles of agile risk management and how these relate to individual projects. Explained in clear and concise terms, this synthesis of project risk management and agile techniques is illustrated using the major methodologies such as XP, Scrum and DSDM.Although the agile community frequently cites risk management, research suggests that risk is often narrowly defined and, at best, implicitly treated, which in turn leads to an inability to make informed decisions concerning risk and reward and a poor u

  10. Risk management in Takaful

    OpenAIRE

    Akhter, Waheed

    2010-01-01

    Risk management is of vital importance in Islam and Takāful provides a way to manage risks in business according to Sharī’ah principles. This research paper attempts to identify various types of risks involved in Takāful business that affect operational and investment functions of Takāful operators across the globe. It lays down criteria for Takāful operator to manage those risks effectively. However, Takāful operators often face difficulty in managing market and credit risks as Sharī’ah comp...

  11. Financial Risk Management

    OpenAIRE

    Catalin-Florinel Stanescu; Laurentiu Mircea Simion

    2011-01-01

    Concerns about the financial risk is increasing. In this climate, companies of all types and sizes want a robust framework for financial risk management to meet compliance requirements, contribute to better decision making and increase performance. Financial risk management professionals working with financial institutions and other corporate clients to achieve these objectives.

  12. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

    Directory of Open Access Journals (Sweden)

    Sylvie Provost

    2017-04-01

    Full Text Available Introduction: Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. Methods: We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. Results: A total of 1689 patients took part in the study (60.1% participation rate. Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992, we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Conclusion: Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

  13. Implementation of an integrated primary care cardiometabolic risk prevention and management network in Montréal: does greater coordination of care with primary care physicians have an impact on health outcomes?

    Science.gov (United States)

    Provost, Sylvie; Pineault, Raynald; Grimard, Dominique; Pérez, José; Fournier, Michel; Lévesque, Yves; Desforges, Johanne; Tousignant, Pierre; Borgès Da Silva, Roxane

    2017-04-01

    Chronic disease management requires substantial services integration. A cardiometabolic risk management program inspired by the Chronic Care Model was implemented in Montréal for patients with diabetes or hypertension. One of this study's objectives was to assess the impact of care coordination between the interdisciplinary teams and physicians on patient participation in the program, lifestyle improvements and disease control. We obtained data on health outcomes from a register of clinical data, questionnaires completed by patients upon entry into the program and at the 12-month mark, and we drew information on the program's characteristics from the implementation analysis. We conducted multiple regression analyses, controlling for patient sociodemographic and health characteristics, to measure the association between interdisciplinary team coordination with primary care physicians and various health outcomes. A total of 1689 patients took part in the study (60.1% participation rate). Approximately 40% of patients withdrew from the program during the first year. At the 12-month follow-up (n = 992), we observed a significant increase in the proportion of patients achieving the various clinical targets. The perception by the interdisciplinary team of greater care coordination with primary care physicians was associated with increased participation in the program and the achievement of better clinical results. Greater coordination of patient services between interdisciplinary teams and primary care physicians translates into benefits for patients.

  14. When bad things happen: adverse event reporting and disclosure as patient safety and risk management tools in the neonatal intensive care unit.

    Science.gov (United States)

    Donn, Steven M; McDonnell, William M

    2012-01-01

    The Institute of Medicine has recommended a change in culture from "name and blame" to patient safety. This will require system redesign to identify and address errors, establish performance standards, and set safety expectations. This approach, however, is at odds with the present medical malpractice (tort) system. The current system is outcomes-based, meaning that health care providers and institutions are often sued despite providing appropriate care. Nevertheless, the focus should remain to provide the safest patient care. Effective peer review may be hindered by the present tort system. Reporting of medical errors is a key piece of peer review and education, and both anonymous reporting and confidential reporting of errors have potential disadvantages. Diagnostic and treatment errors continue to be the leading sources of allegations of malpractice in pediatrics, and the neonatal intensive care unit is uniquely vulnerable. Most errors result from systems failures rather than human error. Risk management can be an effective process to identify, evaluate, and address problems that may injure patients, lead to malpractice claims, and result in financial losses. Risk management identifies risk or potential risk, calculates the probability of an adverse event arising from a risk, estimates the impact of the adverse event, and attempts to control the risk. Implementation of a successful risk management program requires a positive attitude, sufficient knowledge base, and a commitment to improvement. Transparency in the disclosure of medical errors and a strategy of prospective risk management in dealing with medical errors may result in a substantial reduction in medical malpractice lawsuits, lower litigation costs, and a more safety-conscious environment. Thieme Medical Publishers, Inc.

  15. Value of risk management

    OpenAIRE

    Vik, Marie Amdal

    2012-01-01

    Master's thesis in Risk management The overall aim of this study was to discuss the validity of the hypothesis that risk management contributes with added value to projects and the enterprise holding the projects, and consequently to the enterprise’s stakeholders. To examine this hypothesis, a case study of three projects taken from the same portfolio at Statoil was selected. The projects were said to have an active risk management. Data was collected from the project’s documentation as...

  16. Supply Cain Risk Management

    OpenAIRE

    Goodwin, Les

    2011-01-01

    “The management of supply chain risk is crucial to any business, more so to Rolls Royce who face an almost doubling of load within the next 10 years. So what is supply chain risk management and how well is it deployed within an operational business of Rolls Royce? What are the tools and techniques available and what are the key issues around implementing world class supply chain risk management with a Supply Chain Unit within Rolls Royce?”

  17. Supply chain risk management

    OpenAIRE

    Christian Hollstein; Frank Himpel

    2013-01-01

    Background: Supply chain risk management increasingly gains prominence in many international industries. In order to strengthen supply chain structures, processes, and networks, adequate potentials for risk management need to be built (focus on effective logistics) and to be utilized (focus on efficient logistics). Natural-based disasters, such as the case of Fukushima, illustrate how crucial risk management is. Method: By aligning a theoretical-conceptual framework with empirical-induct...

  18. Exchange Risk Management Policy

    CERN Document Server

    2005-01-01

    At the Finance Committee of March 2005, following a comment by the CERN Audit Committee, the Chairman invited the Management to prepare a document on exchange risk management policy. The Finance Committee is invited to take note of this document.

  19. Identifying and Managing Risk.

    Science.gov (United States)

    Abraham, Janice M.

    1999-01-01

    The role of the college or university chief financial officer in institutional risk management is (1) to identify risk (physical, casualty, fiscal, business, reputational, workplace safety, legal liability, employment practices, general liability), (2) to develop a campus plan to reduce and control risk, (3) to transfer risk, and (4) to track and…

  20. Risk management overview

    International Nuclear Information System (INIS)

    McGovern, S.

    1995-01-01

    Launching of the first natural gas contract by the New York Mercantile Exchange (NYMEX) in April 1990 was a huge success which allowed natural gas to surpass crude oil as the most successful launch of any commodity contract. Despite this unprecedented initial success it must be kept in mind that in a competitive marketplace there are risks of many kinds (market risks, price risks, basis risks, currency risks and timing risks), that parties must deal with in everyday operations. The concept of risk management was defined, techniques and issues in risk management were explained, a glossary of fully explained industry terms, and basic financial tools most often used in risk management, were provided. 11 figs

  1. [The relevance of clinical risk management].

    Science.gov (United States)

    Gulino, Matteo; Vergallo, Gianluca Montanari; Frati, Paola

    2011-01-01

    Medical activity includes a risk of possible injury or complications for the patients, that should drive the Health Care Institutions to introduce and/ or improve clinical Risk management instruments. Although Italy is still lacking a National project of Clinical Risk Management, a number of efforts have been made by different Italian Regions to introduce instruments of risk management. In addition, most of National Health Care Institutions include actually a Department specifically in charge to manage the clinical risk. Despite the practical difficulties, the results obtained until now suggest that the risk management may represent a useful instrument to contribute to the reduction of errors in clinical conduct. Indeed, the introduction of adequate instruments of prevention and management of clinical risk may help to ameliorate the quality of health care Institution services.

  2. Perspectives: Intellectual Risk Management

    Science.gov (United States)

    Hall, James C.

    2013-01-01

    Ask a college administrator about students and risk management, and you're likely to get a quick and agitated speech about alcohol consumption and bad behavior or a meditation on mental health and campus safety. But in colleges and universities, we manage intellectual risk-taking too. Bring that up, and you'll probably get little out of that same…

  3. Risk Management and Simulation

    DEFF Research Database (Denmark)

    Skovmand, David

    2014-01-01

    Review of: Risk Management and Simulation / Aparna Gupta. Boca Raton, FL: CRC Press, 2013, xxix + 491 pp., $99.95(H), ISBN: 978-1-4398-3594-4.......Review of: Risk Management and Simulation / Aparna Gupta. Boca Raton, FL: CRC Press, 2013, xxix + 491 pp., $99.95(H), ISBN: 978-1-4398-3594-4....

  4. Agricultural risk management

    DEFF Research Database (Denmark)

    Lund, Mogens; Oksen, Arne; Larsen, Torben U.

    2005-01-01

    A new model for risk management in agriculture is described in the paper. The risk model is constructed as a context dependent process, which includes four main phases. The model is aimed at agricultural advisors, who wish to facilitate and disseminate risk management to farmers. It is developed...... and tested by an action research approach in an attempt to make risk management more applicable on family farms. Our obtained experiences indicate that farmers don’t apply probabilistic thinking and other concepts according to formal decision theory....

  5. Characteristics of effective health care managers.

    Science.gov (United States)

    Johnson, Sherryl W

    2005-01-01

    This article provides an overview of traditional and contemporary management theories. Concerns, characteristics, and skills of effective managers are also presented. Further, a self-assessment (survey) of 7 highly effective health care managers in a South Georgia community was conducted to determine their ratings on 6 management indices. The assessment or Scale of Transformational Leadership uses a Likert-type scale to allow for the evaluation of managers. The scale contains 6 management elements for assessment: attention, meaning, trust, self, vision, and feeling. Individual ratings and group summary skills rating are presented. Findings revealed the order of managerial importance of the elements as follows (from highest to lowest): Management of Trust, Management of Attention, Management of Self, Management of Feeling, Management of Meaning, and Management of Risk. As a second tier, the final ratings are corroborated by health care management interns.

  6. Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

    Science.gov (United States)

    Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

    2016-01-01

    OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

  7. The management object in risk management approaches

    OpenAIRE

    Christiansen, Ulrik

    2013-01-01

    Using a systematic review of the last 55 years of research within risk management this paper explores how risk management as a management technology (methodologies, tools and frameworks to mitigate or manage risks) singles out risks as an object for management in order to make action possible. The paper synthesise by developing a framework of how different views on risk management enable and constrain the knowledge about risk and thus frame the possibilities to measure, analyse an...

  8. Individual Property Risk Management

    Directory of Open Access Journals (Sweden)

    Michael S. Finke

    2010-01-01

    Full Text Available This paper reviews household property risk management and estimates normatively optimal choice under theoretical assumptions. Although risk retention limits are common in the financial planning industry, estimates of optimal risk retention that include both financial and human wealth far exceed limits commonly recommended. Households appear to frame property losses differently from other wealth losses leading to wealth-reducing, excess risk transfer. Possible theoretical explanations for excess sensitivity to loss are reviewed. Differences between observed and optimal risk management imply a large potential gain from improved choice.

  9. The impact of risk management practice upon the implementation of recovery-oriented care in community mental health services: a qualitative investigation.

    Science.gov (United States)

    Holley, Jessica; Chambers, Mary; Gillard, Steven

    2016-08-01

    Recovery-oriented care has become guiding principle for mental health policies and practice in the UK and elsewhere. However, a pre-existing culture of risk management practice may impact upon the provision of recovery-oriented mental health services. To explore how risk management practice impacts upon the implementation of recovery-oriented care within community mental health services. Semi-structured interviews using vignettes were conducted with eight mental health worker and service user dyads. Grounded theory techniques were used to develop explanatory themes. Four themes arose: (1) recovery and positive risk taking; (2) competing frameworks of practice; (3) a hybrid of risk and recovery; (4) real-life recovery in the context of risk. In abstract responses to the vignettes, mental health workers described how they would use a positive-risk taking approach in support of recovery. In practice, this was restricted by a risk-averse culture embedded within services. Mental health workers set conditions with which service users complied to gain some responsibility for recovery. A lack of strategic guidance at policy level and lack of support and guidance at practice level may result in resistance to implementing ROC in the context of RMP. Recommendations are made for policy, training and future research.

  10. Cardiovascular risk management of different ethnic groups with type 2 diabetes in primary care in New Zealand.

    Science.gov (United States)

    Elley, C Raina; Kenealy, Tim; Robinson, Elizabeth; Bramley, Dale; Selak, Vanessa; Drury, Paul L; Kerse, Ngaire; Pearson, Janet; Lay-Yee, Roy; Arroll, Bruce

    2008-03-01

    To examine cardiovascular preventive and renal protective treatment for different ethnic groups with diabetes in primary care. The study population included patients with type 2 diabetes attending an annual review in New Zealand primary care during 2004. Primary care data were linked to hospital admission data to identify previous cardiovascular disease (CVD). For those without previous CVD, 5-year cardiovascular risk was calculated. Proportions on, and predictors of appropriate treatment according to guidelines were investigated. Data were available on 29,179 patients. Maori and Pacific participants had high rates of obesity, poor glycaemic control and albuminuria. Two thirds of all participants with previous CVD (68% of Maori and 70% of Pacific) and 44% with high CVD risk received appropriate CVD treatment; 73% of Maori, 62% of Pacific and 65% of European patients with albuminuria received ACE-inhibitors. Those with high CVD risk were more likely, and those that were young were less likely, to receive anti-hypertensive and lipid-lowering treatment after controlling for other factors. Maori and Pacific people were receiving similar high rates of appropriate CVD and renal preventive drug therapy to Europeans, but their prevalence of smoking, obesity, raised HbA1c and albuminuria were substantially higher. Non-drug components of preventive care also need to be addressed to reduce major ethnic disparities in diabetes-related morbidity and mortality in New Zealand.

  11. Optimizing risk management

    International Nuclear Information System (INIS)

    Kindred, G.W.

    2000-01-01

    Commercial nuclear power plant management is focussed on the safe, efficient, economical production of electricity. To accomplish the safe aspect of the equation, risk must be determined for the operation and maintenance of the facility. To accomplish the efficient aspect of the equation, management must understand those risks and factor risk insights into their decision process. The final piece of the equation is economical which is accomplished by minimizing, plant outage durations and proper utilization of resources. Probabilistic Risk Assessment can provide the risk insights to accomplish all three; safety, efficiency, and economically. How? Safe production of electricity can be quantified by use of PRA modeling and other risk insights that can determine the core damage frequency. Efficient production of electricity can be influenced by providing management with quantified risk insights for use in decision making. And, one example of economical production of electricity is by not having over conservative deterministic based defense in depth approaches to system maintenance and availability. By using risk-informed insights nuclear safety can be quantified and risk can be managed. Confidence in this approach can be achieved by ensuring the content and quality of the PRA is standardized throughout the industry. The time has arrived for Probabilistic Risk Assessment to take an active position as a major role player in the safe, efficient, and economical operation of commercial nuclear power plants. (author)

  12. Internal Audit and Risk Management

    OpenAIRE

    Constantin Nicolae Vasile; Alexandru Georgiana

    2011-01-01

    Internal audit and risk management have the same goal: the control of risk. There are various roles for the internal audit in respect of risk management. The main limitations of internal audit in respect of risk management regards assuming risk management tasks. One of the main issues regarding risk management is to make sure that the key risks are taken into consideration and that the management and the board of the organization take action as needed. Internal audit could give advice to mana...

  13. Randomized controlled trial on cardiovascular risk management by practice nurses supported by self-monitoring in primary care

    NARCIS (Netherlands)

    Tiessen, Ans H.; Smit, Andries J.; Broer, Jan; Groenier, Klaas H.; van der Meer, Klaas

    2012-01-01

    Background: Treatment goals for cardiovascular risk management are generally not achieved. Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid. The aim of this study was to compare standard

  14. Risk Management Plan Rule

    Science.gov (United States)

    RMP implements Section 112(r) of the 1990 Clean Air Act amendments, and requires facilities that use extremely hazardous substances to develop a Risk Management Plan and revise/resubmit every five years. Find guidance, factsheets, training, and assistance.

  15. [Quality management in intensive care medicine].

    Science.gov (United States)

    Martin, J; Braun, J-P

    2013-09-01

    Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.

  16. A collaborative cardiologist-pharmacist care model to improve hypertension management in patients with or at high risk for cardiovascular disease

    Directory of Open Access Journals (Sweden)

    Irons BK

    2012-03-01

    Full Text Available Physician led collaborative drug therapy management utilizing clinical pharmacists to aid in the medication management of patients with hypertension has been shown to improve blood pressure control. With recommendations for lower blood pressures in patients with coronary artery disease, a cardiologist-pharmacist collaborative care model may be a novel way to achieve these more rigorous goals of therapy. Objective: The purpose of this project was to evaluate this type of care model in a high cardiac risk patient population. Methods: A retrospective cohort study determined the ability of a cardiologist-pharmacist care model (n=59 to lower blood pressure and achieve blood pressure goals (< 130/80 mmHg in patients with or at high risk for coronary artery disease compared to usual cardiologist care (n=58 in the same clinical setting. Results: The cardiologist-pharmacist care model showed a higher percentage of patients obtaining their goal blood pressure compared to cardiologist care alone, 49.2% versus 31.0% respectively, p=0.0456. Greater reductions in systolic blood pressure (-22 mmHg versus -12 mmHg, p=0.0077 and pulse pressure (-15 mmHg versus -7 mmHg, p=0.0153 were noted in the cardiologist-pharmacist care model. No differences in diastolic blood pressure were found. There was a shorter duration of clinic follow-up (7.0 versus 13.2 months, p=0.0013 but a higher frequency of clinic visits (10.7 versus 3.45, p<0.0001 in the cardiologist-pharmacist care model compared to usual care. The number of antihypertensive agents used did not change over the time period evaluated. Conclusion: This study suggests a team-based approach to hypertensive care using a collaborative cardiologist-pharmacist care model improves blood pressure from baseline in a high cardiac risk patient population and was more likely to obtain more stringent blood pressure goals than usual care.

  17. Financial risk management of pharmacy benefits.

    Science.gov (United States)

    Saikami, D

    1997-10-01

    Financial risk management of pharmacy benefits in integrated health systems is explained. A managed care organization should assume financial risk for pharmacy benefits only if it can manage the risk. Horizontally integrated organizations often do not have much control over the management of drug utilization and costs. Vertically integrated organizations have the greatest ability to manage pharmacy financial risk; virtual integration may also be compatible. Contracts can be established in which the provider is incentivized or placed at partial or full risk. The main concerns that health plans have with respect to pharmacy capitation are formulary management and the question of who should receive rebates from manufacturers. The components needed to managed pharmacy financial risk depend on the type of contract negotiated. Health-system pharmacists are uniquely positioned to take advantage of opportunities opening up through pharmacy risk contracting. Functions most organizations must provide when assuming pharmacy financial risk can be divided into internal and external categories. Internally performed functions include formulary management, clinical pharmacy services and utilization management, and utilization reports for physicians. Functions that can be outsourced include claims processing and administration, provider- and customer support services, and rebates. Organizations that integrate the pharmacy benefit across the health care continuum will be more effective in controlling costs and improving outcomes than organizations that handle this benefit as separate from others. Patient care should not focus on payment mechanisms and unit costs but on developing superior processes and systems that improve health care.

  18. Making Risk Management Strategic

    DEFF Research Database (Denmark)

    Sax, Johanna; Andersen, Torben Juul

    2018-01-01

    Enterprise risk management (ERM) is an established management practice and is increasing in prominence as more firms spend substantial resources implementing ERM frameworks, partially induced by regulatory requirements. Yet, there is a lack of knowledge as to whether such frameworks add value and...... outcomes. The study develops a new multidimensional measure of adherence to ERM practices where earlier studies typically have relied on dichotomous proxies. We discuss the implications of these findings for ERM practice and strategic management in general....

  19. Care for patients with an increased risk for cardiovascular diseases.

    OpenAIRE

    Boheemen, C. van; Geffen, K. van; Philbert, D.; Bos, M.; Dis, I. van; Strijbis, A.; Bouvy, M.; Dijk, L. van

    2010-01-01

    Background: In 2009, a national standard of care for vascular risk management (VRM) was developed. This standard, which was sent to all general practitioners (GPs), contains requirements for optimal care. One requirement is the formulation of a written individual-care plan which contains an extended description of the patient’s cardiovascular risk factors and a plan to reduce the risk. The aim of our study is to describe to what extent current care meets the requirement posed in the care stan...

  20. Effects of the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) on biomedical outcomes, observed cardiovascular events and cardiovascular risks in primary care: a longitudinal comparative study.

    Science.gov (United States)

    Jiao, Fang Fang; Fung, Colman Siu Cheung; Wong, Carlos King Ho; Wan, Yuk Fai; Dai, Daisy; Kwok, Ruby; Lam, Cindy Lo Kuen

    2014-08-21

    To assess whether the Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus (RAMP-DM) led to improvements in biomedical outcomes, observed cardiovascular events and predicted cardiovascular risks after 12-month intervention in the primary care setting. A random sample of 1,248 people with diabetes enrolled to RAMP-DM for at least 12 months was selected and 1,248 people with diabetes under the usual primary care were matched by age, sex, and HbA1c level at baseline as the usual care group. Biomedical and cardiovascular outcomes were measured at baseline and at 12-month after the enrollment. Difference-in-differences approach was employed to measure the effect of RAMP-DM on the changes in biomedical outcomes, proportion of subjects reaching treatment targets, observed and predicted cardiovascular risks. Compared to the usual care group, RAMP-DM group had lower cardiovascular events incidence (1.21% vs 2.89%, P = 0.003), and net decrease in HbA1c (-0.20%, P risks (total CVD risk, -2.06%, P risk, -1.43%, P risk, -0.71%, P risks. The RAMP-DM resulted in greater improvements in HbA1c and reduction in observed and predicted cardiovascular risks at 12 months follow-up, which indicated a risk-stratification multidisciplinary intervention was an effective strategy for managing Chinese people with diabetes in the primary care setting. ClinicalTrials.gov, NCT02034695.

  1. Governmental management of chemical risk

    International Nuclear Information System (INIS)

    Zimmerman, R.

    1990-01-01

    This book is organized under the following headings: risk management in the government context; legal and regulatory decrees and directives for managing chemical risk; incentive-based approaches for regulating risk; risk management in the federal system; and traditional approaches and new initiatives for managing chemical risk

  2. Risk management versus incentives

    International Nuclear Information System (INIS)

    Aven, E.; Lovas, K.; Osmundsen, P.

    2006-01-01

    Portfolio theory indicates that risk management should take place at the group level. Hedging at the project level or in the individual business areas may lead to suboptimal results. However, the efficiency of a profit centre depends on its management's being able to influence factors that are crucial to the unit's financial results. Price hedging could be one such factor. In the wider perspective, this constitutes part of the balancing between centralisation and decentralisation. This article covers important elements of risk management and incentive design. It goes on to discuss the balancing of overall risk management at the group level and incentive design in profit centres and corporate units. Throughout the article, the oil industry serves as a case. (author)

  3. Risk management guide

    International Nuclear Information System (INIS)

    Briscoe, G.J.

    1977-06-01

    Risk management requires an assessment or a knowledge of risk. This, in turn, requires identification of hazards (sources of risk) and a determination of risk (evaluation of the hazard degree). The hazard identification and risk analysis techniques presented in this Guide are, in general, based on the MORT concept that accidents result from unwanted energy flow in the absence of adequate controls and/or barriers. This Guide presents an analytical tree designed to prevent oversight of specific energy sources in risk identification. Hazard identification by field personnel is also discussed. Quantitative risk analysis is discussed in the following section. A method for summary of the risks for each energy classification is given. This method uses a graphical log-normal projection so that low probability events, which are not adequately represented in the experience data, are included in the risk assessment. This permits a more acceptable risk assessment since catastrophes are not ignored, even though the actual risk is only approximated. In addition, a few examples of risk analysis of specific hazards are given. Rudimentary probability and fault tree theory are used in these examples. Total risk assessment and resource allocation and safety performance trend analysis are discussed

  4. Evaluation of the quality of care of a multi-disciplinary risk factor assessment and management programme (RAMP for diabetic patients

    Directory of Open Access Journals (Sweden)

    Fung Colman SC

    2012-12-01

    Full Text Available Abstract Background Type 2 Diabetes Mellitus (DM is a common chronic disease associated with multiple clinical complications. Management guidelines have been established which recommend a risk-stratified approach to managing these patients in primary care. This study aims to evaluate the quality of care (QOC and effectiveness of a multi-disciplinary risk assessment and management programme (RAMP for type 2 diabetic patients attending government-funded primary care clinics in Hong Kong. The evaluation will be conducted using a structured and comprehensive evidence-based evaluation framework. Method/design For evaluation of the quality of care, a longitudinal study will be conducted using the Action Learning and Audit Spiral methodologies to measure whether the pre-set target standards for criteria related to the structure and process of care are achieved. Each participating clinic will be invited to complete a Structure of Care Questionnaire evaluating pre-defined indicators which reflect the setting in which care is delivered, while process of care will be evaluated against the pre-defined indicators in the evaluation framework. Effectiveness of the programme will be evaluated in terms of clinical outcomes, service utilization outcomes, and patient-reported outcomes. A cohort study will be conducted on all eligible diabetic patients who have enrolled into RAMP for more than one year to compare their clinical and public service utilization outcomes of RAMP participants and non-participants. Clinical outcome measures will include HbA1c, blood pressure (both systolic and diastolic, lipids (low-density lipoprotein cholesterol and future cardiovascular diseases risk prediction; and public health service utilization rate will include general and specialist outpatient, emergency department attendances, and hospital admissions annually within 5 years. For patient-reported outcomes, a total of 550 participants and another 550 non-participants will be

  5. Managing Risk and Opportunity

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Garvey, Maxine; Roggi, Oliviero

    outcomes. This topic is timely and of interest both to the academic community as well as to practicing managers, executives, and directors. The volume focuses on contemporary risk leadership issues based on recent research insights but avoids excessive technical language and mathematical formulas. The book...... is framed around the challenges imposed on executives and directors in dealing with an increasingly complex and unpredictable world. This requires a new risk leadership focus that not only avoids the downside risks but also considers ways to exploit the upside potential offered by a dynamic environment....... The underlying logic is built on the principles of financial economics where benefits derive from reducing bankruptcy costs and increasing future cash inflows. This provides a stringent framework for analyzing the effect of different risk management actions and behaviors in effective risk-taking organizations...

  6. Air quality risk management.

    Science.gov (United States)

    Williams, Martin L

    2008-01-01

    Rather than attempt to provide a comprehensive account of air quality risk assessment, as might be found in a textbook or manual, this article discusses some issues that are of current importance in the United Kingdom and the rest of Europe, with special emphasis on risk assessment in the context of policy formulation, and emerging scientific knowledge. There are two pollutants of particular concern and that both pose challenges for risk assessment and policy, and they are particulate matter (PM) and ozone. The article describes some issues for health risk assessment and finally some forward-looking suggestions for future approaches to air quality management.

  7. Managing power risk

    International Nuclear Information System (INIS)

    Rudd, D.C.

    1999-01-01

    Issues regarding the management of financial risks in the electric power market were discussed. The nature of the risk was defined for electricity producers, local utilities, traders/dealers, and brokers, each of which are exposed to different types of risks with the exception of credit risk, which is common to all. The main features of options, swaps, CFDs, bilateral financial contracts, futures contracts and the terms of the NYMEX electricity contract were outlined. Basic derivative strategies, the role of the broker, the elements of emissions trading, and trading strategies for consumers were also explained. 3 fig

  8. QUARITE (quality of care, risk management and technology in obstetrics: a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali

    Directory of Open Access Journals (Sweden)

    Gaye Alioune

    2009-09-01

    Full Text Available Abstract Background Maternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel. Methods/Design This is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1 Educational outreach visits; and 2 the implementation of facility-based maternal death reviews. The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all

  9. QUARITE (quality of care, risk management and technology in obstetrics): a cluster-randomized trial of a multifaceted intervention to improve emergency obstetric care in Senegal and Mali.

    Science.gov (United States)

    Dumont, Alexandre; Fournier, Pierre; Fraser, William; Haddad, Slim; Traore, Mamadou; Diop, Idrissa; Gueye, Mouhamadou; Gaye, Alioune; Couturier, François; Pasquier, Jean-Charles; Beaudoin, François; Lalonde, André; Hatem, Marie; Abrahamowicz, Michal

    2009-09-18

    Maternal and perinatal mortality are major problems for which progress in sub-Saharan Africa has been inadequate, even though childbirth services are available, even in the poorest countries. Reducing them is the aim of two of the main Millennium Development Goals. Many initiatives have been undertaken to remedy this situation, such as the Advances in Labour and Risk Management (ALARM) International Program, whose purpose is to improve the quality of obstetric services in low-income countries. However, few interventions have been evaluated, in this context, using rigorous methods for analyzing effectiveness in terms of health outcomes. The objective of this trial is to evaluate the effectiveness of the ALARM International Program (AIP) in reducing maternal mortality in referral hospitals in Senegal and Mali. Secondary goals include evaluation of the relationships between effectiveness and resource availability, service organization, medical practices, and satisfaction among health personnel. This is an international, multi-centre, controlled cluster-randomized trial of a complex intervention. The intervention is based on the concept of evidence-based practice and on a combination of two approaches aimed at improving the performance of health personnel: 1) Educational outreach visits; and 2) the implementation of facility-based maternal death reviews. The unit of intervention is the public health facility equipped with a functional operating room. On the basis of consent provided by hospital authorities, 46 centres out of 49 eligible were selected in Mali and Senegal. Using randomization stratified by country and by level of care, 23 centres will be allocated to the intervention group and 23 to the control group. The intervention will last two years. It will be preceded by a pre-intervention one-year period for baseline data collection. A continuous clinical data collection system has been set up in all participating centres. This, along with the inventory of

  10. Operations management in health care.

    Science.gov (United States)

    Henderson, M D

    1995-01-01

    Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

  11. Management of radiation risk

    International Nuclear Information System (INIS)

    Hubert, P.

    1996-01-01

    The need to control the risk from ionizing radiation can be tracked back to the eve of the twentieth century. However, as knowledge improved and practices expanded, the approaches to this control have evolved. No longer is the mere respect of some forms of exposure limits or safety related standards sufficient. Rather, it is widely admitted that there is a need for managing radiation risk, both by balancing the advantages and disadvantages of enhancing protection and by setting up a proper organization that allows handling of the risk. This paper describes the multiple aspects of radiation risk management and points out the main related issues. It critically analyzes ALARA and ICRP recommendations. 74 refs, 8 figs, 5 tabs

  12. Assessing the effect of increased managed care on hospitals.

    Science.gov (United States)

    Mowll, C A

    1998-01-01

    This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

  13. Managing Chemical & Material Risks

    Science.gov (United States)

    2011-12-01

    Certification Program Acquisition, Technology and Logistics 9 DoD Hexavalent Chromium Risk Reduction Non- Chrome Primer II EXAVAJ ENT CHROM lrUMI...Royal Demolition eXplosive (RDX) • Cyclotrimethylenetrinitramine  Hexavalent Chromium (Cr6+) Naphthalene …pending downgrade to watch list Beryllium...T1me (secondo) 700 Acquisition, Technology and Logistics 10 Hexavalent Chromium Risk Management Actions • DoD minimization policy signed April

  14. Managing risk at Hanford

    International Nuclear Information System (INIS)

    Hesser, W.A.; Stillwell, W.G.; Rutherford, W.A.

    1994-01-01

    Clearly, there is sufficient motivation from Washington for the Hanford community to pay particular attention to the risks associated with the substantial volumes of radiological, hazardous, and mixed waste at Hanford. But there is also another reason for emphasizing risk: Hanford leaders have come to realize that their decisions must consider risk and risk reduction if those decisions are to be technically sound, financially affordable, and publicly acceptable. The 560-square miles of desert land is worth only a few thousand dollars an acre (if that) -- hardly enough to justify the almost two billion dollars that will be spent at Hanford this year. The benefit of cleaning up the Hanford Site is not the land but the reduction of potential risk to the public and the environment for future generations. If risk reduction is our ultimate goal, decisions about priority of effort and resource allocation must consider those risks, now and in the future. The purpose of this paper is to describe how Hanford is addressing the issues of risk assessment, risk management, and risk-based decision making and to share some of our experiences in these areas

  15. Investigation of risk management auditing

    International Nuclear Information System (INIS)

    Cao Lu

    2012-01-01

    2004, COSO published 'Enterprise Risk Management Framework', 2009, SASAC issued the 'central enterprise-wide risk management guidelines' to promote risk management within the formal state-owned enterprises in medium and large. Nuclear Group, which risk management in all branches to carry out the project homeopathic, and A Ⅱ will carry out risk management program as the first unit has accumulated more experience. This article from the perspective of internal control, based on the company's risk management practices carried out to try for the nuclear power enterprise risk management audit to describe and propose new ideas. Which expounds the significance of risk management, audit, risk management audit of the ways and means, for practical application of risk management audit of a representative summary of the issues and the ways and means to solve the problem of forward-looking recommendations. (authors)

  16. Managing Risk and Opportunity

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Garvey, Maxine; Roggi, Oliviero

    outcomes. This topic is timely and of interest both to the academic community as well as to practicing managers, executives, and directors. The volume focuses on contemporary risk leadership issues based on recent research insights but avoids excessive technical language and mathematical formulas. The book...... is framed around the challenges imposed on executives and directors in dealing with an increasingly complex and unpredictable world. This requires a new risk leadership focus that not only avoids the downside risks but also considers ways to exploit the upside potential offered by a dynamic environment...

  17. Risk management in customs control

    OpenAIRE

    Drobot, Elena; Klevleeva, Aziza

    2016-01-01

    The particularities of risk-management system implementation within customs control are discussed in the article. The authors single out the elements of risk-management system, evaluate effectiveness of risk-management in customs control. The main reasons for non-implementation of risk-management system in customs control are described, as well. Particular attention is paid to the benefits of customs risk management.

  18. Risk management in nuclear projects

    International Nuclear Information System (INIS)

    Salles, Claudio J.R.

    2002-01-01

    The risk management will be defined by different aspects: danger or loss possibility, or responsibility for damage. The risk management is one stage of project management. The risk management is a continuous process of planning, identification, quantification, answer and risk control to maximize the success potential of activity. The reduction of risk is part of priority establishment. This work will indicate how introduce this important instrument in the management of nuclear projects. (author)

  19. The Management Object in Risk Management Approaches

    DEFF Research Database (Denmark)

    Christiansen, Ulrik

    Using a systematic review of the last 55 years of research within risk management this paper explores how risk management as a management technology (methodologies, tools and frameworks to mitigate or manage risks) singles out risks as an object for management in order to make action possible....... The paper synthesise by developing a framework of how different views on risk management enable and constrain the knowledge about risk and thus frame the possibilities to measure, analyse and calculate uncertainty and risk. Inspired by social studies of finance and accounting, the paper finally develops...... three propositions that illustrate how the framing of risk establishes a boundary for how managers might understand value creation and the possible future and how this impacts the possible responses to risk....

  20. Risk of Nonfatal Stroke in Type 2 Diabetes Mellitus Patients: A Retrospective Comparison Between Disease Management Programs and Standard Care.

    Science.gov (United States)

    Wiefarn, Stefan; Heumann, Christian; Rettelbach, Anja; Kostev, Karel

    2017-07-01

    The present retrospective study examines the influence of disease management programs on nonfatal stroke in type 2 diabetes mellitus (T2DM) patients in Germany. The evaluation is based on retrospective patient data from the Disease Analyzer (IMS Health). The analysis included 169 414 T2DM patients aged 40 years and older with an initial prescription of antihyperglycemic therapy between January 2004 and December 2014. A total of 86 713 patients participated in a disease management program (DMP) for T2DM and 82 701 patients received standard care. The main outcome measure of this study was nonfatal stroke. Kaplan-Meier curves of DMP and SC patients were compared using log rank test. The Cox proportional hazards model was used to provide an adjusted estimate of the DMP effect. It is apparent from the baseline characteristics that the general health of patients receiving standard care was poorer than that of patients participating in a DMP. The baseline HbA1c value was 7.6% in the DMP group and 7.8% in the SC group. Furthermore, the SC group had a higher proportion of preexisting conditions, such as coronary heart disease (CHD), peripheral arterial occlusive disease (pAOD), and renal insufficiency. The proportion of patients who received insulin in first year therapy was higher in the SC group. Time to event analysis showed that DMP was associated with a delayed occurrence of stroke, because stroke occurred an average of 350 days later in DMP patients than in patients receiving SC (DMP: 1.216 days, RV: 866 days). The Cox model with covariable adjustment confirmed the significant association of DMPs with nonfatal stroke in patients with type 2 diabetes mellitus (HR 0.71; 95% CI: 0.69-0.74). The present study indicates that DMPs are positively associated with stroke. The possible reasons for this must be verified in further studies.

  1. Continuous Risk Management: An Overview

    Science.gov (United States)

    Rosenberg, Linda; Hammer, Theodore F.

    1999-01-01

    Software risk management is important because it helps avoid disasters, rework, and overkill, but more importantly because it stimulates win-win situations. The objectives of software risk management are to identify, address, and eliminate software risk items before they become threats to success or major sources of rework. In general, good project managers are also good managers of risk. It makes good business sense for all software development projects to incorporate risk management as part of project management. The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to implement risk management. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This is an introductory tutorial to continuous risk management based on this course. The rational for continuous risk management and how it is incorporated into project management are discussed. The risk management structure of six functions is discussed in sufficient depth for managers to understand what is involved in risk management and how it is implemented. These functions include: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  2. Risk Management of NASA Projects

    Science.gov (United States)

    Sarper, Hueseyin

    1997-01-01

    Various NASA Langley Research Center and other center projects were attempted for analysis to obtain historical data comparing pre-phase A study and the final outcome for each project. This attempt, however, was abandoned once it became clear that very little documentation was available. Next, extensive literature search was conducted on the role of risk and reliability concepts in project management. Probabilistic risk assessment (PRA) techniques are being used with increasing regularity both in and outside of NASA. The value and the usage of PRA techniques were reviewed for large projects. It was found that both civilian and military branches of the space industry have traditionally refrained from using PRA, which was developed and expanded by nuclear industry. Although much has changed with the end of the cold war and the Challenger disaster, it was found that ingrained anti-PRA culture is hard to stop. Examples of skepticism against the use of risk management and assessment techniques were found both in the literature and in conversations with some technical staff. Program and project managers need to be convinced that the applicability and use of risk management and risk assessment techniques is much broader than just in the traditional safety-related areas of application. The time has come to begin to uniformly apply these techniques. The whole idea of risk-based system can maximize the 'return on investment' that the public demands. Also, it would be very useful if all project documents of NASA Langley Research Center, pre-phase A through final report, are carefully stored in a central repository preferably in electronic format.

  3. Information Risk Management and Resilience

    Science.gov (United States)

    Dynes, Scott

    Are the levels of information risk management efforts within and between firms correlated with the resilience of the firms to information disruptions? This paper examines the question by considering the results of field studies of information risk management practices at organizations and in supply chains. The organizations investigated differ greatly in the degree of coupling from a general and information risk management standpoint, as well as in the levels of internal awareness and activity regarding information risk management. The comparison of the levels of information risk management in the firms and their actual or inferred resilience indicates that a formal information risk management approach is not necessary for resilience in certain sectors.

  4. Nuclear risk management

    International Nuclear Information System (INIS)

    2001-01-01

    This paper gives the list of contributions to Eurosafe 2001 which was organised around two round tables on the first day and five seminars on the second day. The first round table dealt with the technical, organisational and societal aspects of risk management aimed at the prevention of accidents in nuclear power plants. The second round table focused on radiological risks from the normal operation of nuclear installations. Special consideration has been given to the involvement of stakeholders. The five seminars were held in order to provide opportunities for comparing experiences and learning about recent activities of IRSN, GRS and their partners in the European Union and Eastern Europe: - Safety assessment and analysis of nuclear installations; -Nuclear safety research; -Environment and radiation protection; - Waste management; - Nuclear material security. (author)

  5. Nuclear risk management

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    This paper gives the list of contributions to Eurosafe 2001 which was organised around two round tables on the first day and five seminars on the second day. The first round table dealt with the technical, organisational and societal aspects of risk management aimed at the prevention of accidents in nuclear power plants. The second round table focused on radiological risks from the normal operation of nuclear installations. Special consideration has been given to the involvement of stakeholders. The five seminars were held in order to provide opportunities for comparing experiences and learning about recent activities of IRSN, GRS and their partners in the European Union and Eastern Europe: - Safety assessment and analysis of nuclear installations; -Nuclear safety research; -Environment and radiation protection; - Waste management; - Nuclear material security. (author)

  6. Credit risk management in banks

    OpenAIRE

    Pětníková, Tereza

    2014-01-01

    The subject of this diploma thesis is managing credit risk in banks, as the most significant risk faced by banks. The aim of this work is to define the basic techniques, tools and methods that are used by banks to manage credit risk. The first part of this work focuses on defining these procedures and describes the entire process of credit risk management, from the definition of credit risk, describing credit strategy and policy, organizational structure, defining the most used credit risk mi...

  7. Professional management for eye care

    Directory of Open Access Journals (Sweden)

    AK Sivakumar

    2006-09-01

    Full Text Available IntroductionThe global initiative VISION 2020: The Right to Sight, estimates that only 25 per cent of existing infrastructure is used for eye care, while the target utilisation is set at 90 per cent. This requires a complete reorganisation. Many providers have the potential to significantly enhance their service by adopting professional management practice and new technologies in clinical services. This article addresses this opportunity from a professional management perspective.The responsibilities of a hospital administrator could be broadly classified as managing patient care, functional areas, support services, and developmental work. Eye care providers need to focus on four key areas. Strategic management to enhance the efficiency of their organisations requires: human resources management; quality management; marketing; and financial sustainability.

  8. Current Chemical Risk Management Activities

    Science.gov (United States)

    EPA's existing chemicals programs address pollution prevention, risk assessment, hazard and exposure assessment and/or characterization, and risk management for chemicals substances in commercial use.

  9. Managing Complex Environmental Risks

    Energy Technology Data Exchange (ETDEWEB)

    Karlsson, Mikael [Karlstad Univ. (Sweden). Dept. of Environmental Sciences

    2006-09-15

    Environmental and public health risks are often handled in a process in which experts, and sometimes policy makers, try their best to quantitatively assess, evaluate and manage risks. This approach harmonises with mainstream interpretations of sustainable development, which aim at defining a desirable relationship between human and natural systems, for instance by policies that define limit values of different forms of disturbances. However, under conditions of high scientific incertitude, diverging values and distrust, this approach is far from satisfactory. The use of cell phones, hazardous chemicals, nuclear or fossil energy systems, and modern biotechnology are examples of activities causing such risks with high complexity. Against this background, a complementary interpretation of the concept of sustainable development is suggested. This interpretation is operationalised through new formulations of three common principles for public risk management; the precautionary principle, the polluter pays principle and the principle of public participation. Implementation of these reformulated principles would challenge some foundations of present mainstream views on environmental decision-making, but would on the other hand contribute to improved practices for long-term human welfare and planetary survival (full text of contribution)

  10. Managing Complex Environmental Risks

    International Nuclear Information System (INIS)

    Karlsson, Mikael

    2006-01-01

    Environmental and public health risks are often handled in a process in which experts, and sometimes policy makers, try their best to quantitatively assess, evaluate and manage risks. This approach harmonises with mainstream interpretations of sustainable development, which aim at defining a desirable relationship between human and natural systems, for instance by policies that define limit values of different forms of disturbances. However, under conditions of high scientific incertitude, diverging values and distrust, this approach is far from satisfactory. The use of cell phones, hazardous chemicals, nuclear or fossil energy systems, and modern biotechnology are examples of activities causing such risks with high complexity. Against this background, a complementary interpretation of the concept of sustainable development is suggested. This interpretation is operationalised through new formulations of three common principles for public risk management; the precautionary principle, the polluter pays principle and the principle of public participation. Implementation of these reformulated principles would challenge some foundations of present mainstream views on environmental decision-making, but would on the other hand contribute to improved practices for long-term human welfare and planetary survival (full text of contribution)

  11. Minimal intervention dentistry: part 3. Paediatric dental care--prevention and management protocols using caries risk assessment for infants and young children.

    Science.gov (United States)

    Ramos-Gomez, F J; Crystal, Y O; Domejean, S; Featherstone, J D B

    2012-11-01

    Recent increases in caries prevalence in young children throughout the world highlight the need for a simple but effective infant oral care programme. This programme needs to include a medical disease prevention management model with an early establishment of a dental home and a treatment approach based on individual patient risk. This article presents an updated approach with practical forms and tools based on the principles of caries management by risk assessment, CAMBRA. This method will aid the general practitioner to develop and maintain a comprehensive protocol adequate for infant and young children oral care visits. Perinatal oral health is vitally important in preventing early childhood caries (ECC) in young children. Providing dental treatment to expectant mothers and their young children in a 'dual parallel track' is an effective innovative strategy and an efficient practice builder. It promotes prevention rather than intervention, and this may be the best way to achieve long-lasting oral health for young patients. General dental practice can adopt easy protocols that will promote early preventive visits and anticipatory guidance/counselling rather than waiting for the need for restorative treatment.

  12. Critical care management of acute ischemic stroke.

    Science.gov (United States)

    Coplin, William M

    2012-06-01

    Acute ischemic stroke (AIS) can have profound and devastating effects on the CNS and several other organs. Approximately 15% to 20% of patients with AIS are admitted to an intensive care unit and cared for by a multidisciplinary team. This article discusses the critical care management of patients with AIS. Patients with AIS require attention to airway, pulmonary status, blood pressure, glucose, temperature, cardiac function, and, sometimes, life-threatening cerebral edema. The lack of disease-specific data has led to numerous management approaches and limited guidance on choosing among them. Existing guidelines emphasize risk factors, prevention, natural history, and prevention of bleeding but provide little discussion of the complex critical care issues involved in caring for patients with AIS.

  13. Moral challenges in managed care

    Directory of Open Access Journals (Sweden)

    Leandri Hattingh

    2015-11-01

    Full Text Available Managed health care in South Africa is faced with complex moral challenges, where different stakeholders appeal to different ethics principles to guide decision making. The traditional bio-medical ethics principles of beneficence, non-maleficence and respect for autonomy are typically emphasised in clinical practice, while third party funders appeal to the principle of justice to guide the allocation of limited, pooled resources. Health care professionals working in managed care are particularly exposed to these conflicts, vis-à-vis incongruence between the ethics guidelines from their professional bodies and the legislation pertaining to managed care. Common understanding of the claims and responsibilities of each of the stakeholders may promote a more coherent, sustainable health care system. 

  14. Medicaid Managed Care Enrollment Report

    Data.gov (United States)

    U.S. Department of Health & Human Services — This report is composed annually and profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. This report also provides...

  15. Clinical risk assessment in intensive care unit

    Directory of Open Access Journals (Sweden)

    Saeed Asefzadeh

    2013-01-01

    Full Text Available Background: Clinical risk management focuses on improving the quality and safety of health care services by identifying the circumstances and opportunities that put patients at risk of harm and acting to prevent or control those risks. The goal of this study is to identify and assess the failure modes in the ICU of Qazvin′s Social Security Hospital (Razi Hospital through Failure Mode and Effect Analysis (FMEA. Methods: This was a qualitative-quantitative research by Focus Discussion Group (FDG performed in Qazvin Province, Iran during 2011. The study population included all individuals and owners who are familiar with the process in ICU. Sampling method was purposeful and the FDG group members were selected by the researcher. The research instrument was standard worksheet that has been used by several researchers. Data was analyzed by FMEA technique. Results: Forty eight clinical errors and failure modes identified, results showed that the highest risk probability number (RPN was in respiratory care "Ventilator′s alarm malfunction (no alarm" with the score 288, and the lowest was in gastrointestinal "not washing the NG-Tube" with the score 8. Conclusions: Many of the identified errors can be prevented by group members. Clinical risk assessment and management is the key to delivery of effective health care.

  16. Glossary of Managed Care Definitions

    Science.gov (United States)

    ... or treatment provided to a plan member. Coverage : decision making process that identifies what services or products are ... themselves and pay a monthly premium for it. Mental health care : medical ... abuse. Mixed model or network HMO : a managed care plan that ...

  17. CEA - 2014 risk management assessment

    International Nuclear Information System (INIS)

    Bonnevie, Edwige; Verwaerde, Daniel; Maillot, Bernard

    2015-06-01

    After introducing presentations of CEA managers in charge of risk management and controls, this document presents and comments the actions undertaken by the CEA and the obtained results in terms of risk management in different fields: protection and control of the environment, installation safety, health, safety and radiation protection, transport of hazardous materials, waste management, protection of sites, installations and heritage, management of emergency situations, management of legal risks, internal audits and controls. Other topics are addressed like the presentation of the risk management department, and the role of the CEA in the relationship between research and industry

  18. CEA: risk management assessment 2011

    International Nuclear Information System (INIS)

    Bigot, Bernard; Bonnevie, Edwige; Maillot, Bernard

    2012-01-01

    This report proposes a qualitative and quantitative overview of CEA activities in the field of risk management during 2011. These activities concerned the impact on the environment, the safety of installations, the management of professional risks (safety and health at work), the radiological protection of workers, the transports of hazardous materials, waste management, protection of sites, installations and heritage, the management of emergency situations, the management of law risks, controls and audits

  19. Designing the role of the embedded care manager.

    Science.gov (United States)

    Hines, Patricia; Mercury, Marge

    2013-01-01

    : The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a means to achieve this objective, health plans and health systems are moving the care manager out of a centralized location within their organizations to "embedding" them into physician offices. This move enables the care manager to work alongside the primary care physicians and their high-risk patients. This article discusses the framework for designing and implementing an embedded care manager role into a physician practice. Key elements of the program are discussed. IMPLICATIONS FOR CARE MANAGEMENT:: Historically care management has played a foundational role in improving the quality of care for individuals and populations via the efficient and effective use of resources. Now with the goals of health care reform, a successful transition from a volume-based to value-based reimbursement system requires primary care physicians to welcome care managers into their practices to improve patient care, quality, and costs through care coordination across health care settings and populations. : As patient-centered medical homes and integrated delivery systems formulate their plans for population health management, their efforts have included embedding a care manager in the primary practice setting. Having care managers embedded at the physician offices increases their ability to collaborate with the physician and their staff in the implementation and monitoring care plans for their patients. : Implementing an embedded care manager into an existing physician's practice requires the following:Although the embedded care manager is a highly evolving role, physician groups are beginning to realize the benefits from their care management collaborations. Examples cited include improved outreach and coordination, patient adherence to care plans, and improved quality of life.

  20. Risk Management in Cocurricular Activities.

    Science.gov (United States)

    Webb, Edward M.

    1988-01-01

    Discusses risk management for colleges' cocurricular activities. Discusses tort liability, contributory negligence, and assumption of risk. Provides six concrete steps for managing risks responsibly and professionally: adopting an educational mission statement, assigning risk to others, establishing safety standards, training club advisors,…

  1. Evaluation of home care management of umbilical cord stumps by ...

    African Journals Online (AJOL)

    Background: Umbilical cord care is an integral part of neonatal care in all communities and cultures and appropriate cord care reduces the risk of infection in the newborn infant. Objective: The present study assessed the home care management of the umbilical stump by the mothers at Ilesa, Southwestern Nigeria. Subjects ...

  2. Managing Corruption Risks

    DEFF Research Database (Denmark)

    Krause Hansen, Hans

    2011-01-01

    This article investigates the emerging engagement of private actors and specifically Western corporations in international anti-corruption, drawing on Foucauldian studies of governmentality. It explores this engagement as governing practices that have emanated quite independently from the inter......-state system commonly understood to be at the core of the anti-corruption regime. It demonstrates how corporate anti-corruption ties in with a relatively new way of perceiving corruption. In this framing, anti-corruption comes out as risk management, which is latched on to notions of corporate social...... responsibility and business ethics. Moreover, the constitution of corruption risk relates to the rise of new actors and networks engaged in a wider business of anti-corruption, including commercial and hybrid actors that supply corporations with managerial instruments, benchmarks for best practice, rankings...

  3. INTERNAL AUDIT AND RISK MANAGEMENT

    OpenAIRE

    Elena RUSE; Georgiana SUSMANSCHI (BADEA); Daniel DĂNECI-PĂTRĂU

    2014-01-01

    The existence of risk in economic activity can not be denied. In fact, the risk is a concept which exists in every activity, the term of risk being identified with uncertainty, respectively the (un)chance to produce an undesirable event. Internal audit and risk management aim at the same goal, namely the control of risks. Internal Audit performs several roles in risk management plan. The objectives of the internal audit function varies from company to company, but in all economic entities int...

  4. Managing Climate Change Risks

    Energy Technology Data Exchange (ETDEWEB)

    Jones, R. [CSIRO Atmospheric Research, PMB1 Aspendale, Victoria 3195 (Australia)

    2003-07-01

    Issues of uncertainty, scale and delay between action and response mean that 'dangerous' climate change is best managed within a risk assessment framework that evolves as new information is gathered. Risk can be broadly defined as the combination of likelihood and consequence; the latter measured as vulnerability to greenhouse-induced climate change. The most robust way to assess climate change damages in a probabilistic framework is as the likelihood of critical threshold exceedance. Because vulnerability is dominated by local factors, global vulnerability is the aggregation of many local impacts being forced beyond their coping ranges. Several case studies, generic sea level rise and temperature, coral bleaching on the Great Barrier Reef and water supply in an Australian catchment, are used to show how local risk assessments can be assessed then expressed as a function of global warming. Impacts treated thus can be aggregated to assess global risks consistent with Article 2 of the UNFCCC. A 'proof of concept' example is then used to show how the stabilisation of greenhouse gases can constrain the likelihood of exceeding critical thresholds at both the both local and global scale. This analysis suggests that even if the costs of reducing greenhouse gas emissions and the benefits of avoiding climate damages can be estimated, the likelihood of being able to meet a cost-benefit target is limited by both physical and socio-economic uncertainties. In terms of managing climate change risks, adaptation will be most effective at reducing vulnerability likely to occur at low levels of warming. Successive efforts to mitigate greenhouse gases will reduce the likelihood of reaching levels of global warming from the top down, with the highest potential temperatures being avoided first, irrespective of contributing scientific uncertainties. This implies that the first cuts in emissions will always produce the largest economic benefits in terms of avoided

  5. Communicating Risk to Program Managers

    Science.gov (United States)

    Shivers, C. Herbert

    2005-01-01

    Program Managers (PM) can protect program resources and improve chances of success by anticipating, understanding and managing risks. Understanding the range of potential risks helps one to avoid or manage the risks. A PM must choose which risks to accept to reduce fire fighting, must meet the expectations of stakeholders consistently, and avoid falling into costly "black holes" that may open. A good risk management process provides the PM more confidence to seize opportunities save money, meet schedule, even improve relationships with people important to the program. Evidence of managing risk and sound internal controls can mean better support from superiors for the program by building a trust and reputation from being on top of issues. Risk managers have an obligation to provide the PM with the best information possible to allow the benefits to be realized (Small Business Consortium, 2004). The Institute for Chartered Accountants in England and Wales sees very important benefits for companies in providing better information about what they do to assess and manage key business risks. Such information will: a) provide practical forward-looking information; b) reduce the cost of capital; c) encourage better risk management; and d) improve accountability for stewardship, investor protection and the usefulness of financial reporting. We are particularly convinced that enhanced risk reporting will help listed companies obtain capital at the lowest possible cost (The Institute of Chartered Accountants in England &Wales, June 2002). Risk managers can take a significant role in quantifying the success of their department and communicating those figures to executive (program) management levels while pushing for a broader risk management role. Overall, risk managers must show that risk management work matters in the most crucial place-the bottom line- as they prove risk management can be a profit center (Sullivan, 2004).

  6. Pharmacist managed diabetes and cardiovascular risk reduction clinic in kidney transplant recipients: bridging the gap in care transition.

    Science.gov (United States)

    Pinelli, Nicole R; Clark, Lindsey M; Carrington, Anne C; Carrington, Julia L; Malinzak, Lauren; Patel, Anita

    2014-12-01

    The purpose was to assess the feasibility of a care transition intervention for kidney transplant recipients (KTRs) with diabetes. Results document improved quality indicators and reduced resource utilization. These findings imply that a care transition intervention for KTRs with diabetes is feasible and associated with improved patient outcomes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Care for patients with an increased risk for cardiovascular diseases.

    NARCIS (Netherlands)

    Boheemen, C. van; Geffen, K. van; Philbert, D.; Bos, M.; Dis, I. van; Strijbis, A.; Bouvy, M.; Dijk, L. van

    2010-01-01

    Background: In 2009, a national standard of care for vascular risk management (VRM) was developed. This standard, which was sent to all general practitioners (GPs), contains requirements for optimal care. One requirement is the formulation of a written individual-care plan which contains an extended

  8. Managing information technology security risk

    Science.gov (United States)

    Gilliam, David

    2003-01-01

    Information Technology (IT) Security Risk Management is a critical task for the organization to protect against the loss of confidentiality, integrity and availability of IT resources. As systems bgecome more complex and diverse and and attacks from intrusions and malicious content increase, it is becoming increasingly difficult to manage IT security risk. This paper describes a two-pronged approach in addressing IT security risk and risk management in the organization: 1) an institutional enterprise appraoch, and 2) a project life cycle approach.

  9. Credit derivatives and risk management

    OpenAIRE

    Michael S. Gibson

    2007-01-01

    The striking growth of credit derivatives suggests that market participants find them to be useful tools for risk management. I illustrate the value of credit derivatives with three examples. A commercial bank can use credit derivatives to manage the risk of its loan portfolio. An investment bank can use credit derivatives to manage the risks it incurs when underwriting securities. An investor, such as an insurance company, asset manager, or hedge fund, can use credit derivatives to align its...

  10. Respiratory care management information systems.

    Science.gov (United States)

    Ford, Richard M

    2004-04-01

    Hospital-wide computerized information systems evolved from the need to capture patient information and perform billing and other financial functions. These systems, however, have fallen short of meeting the needs of respiratory care departments regarding work load assessment, productivity management, and the level of outcome reporting required to support programs such as patient-driven protocols. The respiratory care management information systems (RCMIS) of today offer many advantages over paper-based systems and hospital-wide computer systems. RCMIS are designed to facilitate functions specific to respiratory care, including assessing work demand, assigning and tracking resources, charting, billing, and reporting results. RCMIS incorporate mobile, point-of-care charting and are highly configurable to meet the specific needs of individual respiratory care departments. Important and substantial benefits can be realized with an RCMIS and mobile, wireless charting devices. The initial and ongoing costs of an RCMIS are justified by increased charge capture and reduced costs, by way of improved productivity and efficiency. It is not unusual to recover the total cost of an RCMIS within the first year of its operation. In addition, such systems can facilitate and monitor patient-care protocols and help to efficiently manage the vast amounts of information encountered during the practitioner's workday. Respiratory care departments that invest in RCMIS have an advantage in the provision of quality care and in reducing expenses. A centralized respiratory therapy department with an RCMIS is the most efficient and cost-effective way to monitor work demand and manage the hospital-wide allocation of respiratory care services.

  11. The Key to Risk Management: Management

    OpenAIRE

    Adrian E. Tschoegl

    2000-01-01

    The Barings, Daiwa Bank and Sumitomo Corp. financial debacles in the mid-1990s suggest that management failures rather than misfortune, errors, or complexity are a major source of the risk of financial debacles. These errors are systematic and are a concommittant of the structure of trading and of human nature. Risk management systems must take these facts into account.

  12. Risk Management in Insurance Companies

    OpenAIRE

    Yang, Xufeng

    2006-01-01

    Insurance is the uncertain business in uncertain society. Today, insures face more complex and difficult risks. Efficient risk management mechanisms are essential for the insurers. The paper is set out initially to explore UK insurance companies risk management and risk disclosure by examining companies annual report after all the listed insurance companies are required to disclose risk information in their annual report, which seeks to reflect the recent development in UK insurance companies...

  13. Information systems for risk management

    OpenAIRE

    Michael S. Gibson

    1997-01-01

    Risk management information systems are designed to overcome the problem of aggregating data across diverse trading units. The design of an information system depends on the risk measurement methodology that a firm chooses. Inherent in the design of both a risk management information system and a risk measurement methodology is a tradeoff between the accuracy of the resulting measures of risk and the burden of computing them. Technical progress will make this tradeoff more favorable over time...

  14. Framework for systematic risk management

    International Nuclear Information System (INIS)

    Knief, R.A.; Mahn, J.A.; Briant, V.S.; Lee, R.B.; Long, R.L.

    1991-01-01

    The first paper of the Symposium described GPU Nuclear's Risk Management Group (RMG) and the use of literature search and interviews in a extensive study of risk management. One of the most important goals of the study was to identify comprehensive approaches to managing risk in the nuclear and major high-technology industries. This paper discusses RMG's multi-step generic risk-management process consisting of the following steps to: identify hazards; screen hazards and identify preventive actions, including costs; evaluate hazards for severity, probable frequency, and cost of preventive actions; prioritize preventive actions (preference to high risk and low cost); implement preventive actions; monitor and provide feedback

  15. Managed care: mastering the moving parts.

    Science.gov (United States)

    Boyd, Dawn; Finman, Larry

    2010-05-01

    A hospital's success with managed care depends on how thoroughly the hospital understands its interrelated aspects, including: Managed care strategy Contract negotiations. Contract language. Key performance indicators. Modeling. Contract termination provisions. Movement from wholesale to retail health care.

  16. Trends in risk management in nuclear industry

    International Nuclear Information System (INIS)

    Kim, Inn Seock

    1996-01-01

    Safety management may be classified into three dimensions: risk management, accident management, and emergency management. This paper addresses the recent trends of safety management in nuclear industry, focussing on risk management and accident management

  17. Risk assessment and risk management in managed aquifer recharge

    CSIR Research Space (South Africa)

    Page, D

    2012-06-01

    Full Text Available This chapter presents the methodologies used for risk assessment and risk management in MAR in Australia and the European Union, qualitative and quantitative approaches adopted within the RECLAIM Water project and case studies where the outcomes...

  18. Methods of Financial Risk Management

    Directory of Open Access Journals (Sweden)

    Korzh Natalia

    2016-10-01

    Full Text Available The essence and nature of financial risks are investigated. Their classification is conducted. The features of financial risk management and the main methods of management are considered. The ways of risk compensation are identified. It is proved that the objective external risk basis is such market imperfections as externalities of enterprises and incomplete information about the operation of the business environment and internal objective basis risk – the objective function to maximise profits in a competitive environment. It is revealed that to compensate market imperfections business entities should develop a strategy that combines fill in missing information and neutralise or minimise externalities that tactically implemented in financial risk management programs.

  19. Reengineering health care materials management.

    Science.gov (United States)

    Connor, L R

    1998-01-01

    Health care executives across the country, faced with intense competition, are being forced to consider drastic cost cutting measures as a matter of survival. The entire health care industry is under siege from boards of directors, management and others who encourage health care systems to take actions ranging from strategic acquisitions and mergers to simple "downsizing" or "rightsizing," to improve their perceived competitive positions in terms of costs, revenues and market share. In some cases, management is poorly prepared to work within this new competitive paradigm and turns to consultants who promise that following their methodologies can result in competitive advantage. One favored methodology is reengineering. Frequently, cost cutting attention is focused on the materials management budget because it is relatively large and is viewed as being comprised mostly of controllable expenses. Also, materials management is seldom considered a core competency for the health care system and the organization performing these activities does not occupy a strongly defensible position. This paper focuses on the application of a reengineering methodology to healthcare materials management.

  20. IMPLEMENTING A RISK MANAGEMENT STANDARD

    Directory of Open Access Journals (Sweden)

    Constantin PREDA

    2013-01-01

    Full Text Available After risk management “conquered” more and more project managers’ minds and showed its benefits for business and programs, the need to have a global risk management standard has become a crucial issue in the world of risk management. But having a global risk management standard has been a big challenge, starting from the decision of developing the standard (March-June 2005, to the moment of publishing it, November 2009. So, developing the ISO 31000:2009 standard has been more or less like a bumpy ride. Apparently, the people involved in developing the global risk management standard understood from the very beginning that no challenges are too big, nor any tasks too small and that the task of having a new, comprehensive global risk management standard should be completed with excellence: defining the principles and the framework guiding the risk management process applicable for all type of organizations and for a wide range of activities. Coming up with a global standard should always be based on the real organizations’ needs and should fulfill real risk management requirements. The article is trying to present the pros and cons of risk management standard implementation, challenging the implementation process itself and the added value of implementing the standard due to the lack of implementation enablers, like risk culture, a real problem especially in an international environment.

  1. RISK MANAGEMENT: AN INTEGRATED APPROACH TO RISK MANAGEMENT AND ASSESSMENT

    Directory of Open Access Journals (Sweden)

    Szabo Alina

    2012-12-01

    Full Text Available Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the ‘top 8-12’ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in the area and the professional expertise, this article outlines an integrated approach to risk assessment and risk management reporting processes, by separating the risk in two main categories: strategic and operational risks. The focus is on risk prioritization and scoring; the final output will comprise a mix of strategic and operational (‘top 8-12’ risks, which should be used to establish the annual Internal Audit plan. Originality/value: By using an integrated approach to risk assessment and risk management will eliminate the need for a separate Internal Audit risk assessment over prevailing risks. It will reduce the level of risk assessment overlap by different functions (Tax, Treasury, Information System over the same risk categories as a single methodology, is used and will align timings of risk assessment exercises. The risk prioritization by usage of risk and control scoring criteria highlights the combination between financial and non-financial impact criteria allowing risks that do not naturally lend themselves to a financial amount to be also assessed consistently. It is emphasized the usage of score method to prioritize the risks included in the annual audit plan in order to increase accuracy and timelines.

  2. RISK MANAGEMENT IN CUSTOMS CONTROL

    Directory of Open Access Journals (Sweden)

    Elena Valerievna Drobot

    2017-06-01

    Full Text Available Customs administrations operating in the modern global economy are faced with a complex range of challenges. The prime responsibilities remain the collection of revenues and the protection of the society, but these demanding tasks must be performed effectively and efficiently, whilst at the same time facilitating the flow of legitimate goods. Risk management is a logical and systematic method of identifying, analyzing and managing risks. Risk management can be associated with any activity, function or process within the organization and will enable the organization to take advantage of opportunities and minimize potential losses. Minimization of the human factor in customs control through the implementation of non-intrusive inspection equipment can be very useful. The particularities of risk-management system (RMS implementation within customs control are discussed in the article. The authors single out the elements of the risk-management system, evaluate the effectiveness of risk-management in customs control. The main reasons for non-implementation of the risk-management system in customs control are described as well. The particular attention is paid to the benefits of customs risk management. The authors’ hypothesis is that risk management in customs control must find a balance between costs and benefits to address all risks equally. Criteria are needed to decide what constitutes an acceptable or unacceptable risk. Thus, system analysis and risk management system are the effective mechanisms for acceleration of customs clearance and improve the quality of customs control. As a conclusion, the authors give recommendations for the improvement of the effectiveness of risk management system in customs control.

  3. Risk management and corporate value

    Directory of Open Access Journals (Sweden)

    Milan Cupic

    2015-12-01

    Full Text Available The paper presents a theoretical framework for assessing the impact of risk management on corporate value. As the relevant factors that determine this impact, the paper analyzes market imperfections and investors’ risk aversion. The results of the present research indicate that risk management contributes to an increase in corporate value if, under the influence of market imperfections, corporate risk exposure is concave. As an expression of market imperfections, the paper analyzes the costs of financial distress, agency costs, and taxation. The results of the research also indicate that the risk management policy should not aim to minimize, but rather optimize risk exposure, by taking into account the costs of risk management, investors’ risk aversion and the competitive advantage a corporation has on the relevant market.

  4. Risk management of precious metals

    NARCIS (Netherlands)

    S.M. Hammoudeh (Shawkat); F. Malik (Farooq); M.J. McAleer (Michael)

    2010-01-01

    textabstractThis paper examines volatility and correlation dynamics in price returns of gold, silver, platinum and palladium, and explores the corresponding risk management implications for market risk and hedging. Value-at-Risk (VaR) is used to analyze the downside market risk associated with

  5. Risk Management in Logystics Chains

    OpenAIRE

    Butrin, Andrey; Vikulov, Vladimir

    2013-01-01

    Article is devoted to risk management of supply chain. The authors considered indicators of supply chain risks, including risks caused by supplier. Authors formed a method of optimizing the level of supply chain risk in the integration with suppliers and customers.

  6. Improving Information Security Risk Management

    Science.gov (United States)

    Singh, Anand

    2009-01-01

    manaOptimizing risk to information to protect the enterprise as well as to satisfy government and industry mandates is a core function of most information security departments. Risk management is the discipline that is focused on assessing, mitigating, monitoring and optimizing risks to information. Risk assessments and analyses are critical…

  7. RISKS MANAGEMENT: NEW LITERATURE REVIEW

    OpenAIRE

    Ennouri Wissem

    2013-01-01

    The complexity of the industrial activities and the important mass of flows crossing the supply chain promotes the emergence of risks that must be considered in the decision process. For this reason, we have developed this paper to clarify the basics of risk management through a short new suggestion of literature review for risk management. Our justification of this attempt is that this area is the most discussed in our days and it is impossible to present all definition of the risk concept, ...

  8. Integrated supply chain risk management

    OpenAIRE

    Riaan Bredell; Jackie Walters

    2007-01-01

    Integrated supply chain risk management (ISCRM) has become indispensable to the theory and practice of supply chain management. The economic and political realities of the modern world require not only a different approach to supply chain management, but also bold steps to secure supply chain performance and sustainable wealth creation. Integrated supply chain risk management provides supply chain organisations with a level of insight into their supply chains yet to be achieved. If correctly ...

  9. Collaborative care management effectively promotes self-management: patient evaluation of care management for depression in primary care.

    Science.gov (United States)

    DeJesus, Ramona S; Howell, Lisa; Williams, Mark; Hathaway, Julie; Vickers, Kristin S

    2014-03-01

    Chronic disease management in the primary care setting increasingly involves self-management support from a nurse care manager. Prior research had shown patient acceptance and willingness to work with care managers. This survey study evaluated patient-perceived satisfaction with care management and patient opinions on the effectiveness of care management in promoting self-management. Qualitative and quantitative survey responses were collected from 125 patients (79% female; average age 46; 94% Caucasian) enrolled in care management for depression. Qualitative responses were coded with methods of content analysis by 2 independent analysts. Patients were satisfied with depression care management. Patients felt that care management improved their treatment above and beyond other aspects of their depression treatment (mean score, 6.7 [SD, 2]; 10 = Very much), increased their understanding of depression self-management (mean score, 7.2 [SD, 2]; 10 = Very much), and increased the frequency of self-management goal setting (mean score, 6.9 [SD, 3]; 10 = Very much). Predominant qualitative themes emphasized that patients value emotional, motivational, and relational aspects of the care manager relationship. Patients viewed care managers as caring and supportive, helpful in creating accountability for patients and knowledgeable in the area of depression care. Care managers empower patients to take on an active role in depression self-management. Some logistical challenges associated with a telephonic intervention are described. Care manager training should include communication and motivation strategies, specifically self-management education, as these strategies are valued by patients. Barriers to care management, such as scheduling telephone calls, should be addressed in future care management implementation and study.

  10. Big data in health care: using analytics to identify and manage high-risk and high-cost patients.

    Science.gov (United States)

    Bates, David W; Saria, Suchi; Ohno-Machado, Lucila; Shah, Anand; Escobar, Gabriel

    2014-07-01

    The US health care system is rapidly adopting electronic health records, which will dramatically increase the quantity of clinical data that are available electronically. Simultaneously, rapid progress has been made in clinical analytics--techniques for analyzing large quantities of data and gleaning new insights from that analysis--which is part of what is known as big data. As a result, there are unprecedented opportunities to use big data to reduce the costs of health care in the United States. We present six use cases--that is, key examples--where some of the clearest opportunities exist to reduce costs through the use of big data: high-cost patients, readmissions, triage, decompensation (when a patient's condition worsens), adverse events, and treatment optimization for diseases affecting multiple organ systems. We discuss the types of insights that are likely to emerge from clinical analytics, the types of data needed to obtain such insights, and the infrastructure--analytics, algorithms, registries, assessment scores, monitoring devices, and so forth--that organizations will need to perform the necessary analyses and to implement changes that will improve care while reducing costs. Our findings have policy implications for regulatory oversight, ways to address privacy concerns, and the support of research on analytics. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Disease Management, Case Management, Care Management, and Care Coordination: A Framework and a Brief Manual for Care Programs and Staff.

    Science.gov (United States)

    Ahmed, Osman I

    2016-01-01

    With the changing landscape of health care delivery in the United States since the passage of the Patient Protection and Affordable Care Act in 2010, health care organizations have struggled to keep pace with the evolving paradigm, particularly as it pertains to population health management. New nomenclature emerged to describe components of the new environment, and familiar words were put to use in an entirely different context. This article proposes a working framework for activities performed in case management, disease management, care management, and care coordination. The author offers standard working definitions for some of the most frequently used words in the health care industry with the goal of increasing consistency for their use, especially in the backdrop of the Centers for Medicaid & Medicare Services offering a "chronic case management fee" to primary care providers for managing the sickest, high-cost Medicare patients. Health care organizations performing case management, care management, disease management, and care coordination. Road map for consistency among users, in reporting, comparison, and for success of care management/coordination programs. This article offers a working framework for disease managers, case and care managers, and care coordinators. It suggests standard definitions to use for disease management, case management, care management, and care coordination. Moreover, the use of clear terminology will facilitate comparing, contrasting, and evaluating all care programs and increase consistency. The article can improve understanding of care program components and success factors, estimate program value and effectiveness, heighten awareness of consumer engagement tools, recognize current state and challenges for care programs, understand the role of health information technology solutions in care programs, and use information and knowledge gained to assess and improve care programs to design the "next generation" of programs.

  12. Managing the risks of risk management on large fires

    Science.gov (United States)

    Donald G. MacGregor; Armando González-Cabán

    2013-01-01

    Large fires pose risks to a number of important values, including the ecology, property and the lives of incident responders. A relatively unstudied aspect of fire management is the risks to which incident managers are exposed due to organizational and sociopolitical factors that put them in a position of, for example, potential liability or degradation of their image...

  13. The Uncertainties of Risk Management

    DEFF Research Database (Denmark)

    Vinnari, Eija; Skærbæk, Peter

    2014-01-01

    for expanding risk management. More generally, such uncertainties relate to the professional identities and responsibilities of operational managers as defined by the framing devices. Originality/value – The paper offers three contributions to the extant literature: first, it shows how risk management itself......Purpose – The purpose of this paper is to analyse the implementation of risk management as a tool for internal audit activities, focusing on unexpected effects or uncertainties generated during its application. Design/methodology/approach – Public and confidential documents as well as semi......-structured interviews are analysed through the lens of actor-network theory to identify the effects of risk management devices in a Finnish municipality. Findings – The authors found that risk management, rather than reducing uncertainty, itself created unexpected uncertainties that would otherwise not have emerged...

  14. Continuous Risk Management at NASA

    Science.gov (United States)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions. This risk management structure of functions has been taught to projects at all NASA Centers and is being successfully implemented on many projects. This presentation will give project managers the information they need to understand if risk management is to be effectively implemented on their projects at a cost they can afford.

  15. DEFENSE PROGRAMS RISK MANAGEMENT FRAMEWORK

    Directory of Open Access Journals (Sweden)

    Constantin PREDA

    2012-01-01

    Full Text Available For the past years defense programs have faced delays in delivering defense capabilities and budget overruns. Stakeholders are looking for ways to improve program management and the decision making process given the very fluid and uncertain economic and political environment. Consequently, they have increasingly resorted to risk management as the main management tool for achieving defense programs objectives and for delivering the defense capabilities strongly needed for the soldiers on the ground on time and within limited defense budgets. Following a risk management based decision-making approach the stakeholders are expected not only to protect program objectives against a wide range of risks but, at the same time, to take advantage of the opportunities to increase the likelihood of program success. The prerequisite for making risk management the main tool for achieving defense programs objectives is the design and implementation of a strong risk management framework as a foundation providing an efficient and effective application of the best risk management practices. The aim of this paper is to examine the risk management framework for defense programs based on the ISO 31000:2009 standard, best risk management practices and the defense programs’ needs and particularities. For the purposes of this article, the term of defense programs refers to joint defense programs.

  16. RISK MANAGEMENT: AN INTEGRATED APPROACH TO RISK MANAGEMENT AND ASSESSMENT

    OpenAIRE

    Szabo Alina

    2012-01-01

    Purpose: The objective of this paper is to offer an overview over risk management cycle by focusing on prioritization and treatment, in order to ensure an integrated approach to risk management and assessment, and establish the ‘top 8-12’ risks report within the organization. The interface with Internal Audit is ensured by the implementation of the scoring method to prioritize risks collected from previous generated risk report. Methodology/approach: Using evidence from other research in ...

  17. NGNP Risk Management Database: A Model for Managing Risk

    International Nuclear Information System (INIS)

    Collins, John

    2009-01-01

    To facilitate the implementation of the Risk Management Plan, the Next Generation Nuclear Plant (NGNP) Project has developed and employed an analytical software tool called the NGNP Risk Management System (RMS). A relational database developed in Microsoft(reg s ign) Access, the RMS provides conventional database utility including data maintenance, archiving, configuration control, and query ability. Additionally, the tool's design provides a number of unique capabilities specifically designed to facilitate the development and execution of activities outlined in the Risk Management Plan. Specifically, the RMS provides the capability to establish the risk baseline, document and analyze the risk reduction plan, track the current risk reduction status, organize risks by reference configuration system, subsystem, and component (SSC) and Area, and increase the level of NGNP decision making.

  18. NGNP Risk Management Database: A Model for Managing Risk

    Energy Technology Data Exchange (ETDEWEB)

    John Collins

    2009-09-01

    To facilitate the implementation of the Risk Management Plan, the Next Generation Nuclear Plant (NGNP) Project has developed and employed an analytical software tool called the NGNP Risk Management System (RMS). A relational database developed in Microsoft® Access, the RMS provides conventional database utility including data maintenance, archiving, configuration control, and query ability. Additionally, the tool’s design provides a number of unique capabilities specifically designed to facilitate the development and execution of activities outlined in the Risk Management Plan. Specifically, the RMS provides the capability to establish the risk baseline, document and analyze the risk reduction plan, track the current risk reduction status, organize risks by reference configuration system, subsystem, and component (SSC) and Area, and increase the level of NGNP decision making.

  19. Optimizing diabetes management: managed care strategies.

    Science.gov (United States)

    Tzeel, E Albert

    2013-06-01

    Both the prevalence of type 2 diabetes mellitus (DM) and its associated costs have been rising over time and are projected to continue to escalate. Therefore, type 2 DM (T2DM) management costs represent a potentially untenable strain on the healthcare system unless substantial, systemic changes are made. Managed care organizations (MCOs) are uniquely positioned to attempt to make the changes necessary to reduce the burdens associated with T2DM by developing policies that align with evidence-based DM management guidelines and other resources. For example, MCOs can encourage members to implement healthy lifestyle choices, which have been shown to reduce DM-associated mortality and delay comorbidities. In addition, MCOs are exploring the strengths and weaknesses of several different benefit plan designs. Value-based insurance designs, sometimes referred to as value-based benefit designs, use both direct and indirect data to invest in incentives that change behaviors through health information technologies, communications, and services to improve health, productivity, quality, and financial trends. Provider incentive programs, sometimes referred to as "pay for performance," represent a payment/delivery paradigm that places emphasis on rewarding value instead of volume to align financial incentives and quality of care. Accountable care organizations emphasize an alignment between reimbursement and implementation of best practices through the use of disease management and/ or clinical pathways and health information technologies. Consumer-directed health plans, or high-deductible health plans, combine lower premiums with high annual deductibles to encourage members to seek better value for health expenditures. Studies conducted to date on these different designs have produced mixed results.

  20. Selecting Copulas for Risk Management

    NARCIS (Netherlands)

    H.J.W.G. Kole (Erik); C.G. Koedijk (Kees); M.J.C.M. Verbeek (Marno)

    2006-01-01

    textabstractCopulas offer financial risk managers a powerful tool to model the dependence between the different elements of a portfolio and are preferable to the traditional, correlation-based approach. In this paper we show the importance of selecting an accurate copula for risk management. We

  1. Corporate risk management : an overview

    NARCIS (Netherlands)

    Oosterhof, Casper M.

    2001-01-01

    Corporate risk management and hedging are important activities within financial as well as non-financial corporations. Under the assumptions of Modigliani and Miller [1958], corporate risk management is a redundant activity. However, the existence of market imperfections can explain the corporate

  2. The impact of managed care in dentistry.

    Science.gov (United States)

    Clouse, H R

    1999-01-01

    Managed care plans attempt to control health care expenditures aggressively. These plans directly influence access to medical care and the type, level, and frequency of care rendered. As a result, hospital stays are reduced, focus shifts from inpatient to outpatient care, and patients are responsible for a larger share of health care costs. Dentistry is not immune from the impact of managed care. The attractiveness of the dental market has drawn many managed care organizations, insurers, and entrepreneurs to encourage dentists to participate in a wide variety of managed care programs. However, the delivery of dental care differs markedly in many respects from that of medical care. Therefore, many of the cost saving aspects of managed care that have been so successful in medicine may not result in similar cost savings in dentistry.

  3. The Supply Chain Risk Management

    OpenAIRE

    Skitsko Volodymyr I.; Voynikov Mykola Yu.

    2018-01-01

    The article considers current approaches of risk-management in supply chains, the main steps of the risk management process are analyzed and detailed both for a separate enterprise – participant of supply chain, for the supply chain in general, and for the Beer game, based on the international risk management standards. The article provides a way to assess the risks of the «producer» in the Beer game according to the three strategies of its behavior, which presumably can correspond to differe...

  4. Risk management for whales

    OpenAIRE

    Cont, R; Wagalath, L

    2016-01-01

    We propose framework for modeling portfolio risk which integrates market risk with liquidation costs which may arise in stress scenarios. Our model provides a systematic method for computing liquidation-adjusted risk measures for a portfolio. Calculation of Liquidation-adjusted VaR (LVaR) for sample portfolios reveals a substantial impact of liquidation costs on portfolio risk for portfolios with large concentrated positions.

  5. Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Sedighe Moradi

    2016-01-01

    Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

  6. Business risk management

    International Nuclear Information System (INIS)

    Cosby, C.

    2015-01-01

    Bruce Power's definition: an emerging and demonstrable event or change in business plan assumptions that could impact Bruce Power's achievement of its business plan objectives and results. Risks can be either negative (threats) or positive (opportunities). Risks against the 5 year business plan Net Risk = impact * probability.

  7. Business risk management

    Energy Technology Data Exchange (ETDEWEB)

    Cosby, C., E-mail: Christine.cosby@brucepower.com [Bruce Power, Tiverton, ON (Canada)

    2015-07-01

    Bruce Power's definition: an emerging and demonstrable event or change in business plan assumptions that could impact Bruce Power's achievement of its business plan objectives and results. Risks can be either negative (threats) or positive (opportunities). Risks against the 5 year business plan Net Risk = impact * probability.

  8. Application of the analytical hierarchy process to establish health care waste management systems that minimise infection risks in developing countries

    CSIR Research Space (South Africa)

    Brent, AC

    2007-01-01

    Full Text Available (see Fig. 2), and structured into the appropriate levels (see Table 2). These hier- archy trees are shown in Figs. 3–8 of Appendix A. 4. Results of the workshops 4.1. Definitions of the hierarchical trees The definitions of each hierarchical tree....349 NEC 0.045 EL 0.200 NEL 0.028 DP 0.292 NP 0.038 Alternatives Risk factors EC + EL + DP 1.0 nEC + EL + DP 1.6 EC + nEL + DP 1.3 nEC + nEL + DP 2.3 EC + EL + nP 1.4 nEC + EL + nP 3.0 A.C. Brent et al. / European Journal of Operational Research...

  9. Managed consumerism in health care.

    Science.gov (United States)

    Robinson, James C

    2005-01-01

    The future of market-oriented health policy and practice lies in "managed consumerism," a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed competition. The optimal locus of incentives will vary among health services according to the nature of the illness, the clinical technology, and the extent of discretion in utilization. A competitive market will manifest a variety of comprehensive and limited benefit designs, broad and narrow contractual networks, and single-and multispecialty provider organizations.

  10. TRManager – Technical Risk Manager

    Directory of Open Access Journals (Sweden)

    Mark A. Gregory

    2009-06-01

    Full Text Available This paper presents research into the development of a new information management technique called Technical Risk Manager. Project management involves the use of processes and information management techniques to aid decision making in the pursuit of project success. Project success may be achieved by meeting time, cost or performance criteria. Current project management practices focus on achieving time and cost project success criteria by using three information management techniques developed in the 1950s: Gantt, PERT and Critical Path Method. Technical Risk Manager has been developed to provide an information management technique that may be used to aid project management decision making in the pursuit of achieving the performance project success criteria.

  11. Smart Grid Risk Management

    Science.gov (United States)

    Abad Lopez, Carlos Adrian

    Current electricity infrastructure is being stressed from several directions -- high demand, unreliable supply, extreme weather conditions, accidents, among others. Infrastructure planners have, traditionally, focused on only the cost of the system; today, resilience and sustainability are increasingly becoming more important. In this dissertation, we develop computational tools for efficiently managing electricity resources to help create a more reliable and sustainable electrical grid. The tools we present in this work will help electric utilities coordinate demand to allow the smooth and large scale integration of renewable sources of energy into traditional grids, as well as provide infrastructure planners and operators in developing countries a framework for making informed planning and control decisions in the presence of uncertainty. Demand-side management is considered as the most viable solution for maintaining grid stability as generation from intermittent renewable sources increases. Demand-side management, particularly demand response (DR) programs that attempt to alter the energy consumption of customers either by using price-based incentives or up-front power interruption contracts, is more cost-effective and sustainable in addressing short-term supply-demand imbalances when compared with the alternative that involves increasing fossil fuel-based fast spinning reserves. An essential step in compensating participating customers and benchmarking the effectiveness of DR programs is to be able to independently detect the load reduction from observed meter data. Electric utilities implementing automated DR programs through direct load control switches are also interested in detecting the reduction in demand to efficiently pinpoint non-functioning devices to reduce maintenance costs. We develop sparse optimization methods for detecting a small change in the demand for electricity of a customer in response to a price change or signal from the utility

  12. A Modified Behavior Risk Factor Surveillance System to Assess Diabetes Self-management Behaviors and Diabetes Care in Monterrey Mexico: A Cross-sectional Study

    Directory of Open Access Journals (Sweden)

    Francisco González-Salazar

    2017-05-01

    Full Text Available Type 2 diabetes mellitus (T2DM is one of the leading causes of death from worldwide non-communicable diseases. The prevalence of diabetes in the Mexico (MX–United States border states exceeds the national rate in both countries. The economic burden of diabetes, due to decreased productivity, disability, and medical costs, is staggering and increases significantly when T2DM-related complications occur. The purpose of this study was to use a modified behavioral risk factor surveillance system (BRFSS to describe the T2DM self-management behaviors, diabetes care, and health perception of a convenience sample of adults with T2DM in Monterrey, MX. This cross-sectional study design, with convenience sampling, was conducted with a convenience sample (n = 351 of adults in the metropolitan area of Monterrey, MX who self-reported a diagnosis of T2DM. Potential participants were recruited from local supermarkets. Twenty-six diabetes and health-related items were selected from the BRFSS and administered in face-to-face interviews by trained data collectors. Data analysis was conducted using descriptive statistics. The mean age was 47 years, and the mean length of time with T2DM was 12 years. The majority was taking oral medication and 34% required insulin. Daily self-monitoring of feet was performed by 56% of the participants; however, only 8.8% engaged in blood glucose self-monitoring. The mean number of health-care provider visits was 9.09 per year, and glycated hemoglobin level (HbA1c was assessed 2.6 times per year. Finally, only 40.5% of the participants recalled having a dilated eye exam. We conclude the modified BRFSS survey administered in a face-to-face interview format is an appropriate tool for assessing engagement in T2DM self-management behaviors, diabetes care, and health perception. Extension of the use of this survey in a more rigorous design with a larger scale survey is encouraged.

  13. INTERNAL AUDIT AND RISK MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Elena RUSE

    2014-04-01

    Full Text Available The existence of risk in economic activity can not be denied. In fact, the risk is a concept which exists in every activity, the term of risk being identified with uncertainty, respectively the (unchance to produce an undesirable event. Internal audit and risk management aim at the same goal, namely the control of risks. Internal Audit performs several roles in risk management plan. The objectives of the internal audit function varies from company to company, but in all economic entities internal audit department aims to improve performance management, enterprise performance and thus improve the internal control system. This paper aims to demonstrate, among other things, that any event that may result in failure is unquestionably classified as risk.

  14. Integrated supply chain risk management

    Directory of Open Access Journals (Sweden)

    Riaan Bredell

    2007-11-01

    Full Text Available Integrated supply chain risk management (ISCRM has become indispensable to the theory and practice of supply chain management. The economic and political realities of the modern world require not only a different approach to supply chain management, but also bold steps to secure supply chain performance and sustainable wealth creation. Integrated supply chain risk management provides supply chain organisations with a level of insight into their supply chains yet to be achieved. If correctly applied, this process may optimise management decision-making and assist in the protection and enhancement of shareholder value.

  15. Managing risk: clinical decision-making in mental health services.

    Science.gov (United States)

    Muir-Cochrane, Eimear; Gerace, Adam; Mosel, Krista; O'Kane, Debra; Barkway, Patricia; Curren, David; Oster, Candice

    2011-01-01

    Risk assessment and management is a major component of contemporary mental health practice. Risk assessment in health care exists within contemporary perspectives of management and risk aversive practices in health care. This has led to much discussion about the best approach to assessing possible risks posed by people with mental health problems. In addition, researchers and commentators have expressed concern that clinical practice is being dominated by managerial models of risk management at the expense of meeting the patient's health and social care needs. The purpose of the present study is to investigate the risk assessment practices of a multidisciplinary mental health service. Findings indicate that mental health professionals draw on both managerial and therapeutic approaches to risk management, integrating these approaches into their clinical practice. Rather than being dominated by managerial concerns regarding risk, the participants demonstrate professional autonomy and concern for the needs of their clients.

  16. Enterprise risk management and disclosure

    Directory of Open Access Journals (Sweden)

    Nicoleta Farcane

    2008-01-01

    Full Text Available Our paper deals with aspects regarding risk and uncertainty. Many risk management methods are today implemented in organizations. This perspective reveals that managers are linked in different forms to the activities they are managing, depending on the conditions and levels of uncertainty they are in. Actually, these multiple levels of uncertainty lead to the conclusion that any situation in an organizational system can be classified in two different models of organizational phenomena: the organizational phenomena that are putting managers and stakeholders in conditions of risk and the organizational phenomena that are putting them in condition of uncertainty. Using content analyze in this paper we survey the disclosure level of risk management information in the annual report of top Romanian listed companies.

  17. RISKS IN INVESTMENT AND MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Ms. Tatiana A. Ykovleva

    2016-12-01

    Full Text Available The article discusses the features of investment risks and their causes, as well as provides a detailed classification of investment risks. The authors reveal the essence and content of the investment process, risk management, providing material for presentation in the form of a diagram. In conclusion, the article explains the use of the system of specialized institutions as a way to exclude the basic, or primary investment risk.

  18. How will computerization revolutionize managed care?

    Science.gov (United States)

    Trabin, T

    1994-01-01

    Computerization of behavioral health care information systems is revolutionizing how payors, managed care companies, and providers exchange information. In this article, an imaginary scenario is depicted of how patient data will be accessed and communicated to facilitate care management of behavioral health care services in the near future.

  19. Managed care innovation and new product development.

    Science.gov (United States)

    Clark, C S; Schuster, T B

    1994-01-01

    This article explores recent innovative activity by managed care payor plans nationwide with particular emphasis on emerging, new relationships between the plans and their purchasers, enrollees, provider panels, and competitors. Because they already practice what advocates of health care reform are now preaching, many managed care plans are leading the charge to transform our health care delivery and financing systems.

  20. Cardiac rehabilitation with a nurse case manager (GoHeart) across local and regional health authorities improves risk factors, self-care and psychosocial outcomes. A one-year follow-up study

    DEFF Research Database (Denmark)

    Hansen, Vibeke Brogaard; Maindal, Helle Terkildsen

    2014-01-01

    %). MAIN OUTCOME MEASURES: Cardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS)) were assessed at admission (phase IIa), at three months at discharge (phase IIb) and at one-year follow-up (phase III). Intention.......01), self-care management (p depression symptoms (p ...OBJECTIVES: In Denmark, the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The objective was to assess effectiveness of CR across sectors coordinated by a nurse case manager (NCM). DESIGN: A one-year follow-up study. SETTING: A CR programme (Go...

  1. Risk factor management: antiatherogenic therapies.

    Science.gov (United States)

    Gielen, Stephan; Sandri, Marcus; Schuler, Gerhard; Teupser, Daniel

    2009-08-01

    Despite the advances in interventional techniques, the management of stable atherosclerosis remains the domain of optimal guideline-oriented therapy. Recent studies on the effects of aggressive lipid lowering on atheroma volume changes using intravascular ultrasound indicate that it is possible to achieve atherosclerosis regression by reaching low-density lipoprotein (LDL) levels less than 75 mg/dl. The pleiotropic anti-inflammatory effects of statins contribute to the reduction of cardiovascular (CV) event observed with aggressive lipid lowering. As a second important strategy to prevent disease progression, lifestyle changes with regular physical exercise are capable of halting the atherosclerotic process and reducing angina symptoms and CV events. Optimal medical therapy, a healthy lifestyle with regular physical exercise, and coronary interventions are not mutually exclusive treatment strategies. Over the last few decades, both have proved to be effective in significantly reducing the CV mortality in the Western world. However, risk factor modification contributed to at least half the effect in the reduction of CV mortality. This figure provides an estimate of what could be achieved if we were to take risk factor modification more seriously - especially in the acute care setting. The knowledge is there: today we have a better understanding on how to stop progression and even induce regression of atherosclerosis. Much research still needs to be done and will be done. In the meantime, however, our primary focus should lie in implementing what is already known. In addition, it is essential not just to treat CV risk factors, but also to treat them to achieve the target values as set by the guidelines of European Society of Cardiology.

  2. Data Management for Evaluating Complications of Health Care

    OpenAIRE

    Streed, Stephen A.; Massanari, R. Michael

    1988-01-01

    This paper describes the design and operating characteristics of a microcomputer-based data management system for assessing complications associated with the delivery of health care. The system was developed in response to the need to promote “risk management” as an essential component of the Quality Assurance effort within the health care delivery environment. The system herein described allows the epidemiological evaluation of complications of health care in a tertiary care referral center....

  3. Risk Management Issues - An Aerospace Perspective

    Science.gov (United States)

    Perera, Jeevan S.

    2011-01-01

    Phased-approach for implementation of risk management is necessary. Risk management system will be simple, accessible and promote communication of information to all relevant stakeholders for optimal resource allocation and risk mitigation. Risk management should be used by all team members to manage risks--risk office personnel. Each group is assigned Risk Integrators who are facilitators for effective risk management. Risks will be managed at the lowest-level feasible, elevate only those risks that require coordination or management from above. Risk reporting and communication is an essential element of risk management and will combine both qualitative and quantitative elements.. Risk informed decision making should be introduced to all levels of management. Provide necessary checks and balances to insure that risks are caught/identified and dealt with in a timely manner, Many supporting tools, processes & training must be deployed for effective risk management implementation. Process improvement must be included in the risk processes.

  4. Applying risk management strategies to strengthen an IDS's investment policy.

    Science.gov (United States)

    Fine, R P

    1998-11-01

    The increased financial risk that not-for-profit integrated delivery systems have assumed to function under managed care has required them to become increasingly reliant on income and gains from their investment portfolios. This reliance underscores the need for these organizations to take steps to effectively manage their investment risk. Not-for-profit IDSs should establish a systematic approach to investment risk management that is based on maintaining a sound fiduciary infrastructure and having a clear understanding of risk exposures, the most important of which are policy and market risk. Applying reasonable and common-sense risk management strategies to investment policy will enhance an IDS's overall financial and competitive strength.

  5. Management of neonatal jaundice in primary care

    Directory of Open Access Journals (Sweden)

    Angeline Wan Seng Lian

    2016-02-01

    Full Text Available The Clinical Practice Guidelines on Management of Neonatal Jaundice 2003 was updated by a multidisciplinary development group and approved by the Ministry of Health Malaysia in 2014. A systematic review of 13 clinical questions was conducted using evidence retrieved mainly from Medline and Cochrane databases. Critical appraisal was done using the Critical Appraisal Skills Programme checklist. Recommendations were formulated based on the accepted 103 evidences and tailored to local setting as stated below. Neonatal jaundice (NNJ is a common condition seen in primary care. Multiple risk factors contribute to severe NNJ, which if untreated can lead to adverse neurological outcomes. Visual assessment, transcutaneous bilirubinometer (TcB and total serum bilirubin (TSB are the methods used for the detection of NNJ. Phototherapy remains the mainstay of the treatment. Babies with severe NNJ should be followed-up to detect and manage sequelae. Strategies to prevent severe NNJ include health education, identification of risk factors, proper assessment and early referral.

  6. Improving Operational Risk Management Using Business Performance Management Technologies

    OpenAIRE

    Bram Pieket Weeserik; Marco Spruit

    2018-01-01

    Operational Risk Management (ORM) comprises the continuous management of risks resulting from: human actions, internal processes, systems, and external events. With increasing requirements, complexity and a growing volume of risks, information systems provide benefits for integrating risk management activities and optimizing performance. Business Performance Management (BPM) technologies are believed to provide a solution for effective Operational Risk Management by offering several combined ...

  7. Scope of environmental risk management

    Energy Technology Data Exchange (ETDEWEB)

    O' Riordan, T

    1979-01-01

    Environmental risk management embraces three techniques for project appraisal: cost/benefit analysis, environmental impact analysis and risk assessment. It also explicitly relates scientific investigations to political judgments, sometimes so closely that the two cannot be separated. Indeed it is now apparent that environmental risk management encompasses procedures both to review the relative merits and priorities of policies as well as to appraise the environmental risks of particular schemes. Until recently this relationship has not been fully appreciated, so much imagination and innovation is still required to develop the most-suitable mechanisms for review.

  8. The Theme of Risk Management

    Directory of Open Access Journals (Sweden)

    Chua, D. K. H.

    2014-07-01

    Full Text Available The papers in this issue of the Journal come from different industry sectors, yet there can be a common theme that ties them together. Two of the papers address explicitly the issue of risk management, while the other three may be related to it in different degrees. One of the critical factors for project success is risk identification, as determined by Chua et al. (1999. The importance of risk management cannot be overemphasized. Failure to identify crucial risk elements in a project can lead to significant project failures in terms of cost and schedule.

  9. Tailoring Risk Management in Design

    DEFF Research Database (Denmark)

    Tegeltija, M.; Oehmen, J.; McMahon, C. A.

    2018-01-01

    While risk quantification research has grown over the last few decades, only a limited number of studies have addressed the overall process integration of these approaches in design risk management. This paper argues that the choice of risk quantification method has strong implications for several...... process aspects. We investigate current risk management maturity models and suggest an expansion to accommodate requirements originating from the choice of quantification method, and to inform the choice of quantification method, based on other process parameters, validated through 3 case companies....

  10. International comparative analyses of healthcare risk management.

    Science.gov (United States)

    Sun, Niuyun; Wang, Li; Zhou, Jun; Yuan, Qiang; Zhang, Zongjiu; Li, Youping; Liang, Minghui; Cheng, Lan; Gao, Guangming; Cui, Xiaohui

    2011-02-01

    Interpretation of the growing body of global literature on health care risk is compromised by a lack of common understanding and language. This series of articles aims to comprehensively compare laws and regulations, institutional management, and administration of incidence reporting systems on medical risk management in the United Kingdom, the United States, Canada, Australia, and Taiwan, so as to provide evidence and recommendations for health care risk management policy in China. We searched the official websites of the healthcare risk management agencies of the four countries and one district for laws, regulatory documents, research reports, reviews and evaluation forms concerned with healthcare risk management and assessment. Descriptive comparative analysis was performed on relevant documents. A total of 146 documents were included in this study, including 2 laws (1.4%), 17 policy documents (11.6%), 41 guidance documents (28.1%), 37 reviews (25.3%), and 49 documents giving general information (33.6%). The United States government implemented one law and one rule of patient safety management, while the United Kingdom and Australia each issued professional guidances on patient safety improvement. The four countries implemented patient safety management policy on four different levels: national, state/province, hospital, and non-governmental organization. The four countries and one district adopted four levels of patient safety management, and the administration modes can be divided into an "NGO-led mode" represented by the United States and Canada and a "government-led mode" represented by the United Kingdom, Australia, and Taiwan. © 2011 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

  11. Applied software risk management a guide for software project managers

    CERN Document Server

    Pandian, C Ravindranath

    2006-01-01

    Few software projects are completed on time, on budget, and to their original specifications. Focusing on what practitioners need to know about risk in the pursuit of delivering software projects, Applied Software Risk Management: A Guide for Software Project Managers covers key components of the risk management process and the software development process, as well as best practices for software risk identification, risk planning, and risk analysis. Written in a clear and concise manner, this resource presents concepts and practical insight into managing risk. It first covers risk-driven project management, risk management processes, risk attributes, risk identification, and risk analysis. The book continues by examining responses to risk, the tracking and modeling of risks, intelligence gathering, and integrated risk management. It concludes with details on drafting and implementing procedures. A diary of a risk manager provides insight in implementing risk management processes.Bringing together concepts ...

  12. Care zoning in a psychiatric intensive care unit: strengthening ongoing clinical risk assessment.

    Science.gov (United States)

    Mullen, Antony; Drinkwater, Vincent; Lewin, Terry J

    2014-03-01

    To implement and evaluate the care zoning model in an eight-bed psychiatric intensive care unit and, specifically, to examine the model's ability to improve the documentation and communication of clinical risk assessment and management. Care zoning guides nurses in assessing clinical risk and planning care within a mental health context. Concerns about the varying quality of clinical risk assessment prompted a trial of the care zoning model in a psychiatric intensive care unit within a regional mental health facility. The care zoning model assigns patients to one of 3 'zones' according to their clinical risk, encouraging nurses to document and implement targeted interventions required to manage those risks. An implementation trial framework was used for this research to refine, implement and evaluate the impact of the model on nurses' clinical practice within the psychiatric intensive care unit, predominantly as a quality improvement initiative. The model was trialled for three months using a pre- and postimplementation staff survey, a pretrial file audit and a weekly file audit. Informal staff feedback was also sought via surveys and regular staff meetings. This trial demonstrated improvement in the quality of mental state documentation, and clinical risk information was identified more accurately. There was limited improvement in the quality of care planning and the documentation of clinical interventions. Nurses' initial concerns over the introduction of the model shifted into overall acceptance and recognition of the benefits. The results of this trial demonstrate that the care zoning model was able to improve the consistency and quality of risk assessment information documented. Care planning and evaluation of associated outcomes showed less improvement. Care zoning remains a highly applicable model for the psychiatric intensive care unit environment and is a useful tool in guiding nurses to carry out routine patient risk assessments. © 2013 John Wiley & Sons

  13. Managing Multiple Risk Factors

    National Research Council Canada - National Science Library

    Lollis, Charlie

    1998-01-01

    ...) contribute to the racial differences in cardiovascular risk and events among women. High levels of socioeconomic stress, higher dietary fat intake and sedentary lifestyle are more prevalent among black than white women...

  14. Care management in nursing within emergency care units

    Directory of Open Access Journals (Sweden)

    Roberta Juliane Tono de Oliveira

    2015-12-01

    Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  15. Care management in nursing within emergency care units.

    Science.gov (United States)

    Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma

    2015-12-01

    Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.

  16. Knowledge management in support of enterprise risk management

    OpenAIRE

    Rodriguez, Eduardo; Edwards, John S.

    2014-01-01

    Risk management and knowledge management have so far been studied almost independently. The evolution of risk management to the holistic view of Enterprise Risk Management requires the destruction of barriers between organizational silos and the exchange and application of knowledge from different risk management areas. However, knowledge management has received little or no attention in risk management. This paper examines possible relationships between knowledge management constructs relate...

  17. Terceirização em cuidados continuados: uma abordagem de gestão de risco Outsourcing in long-term care: a risk management approach

    Directory of Open Access Journals (Sweden)

    Cristina Machado Guimarães

    2012-05-01

    Full Text Available Este artigo tem como objetivo investigar a decisão de externalização, integrada na gestão da cadeia de suprimentos no setor da saúde, nomeadamente os motivos e condicionantes da decisão, os critérios de escolha das atividades a entregar a terceiros, os tipos de acordos possíveis e o impacto que a decisão tem na organização e na pratica. Através do estudo de caso de uma unidade de saúde prestadora de cuidados continuados de forma inovadora, com grandes níveis de customização e em início de atividade, investigou-se todo o processo de terceirização em contexto do início do ciclo de vida de uma organização (não no contexto comum de mudança organizacional e construiu-se uma matriz de avaliação de risco para atividades terceirizadas de modo a permitir a definição do processo de monitorização da performance a implementar. Este estudo visa compreender como se avaliam e balizam os riscos da adopção de uma estratégia de terceirização e sugere um modelo de monitorização, com recurso a ferramentas de gestão de risco. Concluiu-se que uma abordagem de Gestão de Risco pode ser uma solução para monitorização de terceirização em atividade que se iniciam. Retiram-se, ainda, conclusões acerca da insatisfação com os resultados da estratégia de externalização adotada.This article seeks to investigate outsourcing decisions in supply chain management of healthcare organizations, namely the motives and constraints behind the decision, the selection criteria for activities to be outsourced to third parties, the type of possible agreements, and the impact of this decision on the organization per se. A case study of the start-up phase of a Long-term Care unit with an innovative approach and high levels of customization was conducted to understand the outsourcing process in a start-up context (not in the standard context of organizational change and a risk evaluation matrix was created for outsourcing activities in order

  18. The NASA risk management program

    International Nuclear Information System (INIS)

    Buchbinder, B.; Philipson, L.L.

    1989-01-01

    This paper reports that the NASA Risk Management Program has been established to ensure the appropriate application of risk-based procedures in support of the elimination, reduction, or acceptance of significant safety risks of concern in NASA. The term appropriate is emphasized, in that the particular procedures applied to each given risk are to reflect its character and prioritized importance, the technological and economic feasibility of its treatment. A number of key documents have been produced in support of this implementation. Databases, risk analysis tools, and risk communication procedures requisite to the execution of the risk management functions also are being developed or documented. Several risk management applications have been made and a comprehensive application to a major new NASA program is underway. This paper summarizes the development and current status of the NASA Risk Management Program. Some principal actions that have been carried out in NASA in consonance with the program are noted particularly, and views are presented on the program's likely future directions

  19. How to manage risk better

    CSIR Research Space (South Africa)

    Walwyn, DR

    2002-09-01

    Full Text Available Risk management practices in the R&D departments of many chemical and pharmaceutical companies lack much of the rigor and sophistication of the equivalent corporation in the financial sector. For instance investment decisions on research projects...

  20. Risk Management and Value Creation

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Roggi, Oliviero

    Corporate failures, periodic recessions, regional debt crises and volatile financial markets have intensified the focus on risk management as the means to deal with turbulent conditions. The ability to respond effectively to abrupt environmental impacts is considered an important source...... of competitive advantage. Yet, surprisingly little research has analyzed whether the presumed advantages of effective risk management are associated with superior outcomes. Here we present a comprehensive study of risk management effectiveness and the relationship to corporate performance based on more than 33......,500 observations in 3,400 firms over the turbulent 20-year period 1991-2010. Determining effective risk management as the ability to reduce earnings and cash flow volatility, we find that both have significant positive relationships to lagged performance measures after controlling for industry effects, company...

  1. Risk assessment and risk management of mycotoxins.

    Science.gov (United States)

    2012-01-01

    Risk assessment is the process of quantifying the magnitude and exposure, or probability, of a harmful effect to individuals or populations from certain agents or activities. Here, we summarize the four steps of risk assessment: hazard identification, dose-response assessment, exposure assessment, and risk characterization. Risk assessments using these principles have been conducted on the major mycotoxins (aflatoxins, fumonisins, ochratoxin A, deoxynivalenol, and zearalenone) by various regulatory agencies for the purpose of setting food safety guidelines. We critically evaluate the impact of these risk assessment parameters on the estimated global burden of the associated diseases as well as the impact of regulatory measures on food supply and international trade. Apart from the well-established risk posed by aflatoxins, many uncertainties still exist about risk assessments for the other major mycotoxins, often reflecting a lack of epidemiological data. Differences exist in the risk management strategies and in the ways different governments impose regulations and technologies to reduce levels of mycotoxins in the food-chain. Regulatory measures have very little impact on remote rural and subsistence farming communities in developing countries, in contrast to developed countries, where regulations are strictly enforced to reduce and/or remove mycotoxin contamination. However, in the absence of the relevant technologies or the necessary infrastructure, we highlight simple intervention practices to reduce mycotoxin contamination in the field and/or prevent mycotoxin formation during storage.

  2. 76 FR 45724 - Clearing Member Risk Management

    Science.gov (United States)

    2011-08-01

    ... proposed rules address risk management for cleared trades by futures commission merchants, swap dealers... Commission has proposed extensive regulations addressing open access and risk management at the derivatives..., 2011) (Risk Management Requirements for Derivatives Clearing Organizations). These proposed regulations...

  3. Managed care and ethical conflicts: anything new?

    OpenAIRE

    Meyers, C

    1999-01-01

    Does managed care represent the death knell for the ethical provision of medical care? Much of the current literature suggests as much. In this essay I argue that the types of ethical conflicts brought on by managed care are, in fact, similar to those long faced by physicians and by other professionals. Managed care presents new, but not fundamentally different, factors to be considered in medical decision making. I also suggest ways of better understanding and resolving these conflicts, in p...

  4. Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings.

    LENUS (Irish Health Repository)

    Murphy, Mark E

    2017-08-04

    Poorly controlled type 2 diabetes mellitus (T2DM) is a major international health problem. Our aim was to assess the effectiveness of healthcare interventions, specifically targeting patients with poorly controlled T2DM, which seek to improve glycaemic control and cardiovascular risk in primary care settings.

  5. Producers' Complex Risk Management Choices

    NARCIS (Netherlands)

    Pennings, J.M.E.; Isengildina, O.; Irwin, S.H.; Garcia, P.; Good, D.L.

    2008-01-01

    Producers have a wide variety of risk management instruments available, making their choice(s) complex. The way producers deal with this complexity can vary and may influence the impact that the determinants, such as risk aversion, have on their choices. A recently developed choice bracketing

  6. Legal risk management in shipping

    DEFF Research Database (Denmark)

    Siig, Kristina

    The book discusses the most typical legal challenges met in the chartering, broker, agent or port management part of the shipping industry. It discusses these issues in both English and Scandinavian law and gives indications on how to best ensure your legal risk management in these parts...

  7. Duty of Care and Autonomy: How Support Workers Managed the Tension between Protecting Service Users from Risk and Promoting Their Independence in a Specialist Group Home

    Science.gov (United States)

    Hawkins, R.; Redley, M.; Holland, A. J.

    2011-01-01

    Background: In the UK those paid to support adults with intellectual disabilities must manage two potentially conflicting duties that are set out in policy documents as being vital to their role: protecting service users (their duty of care) and recognising service users' autonomy. This study focuses specifically on the support of people with the…

  8. Care management in nursing within emergency care units

    OpenAIRE

    Roberta Juliane Tono de Oliveira; Patrícia Madalena Vieira Hermida; Fernanda Hannah da Silva Copelli; José Luís Guedes dos Santos; Alacoque Lorenzini Erdmann; Selma Regina de Andrade

    2015-01-01

    Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency se...

  9. Price Risk and Risk Management in Agriculture

    Directory of Open Access Journals (Sweden)

    Udo Broll

    2013-06-01

    Full Text Available This note studies the risk-management decisions of a risk-averse farmer. The farmer faces multiple sources of price uncertainty. He sells commodities to two markets at two prices, but only one of these markets has a futures market. We show that the farmer’s optimal commodity futures market position, i.e., a cross-hedge strategy, is actually an over-hedge, a full-hedge, or an under-hedge strategy, depending on whether the two prices are strongly positively correlated, uncorrelated, or negatively correlated, respectively.

  10. Legal Liability and Risk Management in Outdoor Training.

    Science.gov (United States)

    Dynon, John; Loynes, Chris

    1990-01-01

    Describes duties and responsibilities of outdoor instructors under British criminal and civil law. Discusses elements of negligence under civil law including damage, duty of care, standard of care, in loco parentis, students' duty of care, foreseeability, and employer's legal duty. Presents risk management in terms of primary, secondary, and…

  11. Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers.

    Science.gov (United States)

    Sendlhofer, Gerald; Brunner, Gernot; Tax, Christa; Falzberger, Gebhard; Smolle, Josef; Leitgeb, Karina; Kober, Brigitte; Kamolz, Lars Peter

    2015-01-01

    For health care systems in recent years, patient safety has increasingly become a priority issue. National and international strategies have been considered to attempt to overcome the most prominent hazards while patients are receiving health care. Thereby, clinical risk management (CRM) plays a dominant role in enabling the identification, analysis, and management of potential risks. CRM implementation into routine procedures within complex hospital organizations is challenging, as in the past, organizational change strategies using a top-down approach have often failed. Therefore, one of our main objectives was to educate a certain number of risk managers in facilitating CRM using a bottom-up approach. To achieve our primary purpose, five project strands were developed, and consequently followed, introducing CRM: corporate governance, risk management (RM) training, CRM process, information, and involvement. The core part of the CRM process involved the education of risk managers within each organizational unit. To account for the size of the existing organization, we assumed that a minimum of 1 % of the workforce had to be trained in RM to disseminate the continuous improvement of quality and safety. Following a roll-out plan, CRM was introduced in each unit and potential risks were identified. Alongside the changes in the corporate governance, a hospital-wide CRM process was introduced resulting in 158 trained risk managers correlating to 2.0 % of the total workforce. Currently, risk managers are present in every unit and have identified 360 operational risks. Among those, 176 risks were scored as strategic and clustered together into top risks. Effective meeting structures and opportunities to share information and knowledge were introduced. Thus far, 31 units have been externally audited in CRM. The CRM approach is unique with respect to its dimension; members of all health care professions were trained to be able to identify potential risks. A network of risk

  12. Transitional care management in the outpatient setting.

    Science.gov (United States)

    Baldonado, Analiza; Hawk, Ofelia; Ormiston, Thomas; Nelson, Danielle

    2017-01-01

    Patients who are high risk high cost (HRHC), those with severe or multiple medical issues, and the chronically ill elderly are major drivers of rising health care costs.1 The HRHC patients with complex health conditions and functional limitations may likely go to emergency rooms and hospitals, need more supportive services, and use long-term care facilities.2 As a result, these patient populations are vulnerable to fragmented care and "falling through the cracks".2 A large county health and hospital system in California, USA introduced evidence-based interventions in accordance with the Triple AIM3 focused on patient-centered health care, prevention, health maintenance, and safe transitions across the care continuum. The pilot program embedded a Transitional Care Manager (TCM) within an outpatient Family Medicine clinic to proactively assist HRHC patients with outreach assistance, problem-solving and facilitating smooth transitions of care. This initiative is supported by a collaborative team that included physicians, nurses, specialists, health educator, and pharmacist. The initial 50 patients showed a decrease in Emergency Department (ED) encounters (pre-vs post intervention: 33 vs 17) and hospital admissions (pre-vs post intervention: 32 vs 11), improved patient outcomes, and cost saving. As an example, one patient had 1 ED visit and 5 hospital admission with total charges of $217,355.75 in the 6 months' pre-intervention with no recurrence of ED or hospital admissions in the 6 months of TCM enrollment. The preliminary findings showed improvement of patient-centered outcomes, quality of care, and resource utilization however more data is required.

  13. An overview of Medicaid managed care litigation.

    Science.gov (United States)

    Rosenbaum, S; Teitelbaum, J; Kirby, C; Priebe, L; Klement, T

    1998-11-01

    Since the enactment of Medicaid in 1965, states have had the option of offering beneficiaries enrollment in managed care arrangements. With the advent of mandatory managed care reaching millions of beneficiaries (including a growing proportion of disabled recipients), the amount and scope of litigation involving Medicaid managed care plans can be expected to grow. A review of the current litigation regarding Medicaid managed care reveals two basic types of lawsuits: (1) those that challenge the practices of managed care companies under various federal and state laws that safeguard consumer rights, protect health care quality, and prohibit discrimination; and (2) suits that assert claims arising directly under the Medicaid statute and implementing regulations, as well as claims related to Constitutional safeguards that undergird the program. Lawsuits asserting claims arising under Medicaid tend to raise two basic questions: (1) the extent to which enrollment in a Medicaid managed care plan alters existing Medicaid beneficiary rights and state agency duties under federal or state Medicaid law; and (2) the extent to which managed care companies, as agents of the state, act under "color of law" (i.e., undertaking to perform official duties or acting with the imprimatur of state authority). Additionally, states might see an increase in litigation brought by prospective and current contractors who assert that they have been wrongfully denied contracts or improperly penalized for poor performance. These assertions may involve claims that are grounded in federal and state law, the Medicaid statute, and the Constitution. Moreover, in light of the consumer protection elements of the managed care reforms contained in the Balanced Budget Act, future managed care litigation may focus on the manner in which companies carry out states' obligations toward managed care enrollees. Resolution of Medicaid managed care cases involves the application of general principles of

  14. Managing Supplier Sustainability Risk

    OpenAIRE

    Harilainen, Hanna-Riitta

    2014-01-01

    Supply chains are increasingly global, often reaching to developing regions. The media pressure brand owners to be responsible, but a product is only as sustainable as the practices of all the companies involved in manufacturing it are. It’s not enough that the brand owner acts responsibly; sustainable practices have to reach component and raw material suppliers upstream. Image risk has often been recognized as reason for investing in sustainability. In the supply chain context, supplier m...

  15. Energy price risk management

    International Nuclear Information System (INIS)

    Evans, J.W.G.

    1998-01-01

    While long term, fixed price contracts for fuel procurement and export of excess power may lock in the economics of a CHP plant, these do not necessarily give the best pricing opportunities that may exist during the life of those contracts. A more prudent approach may be to vary the length of the contracts and markets are now developing in gas and electricity to assist in the management of such a portfolio. (Author)

  16. Underground risk management information systems

    Energy Technology Data Exchange (ETDEWEB)

    Matsuyama, S.; Inoue, M.; Sakai, T.

    2006-03-15

    JCOAL has conducted Joint Research on an Underground Communication and Risk Management Information System with CSIRO of Australia under a commissioned study project for the promotion of coal use starting in fiscal 2002. The goal of this research project is the establishment of a new Safety System focusing on the comprehensive risk management information system by the name of Nexsys. The main components of the system are the Ethernet type underground communication system that represents the data communication base, and the risk management information system that permits risk analysis in real-time and provides decision support based on the collected data. The Nexsys is an open system and is a core element of the underground monitoring system. Using a vast amount of underground data, it is capable of accommodating a wide range of functions that were not available in the past. Because of it, it is possible to construct an advanced underground safety system. 14 figs., 4 tabs.

  17. Risk Management Analysis on the Car Drivers in Indonesia

    OpenAIRE

    Kuntohadi, Hendro; Pahala, Yosi; Sitanggang, Rohana

    2015-01-01

    Car drivers in Indonesia will always face many kinds of risks. This research contains the context determination of this research, identifies all the significant risks, measures the frequency and impact of all the risks, draws all the identified risks in the chart, and describes how to manage or mitigate the risks. The dangerous risks which have high frequency and high impact are: 1) Many car drivers get the driving license without taking a driving course and without learning carefully the the...

  18. Management or care: different outcomes.

    Science.gov (United States)

    Cohain, Judy Slome

    2007-01-01

    Recently a popular magazine published a birth story of a long, medically managed, first labor of a low-risk woman, which ended in a cesarean. (1) The doctor/writer was convinced that the labor could not be safely managed other than how he described it and that no safe alternative existed to a cesarean delivery. This is another example of the media trend of promoting medical birth stories and not midwifery-supported birth stories. The article below provides two versions of the same woman's labor to show how a woman's choice of birth attendant and labor support can influence the course of labor and the likelihood of cesarean surgery. judyslome@hotmail.com.

  19. Information Needs of Nurse Care Managers

    Science.gov (United States)

    Dorr, David A.; Tran, Hanh; Gorman, Paul; Wilcox, Adam B.

    2006-01-01

    Unmet information needs of physicians and patients are common, but those of nurse care managers – defined as collaborative care planners for with chronic conditions – are less well understood. We taped and transcribed daily activities and conducted semi-structured interviews of 7 care managers, and analyzed questions elicited through this work through a variety of frameworks. PMID:17238532

  20. Risk management for noncombustion wastes

    International Nuclear Information System (INIS)

    Connor, K.K.; Rice, J.S.

    1991-01-01

    The Noncombustion Waste Risk Management Project is designed to incorporate the insights and information developed in these projects into tools that will help utilities make better noncombustion waste management decisions. Specific project goals are to synthesize information useful to utilities on noncombustion wastes, emphasize waste reduction as a priority over end-of-pipe management, develop methods to manage the costs and risks associated with noncombustion wastes (e.g., direct costs, permitting costs, liability costs, public relations costs), develop software and documentation to deliver the information and analysis methods to the industry. This project was initiated EPRI's Environment Division in late 1988. The early phases of the project involved gathering information on current noncombustion waste management practices, specific utility problems and concerns with respect to these wastes, current and potential future regulations, and current and emerging management options. Recent efforts have focused on characterizing the direct and indirect (e.g., lawsuits, remedial action) costs of managing these wastes and on developing and implementing risk management methods for a subset of wastes. The remainder of this paper describes the specific issues addressed by and the results and insights from the three completed waste-specific studies

  1. Managing Cancer Care - Finding Health Care Services

    Science.gov (United States)

    ... my condition? Has it been rated by state, consumer, or other groups for its quality of care? ... be both rewarding and demanding. It can change relationships and require families to cope with all aspects ...

  2. Risk Management in the Exchange Fund Account

    OpenAIRE

    Michel Rochette

    2002-01-01

    In this article, author Michel Rochette of the Bank's Risk-Management Unit briefly describes the initiatives undertaken to identify, analyze, model, and manage the principal risks inherent in the transactions of the Exchange Fund Account (EFA), where the international reserves of the federal government are held. The author focuses on five types of risk: credit risk, market risk, liquidity risk, operational risk, and legal risk. In addition, the author presents the risk-management principles u...

  3. Tailoring Self-Management in Chronic Care

    NARCIS (Netherlands)

    Touwen, ID

    2016-01-01

    Self-management is nowadays seen as an important element in chronic care and therefore, self-management is increasingly embedded in chronic care guidelines; however, implementation in clinical practice is a slow and difficult process. Evidence, from research on self-management interventions, shows

  4. Managing nuclear supplier risks

    International Nuclear Information System (INIS)

    Ramberg, B.

    1990-01-01

    This paper reports that with the appearance of such third-tier suppliers as Argentina, Brazil, South Korea, Taiwan, China, and others capable of producing nuclear components and sensitive nuclear materials, assurance that importers are using nuclear energy benignly and safely may become more uncertain. It is therefore important to integrate emerging exporters and importers into a regime of norms designed to minimize nuclear risks. The experience of the London Nuclear Suppliers Group (NSG) to arrive at a code of conduct is encouraging. Placed in the context of the larger evolving nuclear energy regime that seeks to address nuclear safety, proliferation, terrorism, and military attacks on reactors, the international community has made substantial progress. Still, there is much that remains to be done

  5. Risk management through concurrency

    International Nuclear Information System (INIS)

    Childress, J.R.; Briant, V.B.

    1991-01-01

    More than ever before, management and technical professionals are concerned with the subtle and dynamic relationships between safety and performance in complex and hazardous industries. This is certainly true in the nuclear power industry. With the US electric energy industry on the verge of deregulation and increased competition, and with a virtual stoppage on building new nuclear power plants, the increasing demand for reliable sources of efficient electric energy is pressing the nuclear utilities to increase production. At the same time, public sentiment and regulatory pressures are increasing their focus on safety at all costs. The purpose of this paper is to present a proven approach to creating a new work culture for improved nuclear safety and performance. The concepts and material which make up this paper have been taken from both authors experience, research, and consulting in the nuclear industry for several years, as well as from over 20 years of consulting work on the relationships between organizational behavior, culture, and productivity

  6. Consumer Protection in Managed Care: A Third-Generation Approach.

    Science.gov (United States)

    Rother, John

    1996-01-01

    Discusses three generations of consumer protection issues related to managed care: (1) individual treatment decisions--individuals wanting treatment their plan does not cover or deems unnecessary; (2) insurance practices and risk selection--impact of health management organizations on the rest of the health insurance system; and (3) health plan…

  7. Failing ageing? Risk management in the active ageing society

    DEFF Research Database (Denmark)

    Rostgaard, Tine

    2015-01-01

    According to the European Commission's recent policy initiative on social investment, Danish Long term care offers new and innovative perspectives in ageing and the management of the risks associated thereof with the introduction of reablement (rehabilitering). From the perspective of governmenta......According to the European Commission's recent policy initiative on social investment, Danish Long term care offers new and innovative perspectives in ageing and the management of the risks associated thereof with the introduction of reablement (rehabilitering). From the perspective...

  8. An operations-partnered evaluation of care redesign for high-risk patients in the Veterans Health Administration (VHA): Study protocol for the PACT Intensive Management (PIM) randomized quality improvement evaluation.

    Science.gov (United States)

    Chang, Evelyn T; Zulman, Donna M; Asch, Steven M; Stockdale, Susan E; Yoon, Jean; Ong, Michael K; Lee, Martin; Simon, Alissa; Atkins, David; Schectman, Gordon; Kirsh, Susan R; Rubenstein, Lisa V

    2018-06-01

    Patient-centered medical homes have made great strides providing comprehensive care for patients with chronic conditions, but may not provide sufficient support for patients at highest risk for acute care use. To address this, the Veterans Health Administration (VHA) initiated a five-site demonstration project to evaluate the effectiveness of augmenting the VA's Patient Aligned Care Team (PACT) medical home with PACT Intensive Management (PIM) teams for Veterans at highest risk for hospitalization. Researchers partnered with VHA leadership to design a mixed-methods prospective multi-site evaluation that met leadership's desire for a rigorous evaluation conducted as quality improvement rather than research. We conducted a randomized QI evaluation and assigned high-risk patients to participate in PIM and compared them with high-risk Veterans receiving usual care through PACT. The summative evaluation examines whether PIM: 1) decreases VHA emergency department and hospital use; 2) increases satisfaction with VHA care; 3) decreases provider burnout; and 4) generates positive returns on investment. The formative evaluation aims to support improved care for high-risk patients at demonstration sites and to inform future initiatives for high-risk patients. The evaluation was reviewed by representatives from the VHA Office of Research and Development and the Office of Research Oversight and met criteria for quality improvement. VHA aims to function as a learning organization by rapidly implementing and rigorously testing QI innovations prior to final program or policy development. We observed challenges and opportunities in designing an evaluation consistent with QI standards and operations priorities, while also maintaining scientific rigor. This trial was retrospectively registered at ClinicalTrials.gov on April 3, 2017: NCT03100526. Protocol v1, FY14-17. Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Managing economic risks through simulation

    International Nuclear Information System (INIS)

    Griffin, B.J.; Eresman, R.K.

    1994-01-01

    Industrial operations are commonly managed in terms of such factors as raw material requirements, throughput, equipment reliability, and operator productivity. Simulation can be used to transform standard management performance measures into probabilistic measures which define the associated risks. These results provide valuable insight for effective management of economic risks. Case studies are presented using the Monte Carlo simulation method to demonstrate different applications of simulation techniques, various result formats, and their use for optimizing economic returns. In the first case study, design criteria for a large gas distribution system originally developed from worst-case demand estimates were modelled to provide a risk basis for decisions on alternative upgrading options. In the second, a commercial gas storage facility operation was modelled to develop economic marketing strategies balancing supply and demand requirements from multiple clients. 3 refs

  10. Branding and the Risk Management Imperative

    Directory of Open Access Journals (Sweden)

    Fournier Susan

    2018-05-01

    Full Text Available In an increasingly risky socioeconomic environment, management needs to proactively consider brand-related risks. To understand brands as tools for risk management, they need to understand four types of brand risk: brand reputation risk, brand dilution risk, brand cannibalization risk and brand stretch risk.

  11. Branding and the Risk Management Imperative

    OpenAIRE

    Fournier Susan; Srinivasan Shuba

    2018-01-01

    In an increasingly risky socioeconomic environment, management needs to proactively consider brand-related risks. To understand brands as tools for risk management, they need to understand four types of brand risk: brand reputation risk, brand dilution risk, brand cannibalization risk and brand stretch risk.

  12. Developing and Using Vignettes to Explore the Relationship Between Risk Management Practice and Recovery-Oriented Care in Mental Health Services.

    Science.gov (United States)

    Holley, Jessica; Gillard, Steven

    2018-02-01

    There is a lack of literature evaluating the development and use of vignettes to explore contested constructs in qualitative health care research where a conventional interview schedule might impose assumptions on the data collected. We describe the development and validation of vignettes in a study exploring mental health worker and service user understandings of risk and recovery in U.K. mental health services. Focus groups with mental health workers and service users explored study questions from experiential perspectives. Themes identified in the groups were combined with existing empirical literature to develop a set of vignettes. Feedback focus groups were conducted to validate and amend the vignettes. Following use in research interviews, results suggested that the vignettes had successfully elicited data on issues of risk and recovery in mental health services. Further research using creative, comparative methods is needed to fully understand how vignettes can best be used in qualitative health care research.

  13. Supply Chain Risk Management

    OpenAIRE

    Babková, Ivana

    2008-01-01

    Práce se zabývá problematikou řízení rizika v logistických řetězcích se zaměřením na jeden konkrétní článek řetězce. Definuje základní oblasti risk managementu, jeho hlavní aspekty a systém spojitého plánování. Zabývá se bezpečností práce v pojetí EU, České republiky a Velké Británie. V aplikační části uvádí řízení rizika v jednom článku logistického řetězce, skladu poskytovatele logistických služeb ve Velké Británii.

  14. Risk management for industrial safety

    International Nuclear Information System (INIS)

    Novogno, A.

    1989-01-01

    The catastrophic accidents which have occurred in the last decade, in both developed and developing countries, have drawn the attention of decision-makers in the safety area to the urgent necessity to assess and manage risks from hazardous industrial activities which are concentrated in large industrialized areas. The aim of this paper is to review experience gained in conducting studies in the area of 'comparisons of risks in energy systems' and on the practical application of 'cost effectiveness of risk reduction analysis among different energy systems' (case studies). It is also the aim of the paper to discuss and propose a general framework for defining an 'integrated approach' to risk assessment and management in highly industrialized regions within a country. (author)

  15. Management of postmenopausal osteoporosis for primary care.

    Science.gov (United States)

    Miller, P; Lukert, B; Broy, S; Civitelli, R; Fleischmann, R; Gagel, R; Khosla, S; Lucas, M; Maricic, M; Pacifici, R; Recker, R; Sarran, H S; Short, B; Short, M J

    1998-01-01

    The shift in health care delivery from a subspecialty to primary care system has transferred the responsibility of preventing osteoporotic fractures from specialists in metabolic bone disease to the web of physicians--family practitioners, general internists, pediatricians, and gynecologists--who provide the bulk of primary care. The challenge for this group of physicians is to decrease the rising prevalence of osteoporotic hip and vertebral fractures while operating within the cost parameters. It is the goal of this brief summary to provide primary practitioners with focused guidelines for the management of postmenopausal osteoporosis based on new and exciting developments. Prevention and treatment will change rapidly over the next decade and these advances will require changes in these recommendations. We identified patients at risk for osteoporosis and provided indications for bone mass measurement, criteria for diagnosis of osteoporosis, therapeutic interventions, and biochemical markers of the disease. Prevention and treatment are discussed, including hormone replacement therapy and use of calcitonin, sodium fluoride, bisphosphonates, and serum estrogen receptor modulators. Postmenopausal osteoporosis should no longer be an accepted process of aging. It is both preventable and treatable. Primary care physicians must proactively prevent and treat osteoporosis in their daily practice, and combination therapies are suggested.

  16. Is ALARP applicable to the management of terrorist risks?

    International Nuclear Information System (INIS)

    Guikema, S.D.; Aven, T.

    2010-01-01

    In this paper, we discuss the applicability of the as low as reasonable practicable (ALARP) principle to terrorist risk management. ALARP is a commonly used framework for managing risk due to non-intelligent threats, but terrorism introduces difficult issues, both technically and socially. In particular, the probability of a terrorist attack is difficult to define, terrorist threats are adaptive, and some terrorist risk management actions raise issues of loss of civil liberties not raised by risk management measures for other types of risk. We discuss these issues and their implications for risk management. After showing how ALARP is used to manage the risk from other hazards in different economic sectors, we discuss both the benefits and difficulties associated with extending the ALARP framework for terrorist risk analysis. We conclude that the ALARP framework can be modified to make it appropriate for risk management for adaptive risks, provided that care is taken to explicitly consider adaptive reallocation of risk in response to risk management actions, to account for perceived or actual loss of civil liberties resulting from risk management actions, and to consider the difficulties associated with using probability to measure uncertainty in adversary actions.

  17. 12 CFR 917.3 - Risk management.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 917.3 Section 917.3 Banks and Banking FEDERAL HOUSING FINANCE BOARD GOVERNANCE AND MANAGEMENT OF THE FEDERAL HOME LOAN BANKS POWERS AND RESPONSIBILITIES OF BANK BOARDS OF DIRECTORS AND SENIOR MANAGEMENT § 917.3 Risk management. (a) Risk management...

  18. [Risk Assessment and Risk Management of Chemicals in China].

    Science.gov (United States)

    Wang, Tie-yu; Zhou, Yun-qiao; Li, Qi-feng; Lü, Yong-long

    2016-02-15

    Risk assessment and risk management have been increasingly approved as an effective approach for appropriate disposal and scientific management of chemicals. This study systematically analyzed the risk assessment methods of chemicals from three aspects including health risk, ecological risk and regional risk. Based on the current situation of classification and management towards chemicals in China, a specific framework of risk management on chemicals was proposed by selecting target chemicals, predominant industries and related stakeholders as the objects. The results of the present study will provide scientific support for improving risk assessment and reasonable management of chemicals in China.

  19. A view on risk management

    International Nuclear Information System (INIS)

    Joksimovich, V.

    1991-01-01

    The world at large has enjoyed the benefits of industrial technology for almost two centuries. The managers of industrial facilities as well as members of the public focused on the benefits and typically ignored or underestimated the inherent risks entailed in deployment of these technologies. Two examples will be given for the sake of illustration. In the chemical industry, the impacts of various chemicals on humans are insufficiently understood. In addition, it was not even known that some hazardous chemicals could be formed in the chemical reactions taking place in various chemical reactors. This is equivalent to not knowing that Cesium-iodide compound can be formed within nuclear fuel nor the impact it might have on humans if released, which is inconceivable in the nuclear industry. In the era of risk recognition, many industrial managers proclaimed that safety is everybody's business. The basic premise behind this was that since everyone is responsible, no one can be blamed for accidents. This is, however, shifting because both economics and litigation are now compelling industrial managers to consider risk in conjunction with the benefit. The government managers in many cases interpreted their charter to reap benefits first and pay the price of risks later; e.g., the case of nuclear weapons production facilities seriously contaminated by radioactive and other hazardous materials. Cost of clean-up was estimated at more than $100 billion. Of course, the authors have similar examples in many other industries, e.g., Superfund project of chemical waste sites. The challenge for the technologists is to maximize the benefit/risk ratio, keeping the risks, real or perceived, acceptably small. This brings us to the issue of acceptable risks, the topic of this paper

  20. Developing Risk Management as a Competitive Capability

    OpenAIRE

    Silva, E.; Wu, Y.; Ojiako, U.

    2013-01-01

    At the level of the firm, three major parameters are found to influence the ability of SMEs to develop risk management competencies; these are enterprise risk management, internal control, and risk culture.

  1. Improving ICU risk management and patient safety.

    Science.gov (United States)

    Kielty, Lucy Ann

    2017-06-12

    Purpose The purpose of this paper is to describe a study which aimed to develop and validate an assessment method for the International Electrotechnical Commission (IEC) 80001-1 (IEC, 2010) standard (the Standard); raise awareness; improve medical IT-network project risk management processes; and improve intensive care unit patient safety. Design/methodology/approach An assessment method was developed and piloted. A healthcare IT-network project assessment was undertaken using a semi-structured group interview with risk management stakeholders. Participants provided feedback via a questionnaire. Descriptive statistics and thematic analysis was undertaken. Findings The assessment method was validated as fit for purpose. Participants agreed (63 per cent, n=7) that assessment questions were clear and easy to understand, and participants agreed (82 per cent, n=9) that the assessment method was appropriate. Participant's knowledge of the Standard increased and non-compliance was identified. Medical IT-network project strengths, weaknesses, opportunities and threats in the risk management processes were identified. Practical implications The study raised awareness of the Standard and enhanced risk management processes that led to improved patient safety. Study participants confirmed they would use the assessment method in future projects. Originality/value Findings add to knowledge relating to IEC 80001-1 implementation.

  2. Academic medicine meets managed care: a high-impact collision.

    Science.gov (United States)

    Carey, R M; Engelhard, C L

    1996-08-01

    The managed care revolution is sweeping the country as a result of intense marketing on the part of managed care organizations and the widespread belief that price-sensitive managed care systems will control health costs. Although few believe that managed care alone can adequately stem the growth of nation health care spending, competition based on price has emerged as a powerful force in the health care sector. Academic health center (AHCs) stand to suffer with this new managed care regime because their special missions of teaching, research, and highly specialized clinical care make them more expensive than nonacademic hospitals and place them at a noncompetitive disadvantage. The traditional focus of the acute care hospital with individual departmentally designed programs will be narrow. Major changes will be required on the part of AHCs if they are to survive and preserve patient volume, maintain the integrity of medical education, advance scientific research, and provide highly specialized care. AHCs will have to make unprecedented adjustments in virtually every phase of their operations, particularly in the areas of clinical decision making and speedy patient-related information flow. A premium will be placed on multidisciplinary, inclusive medical services that can assume total health care risks for large populations. New ways of educating students in ambulatory settings with an emphasis on outcomes and population-based health will be needed along with the traditional responsibility of pursuing new approaches to the diagnosis, treatment, and prevention of disease. The extent to which managed care will ultimately alter the traditional role of AHCs in the American health care system is unclear, but successful adaptation in the short term will require them to respond broadly, flexibly, and in a timely fashion to the anticipated health care scene.

  3. Risk management at GPU Nuclear

    International Nuclear Information System (INIS)

    Long, R.L.

    1991-01-01

    This paper reports on GPU Nuclear. Among other goals, it established the independence of key safety functions as highlighted by the lessons learned from the accident. In particular, an independent Nuclear Assurance Division was established which include Quality Assurance, Training and Education, Emergency Preparedness, and Nuclear Safety Assessment. The latter consisted of corporate and site independent-safety-review groups. As the GPU Nuclear organization matured, a mid-1987 reorganization created an even more focused Planning and Nuclear Safety Division bringing together Nuclear Safety Assessment with Licensing and Regulatory Affairs and Risk Management. The Risk Management Group (RMG), which began its work in fall 1987, was formed to develop a framework for proactive identification, evaluation, and cost-effective reduction and management of risks of all types. The RMG set out to learn as much as possible about risks and their management in nuclear and other high-technology industries. This began with a thorough literature search. It progressed to interviews with individuals and organizations which have demonstrated innovative ideas, experience, and reputations for safe and reliable operation

  4. RISK MANAGEMENT USING PROJECT RECON

    Science.gov (United States)

    2016-11-28

    centralized database . • Project Recon (formerly Risk Recon) is designed to be used by all Program Management Offices, Integrated Project Teams and any...Create growth plans to proactively capture benefits • Customize reports to group opportunities by programmatic, technical, business, contracting, and

  5. Integrated Foreign Exchange Risk Management

    DEFF Research Database (Denmark)

    Aabo, Tom; Høg, Esben; Kuhn, Jochen

    Empirical research has focused on export as a proxy for the exchange rate exposure and the use of foreign exchange derivatives as the instrument to deal with this exposure. This empirical study applies an integrated foreign exchange risk management approach with a particular focus on the role...

  6. Strategic management of health care information systems: nurse managers' perceptions.

    Science.gov (United States)

    Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha

    2009-01-01

    The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.

  7. CEA: assessment of risk management 2011

    International Nuclear Information System (INIS)

    2012-06-01

    This report proposes an overview of CEA activities in the field of risk management in different areas: impact on the environment, installation safety, management of occupational risks (occupational health and safety), radiological protection of workers, transportation of hazardous materials, waste management, protection of sites, installations and heritage, management of emergency situations, management of law risks, controls and audits. It finally presents the risk management department

  8. PROJECT MANAGER SKILLS, RISK MANAGEMENT TOOLS

    Directory of Open Access Journals (Sweden)

    Vladut Iacob

    2013-12-01

    Full Text Available Although the projects are different from each other there are many common things that contribute to their success. Looked overall, the success of a project is the result of a multitude of factors. This person is considered the "engine" of the project. The man who makes the action set for the achievement of project objectives to be brought to an end. The project manager must have the technical knowledge and economic diverse. He should be able to choose a team and lead. You must be tenacious, combative, to know how to communicate both within the team and beyond. In a word, the project manager must have an impressive stock of knowledge, skills and abilities and appreciate as Peter Drucker, to "exist for the organization. To be its servant. Any management who forget this will only cause damage to the organization. "This study will focus on highlighting the skills of the project manager and their role in managing difficult situations or risk.

  9. Tank waste remediation system risk management plan

    International Nuclear Information System (INIS)

    Zimmerman, B.D.

    1998-01-01

    The purpose of the Tank Waste Remediation System (TWRS) Risk Management Plan is to describe a consistent approach to risk management such that TWRS Project risks are identified and managed to achieve TWRS Project success. The Risk Management Plan implements the requirements of the Tank Waste Remediation System Systems Engineering Management Plan in the area of risk management. Figure ES-1 shows the relationship of the TWRS Risk Management Plan to other major TWRS Project documents. As the figure indicates, the Risk Management Plan is a tool used to develop and control TWRS Project work. It provides guidance on how TWRS Project risks will be assessed, analyzed, and handled, and it specifies format and content for the risk management lists, which are a primary product of the risk management process. In many instances, the Risk Management Plan references the TWRS Risk Management Procedure, which provides more detailed discussion of many risk management activities. The TWRS Risk Management Plan describes an ongoing program within the TWRS Project. The Risk Management Plan also provides guidance in support of the TWRS Readiness To-Proceed (RTP) assessment package

  10. Reducing the risk, managing safety.

    Science.gov (United States)

    Aldridge, Peter

    2016-02-01

    Fire safety in healthcare premises has always been a challenge to those that discharge this duty. Statutory compliance should be a matter of course, but in an ever increasingly challenged NHS, even this is not a given. While the NHS is driven by managing very complex risk to deliver cutting edge healthcare, providers cannot be risk averse. Which risk, however, takes priority? Here Peter Aldridge, fire and corporate services manager at Leeds Teaching Hospitals NHS Trust, and Secretary to the National Association of Healthcare Fire Officers (NAHFO)--which will this month and next jointly stage fire safety seminars with IHEEM; see page 8--considers the key issues, with input from a fire officer at a leading mental health and community Trust.

  11. Risk Management Practices: The Ghanaian Firms' Perspective ...

    African Journals Online (AJOL)

    Using a quantitative approach the findings of the study are that Ghanaian firms understand risk and risk management. Additionally, operational, liquidity and credit risk are the most dominant risks experienced while risk identification and selection jointly determine risk management practices in Ghana. Based on the findings ...

  12. Overview of the Hanford risk management plan

    International Nuclear Information System (INIS)

    Halverson, T.G.

    1998-01-01

    The Project Hanford Management Contract called for the enhancement of site-wide decision processes, and development of a Hanford Risk Management Plan to adopt or develop a risk management system for the Hanford Site. This Plan provides a consistent foundation for Site issues and addresses site-wide management of risks of all types. It supports the Department of Energy planning and sitewide decision making policy. Added to this requirement is a risk performance report to characterize the risk management accomplishments. This paper presents the development of risk management within the context of work planning and performance. Also discussed are four risk elements which add value to the context

  13. Pharmacist-led, primary care-based disease management improves hemoglobin A1c in high-risk patients with diabetes.

    Science.gov (United States)

    Rothman, Russell; Malone, Robb; Bryant, Betsy; Horlen, Cheryl; Pignone, Michael

    2003-01-01

    We developed and evaluated a comprehensive pharmacist-led, primary care-based diabetes disease management program for patients with Type 2 diabetes and poor glucose control at our academic general internal medicine practice. The primary goal of this program was to improve glucose control, as measured by hemoglobin A1c (HbA1c). Clinic-based pharmacists offered support to patients with diabetes through direct teaching about diabetes, frequent phone follow-up, medication algorithms, and use of a database that tracked patient outcomes and actively identified opportunities to improve care. From September 1999, to May 2000, 159 subjects were enrolled, and complete follow-up data were available for 138 (87%) patients. Baseline HbA1c averaged 10.8%, and after an average of 6 months of intervention, the mean reduction in HbA1c was 1.9 percentage points (95% confidence interval, 1.5-2.3). In predictive regression modeling, baseline HbA1c and new onset diabetes were associated with significant improvements in HbA1c. Age, race, gender, educational level, and provider status were not significant predictors of improvement. In conclusion, a pharmacist-based diabetes care program integrated into primary care practice significantly reduced HbA1c among patients with diabetes and poor glucose control.

  14. Risk Management for e-Business

    Directory of Open Access Journals (Sweden)

    2007-01-01

    Full Text Available In the new Internet economy, risk management plays a critical role to protect the organization and its ability to perform their business mission, not just its IT assets. Risk management is the process of identifying risk, assessing risk, and taking steps to reduce risk to an acceptable level. The risk management is an important component of a IT security program. Information and communications technology management and IT security are responsible for ensuring that technology risks are managed appropriately. These risks originate from the deployment and use of IT assets in various ways, such as configuring systems incorrectly or gaining access to restricted software.

  15. Risk Management Practices by Barbadian Banks

    Directory of Open Access Journals (Sweden)

    Anthony Wood

    2013-07-01

    The main findings of the paper are: risk managers perceive risk management as critical to their banks’ performance; the types of risks causing the greatest exposures are credit risk, operational risk, country/sovereign risk, interest rate risk and market risk; there was a high level of success with current risk management practices and these practices have evolved over time in line with the changing economic environment and regulatory updates. Overall, the findings suggest strongly that in light of the current depressed economic climate, banks operating in Barbados are indeed risk-focused or might we say “risk intelligent”.

  16. Tank waste remediation system risk management list

    International Nuclear Information System (INIS)

    Collard, L.B.

    1995-01-01

    The Tank Waste Remedation System (TWRS) Risk Management List and it's subset of critical risks, the Critical Risk Management List, provide a tool to senior RL and WHC management (Level-1 and -2) to manage programmatic risks that may significantly impact the TWRS program. The programmatic risks include cost, schedule, and performance risks. Performance risk includes technical risk, supportability risk (such as maintainability and availability), and external risk (i.e., beyond program control, for example, changes in regulations). The risk information includes a description, its impacts, as evaluation of the likelihood, consequences and risk value, possible mitigating actions, and responsible RL and WHC managers. The issues that typically form the basis for the risks are presented in a separate table and the affected functions are provided on the management lists

  17. The impact of a disease management program (COACH on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study: a randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Selvaraj Francis Jude

    2012-10-01

    Full Text Available Abstract Background To evaluate the efficacy of Counselling and Advisory Care for Health (COACH programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm and primary care physicians assisted by nurse educators (PCP-NE arm. Methods This was a multi-centre, open label, randomised trial of a disease management programme (COACH among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE and 148 to care provided by primary care physicians (PCP alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio, Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Results Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS mean change from baseline LDL-C were −30.09% and −27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288, with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had

  18. The impact of a disease management program (COACH) on the attainment of better cardiovascular risk control in dyslipidaemic patients at primary care centres (The DISSEMINATE Study): a randomised controlled trial.

    Science.gov (United States)

    Selvaraj, Francis Jude; Mohamed, Mafauzy; Omar, Khairani; Nanthan, Sudha; Kusiar, Zainab; Subramaniam, Selvaraj Y; Ali, Norsiah; Karanakaran, Kamalakaran; Ahmad, Fauziah; Low, Wilson H H

    2012-10-10

    To evaluate the efficacy of Counselling and Advisory Care for Health (COACH) programme in managing dyslipidaemia among primary care practices in Malaysia. This open-label, parallel, randomised controlled trial compared the COACH programme delivered by primary care physicians alone (PCP arm) and primary care physicians assisted by nurse educators (PCP-NE arm). This was a multi-centre, open label, randomised trial of a disease management programme (COACH) among dyslipidaemic patients in 21 Malaysia primary care practices. The participating centres enrolled 297 treatment naïve subjects who had the primary diagnosis of dyslipidaemia; 149 were randomised to the COACH programme delivered by primary care physicians assisted by nurse educators (PCP-NE) and 148 to care provided by primary care physicians (PCP) alone. The primary efficacy endpoint was the mean percentage change from baseline LDL-C at week 24 between the 2 study arms. Secondary endpoints included mean percentage change from baseline of lipid profile (TC, LDL-C, HDL-C, TG, TC: HDL ratio), Framingham Cardiovascular Health Risk Score and absolute risk change from baseline in blood pressure parameters at week 24. The study also assessed the sustainability of programme efficacy at week 36. Both study arms demonstrated improvement in LDL-C from baseline. The least squares (LS) mean change from baseline LDL-C were -30.09% and -27.54% for PCP-NE and PCP respectively. The difference in mean change between groups was 2.55% (p=0.288), with a greater change seen in the PCP-NE arm. Similar observations were made between the study groups in relation to total cholesterol change at week 24. Significant difference in percentage change from baseline of HDL-C were observed between the PCP-NE and PCP groups, 3.01%, 95% CI 0.12-5.90, p=0.041, at week 24. There was no significant difference in lipid outcomes between 2 study groups at week 36 (12 weeks after the programme had ended). Patients who received coaching and advice from

  19. Risk Management for Food Allergy

    DEFF Research Database (Denmark)

    Risk Management for Food Allergy is developed by a team of scientists and industry professionals who understand the importance of allergen risk assessment and presents practical, real-world guidance for food manufacturers. With more than 12 million Americans suffering from food allergies and little...... appropriate "safe" thresholds of ingredients, the food industry must take increasingly proactive steps to avoid direct or cross-contamination as well as ensuring that their products are appropriately labeled and identified for those at risk. This book covers a range of critical topics in this area, including...... indication of what is causing that number to continue to grow, food producers, packagers and distributors need to appropriately process, label and deliver their products to ensure the safety of customers with allergic conditions. By identifying risk factors during processing as well as determining...

  20. Physician-patient communication in managed care.

    OpenAIRE

    Gordon, G H; Baker, L; Levinson, W

    1995-01-01

    The quality of physician-patient communication affects important health care outcomes. Managed care presents a number of challenges to physician-patient communication, including shorter visits, decreased continuity, and lower levels of trust. Good communication skills can help physicians create and maintain healthy relationships with patients in the face of these challenges. We describe 5 communication dilemmas that are common in managed care and review possible solutions suggested by recent ...

  1. Intensive Care Nursing And Time Management

    OpenAIRE

    ÖZCANLI, Derya; İLGÜN, Seda

    2008-01-01

    Time is not like other resources, because it can not be bought, sold, stolen, borrowed, stored, saved, multiplied or changed. All it can be done is spent. Time management means the effective use of resources, including time, in such a way that indi- viduals are effective in achieving important personal goals. With the increasing emphasis on efficiency in health care, how a nurse manages her time is an important consideration. Since intensive care nurs- ing is focused on the care and tr...

  2. The evolution of physician-directed managed care.

    Science.gov (United States)

    Unland, J J

    1995-01-01

    The health care industry is evolving. In the near term, POs will become the state of the art in physician-directed managed care. Eventually, POs will merge into fully integrated group practices. From there, regional POs and group practices will develop their own insurance products. But because these organizations will be dominated by physicians who wish to practice medicine, rather than sell insurance, money will be made by appropriately managing risk and providing high-quality care. In time, physicians will take control and "manage" managed care, as they are the only ones--not administrators, executives, or other business people--who are in a position to fundamentally revise the way medicine is practiced.

  3. Developing risk management dashboards using risk and quality measures: A visual best practices approach.

    Science.gov (United States)

    Bunting, Robert F; Siegal, Dana

    2017-10-01

    Because quality measures are ubiquitous, health care risk management leaders often use them as a proxy for risk management measures. While certain quality measures adequately reflect some aspects of risk management, they are neither a perfect nor complete substitute for well-developed and comprehensive risk management measures. Using a comprehensive approach consisting of quality measures, risk measures, and measures that are less amenable to classification would be the best approach. Identifying the most powerful and informative measures, designing the most appropriate dashboards, and incorporating visual best practices are crucial steps required for evaluating the effectiveness and value of an enterprise risk management program. The authors explain the terms and concepts, review the measures available in the literature, propose new measures, discuss visual best practices, and provide sample dashboard components. © 2017 American Society for Healthcare Risk Management of the American Hospital Association.

  4. 42 CFR 441.476 - Risk management.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Risk management. 441.476 Section 441.476 Public... Self-Directed Personal Assistance Services Program § 441.476 Risk management. (a) The State must... plan for how identified risks will be mitigated. (d) The State must ensure that the risk management...

  5. [The hospital perspective: disease management and integrated health care].

    Science.gov (United States)

    Schrappe, Matthias

    2003-06-01

    Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

  6. Probabilistic risk assessment as an aid to risk management

    International Nuclear Information System (INIS)

    Garrick, B.J.

    1982-01-01

    Probabilistic risk assessments are providing important insights into nuclear power plant safety. Their value is two-fold: first as a means of quantifying nuclear plant risk including contributors to risk, and second as an aid to risk management. A risk assessment provides an analytical plant model that can be the basis for performing meaningful decision analyses for controlling safety. It is the aspect of quantitative risk management that makes probabilistic risk assessment an important technical discipline of the future

  7. Risk Management and Litigation Avoidance in Outdoor Recreation Programming.

    Science.gov (United States)

    Hanna, Glenda

    This paper reviews aspects of Canadian and U.S. law related to liability and negligence of outdoor programs and suggests strategies for risk management. To prove negligence, an individual injured in an outdoor program must prove that the outdoor leader had a duty of care to the participant, standards of care were breached, actual injury was…

  8. Considerations on Integrating Risk and Quality Management

    Directory of Open Access Journals (Sweden)

    Maria POPESCU

    2011-03-01

    Full Text Available This paper aims to highlight the links between risk management and quality management and to study the possibility of their integrated approach. The study reviews the evolution of risk approach within organizations and stresses the need to increase the effectiveness of this approach by incorporating risk management methodology in the quality management system. Starting from this idea, the authors present the current state of risk approach into quality management, basic rules of integrated quality-risk management and major difficulties which may arise in the implementation of integrated quality–risk systems.

  9. Managing risks and hazardous in industrial operations

    Energy Technology Data Exchange (ETDEWEB)

    Almaula, S.C. [Woodward-Clyde International, Oakland, CA (United States)

    1996-12-31

    The main objective of this paper is to demonstrate that it makes good business sense to identify risks and hazards of an operation and take appropriate steps to manage them effectively. Developing and implementing an effective risk and hazard management plan also contibutes to other industry requirements and standards. Development of a risk management system, key elements of a risk management plan, and hazards and risk analysis methods are outlined. Comparing potential risk to the cost of prevention is also discussed. It is estimated that the cost of developing and preparing the first risk management plan varies between $50,000 to $200,000. 3 refs., 2 figs., 1 tab.

  10. Hanford Tanks Initiative risk management guide

    International Nuclear Information System (INIS)

    Schaus, P.S.

    1997-01-01

    This project-specific Risk Management Guide describes the general approach and process being used by the HTI Project to manage risk associated with execution of the HTI mission. It includes the initial identification of risk and the quantification of its likelihood and severity of its consequences. It further addresses the formulation of risk mitigation plans, periodic statusing of the Risk Management List, and risk closure

  11. Managing IT Integration Risk in Acquisitions

    DEFF Research Database (Denmark)

    Henningsson, Stefan; Kettinger, William J.

    2016-01-01

    The article discusses a framework for evaluating risk of information technology (IT) integration in acquisitions. Topics include the use of the experience of serial acquirer Trelleborg AB to show the merits of the framework for managing the risk and to determine low-risk acquisitions......, the importance of managing IT integration risk, and various risk areas for acquisition IT integration....

  12. Risk management in microfinance institutions

    OpenAIRE

    Batin, Artyom

    2014-01-01

    In the following paper I have tried to find the correlation between type of ownership and effective risk management in the operations of microfinance institutions in India. The results found are consistent with the current findings of how the type of ownership does not impact both the financial or social performance of MFIs. Dataset of 72 MFIs was acquired from the Microfinance Information Exchange on MFIs and evaluated using an OLS regression. The results show that the type of ownership insi...

  13. The direct costs of intensive care management and risk factors for financial burden of patients with severe sepsis and septic shock.

    Science.gov (United States)

    Khwannimit, Bodin; Bhurayanontachai, Rungsun

    2015-10-01

    The costs of severe sepsis care from middle-income countries are lacking. This study investigated direct intensive care unit (ICU) costs and factors that could affect the financial outcomes. A prospective cohort study was conducted in the medical ICU of a tertiary referral university teaching hospital in Thailand. A total of 897 patients were enrolled in the study, with 683 (76.1%) having septic shock. Community-, nosocomial, and ICU-acquired infections were documented in 574, 282, and 41 patients, respectively. The median ICU costs per patient were $2716.5 ($1296.1-$5367.6) and $599.9 ($414.3-$948.6) per day. The ICU costs accounted for 64.7% of the hospital costs. In 2008 to 2011, the ICU costs significantly decreased by 40% from $3542.5 to $2124.9, whereas, the daily ICU costs decreased only 3.3% from $609.7 to $589.7. By multivariate logistic regression analysis, age, nosocomial or ICU infection, admission from the emergency department, number of organ failures, ICU length of stay, and fluid balance the first 72 hours were independently associated with ICU costs. The ICU costs of severe sepsis management significantly declined in our study. However, the ICU costs were a financial burden accounting for two thirds of the hospital costs. It is essential for intensivists to contribute a high standard of care within a restricted budget. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Understanding factors that influence the use of risk scoring instruments in the management of patients with unstable angina or non-ST-elevation myocardial infarction in the Netherlands: a qualitative study of health care practitioners' perceptions.

    Science.gov (United States)

    Engel, Josien; Heeren, Marie-Julie; van der Wulp, Ineke; de Bruijne, Martine C; Wagner, Cordula

    2014-09-22

    Cardiac risk scores estimate a patient's risk of future cardiac events or death. They are developed to inform treatment decisions of patients diagnosed with unstable angina or non-ST-elevation myocardial infarction. Despite recommending their use in guidelines and evidence of their prognostic value, they seem underused in practice. The purpose of the study was to gain insight in the motivation for implementing cardiac risk scores, and perceptions of health care practitioners towards the use of these instruments in clinical practice. This qualitative study involved semi-structured interviews with 31 health care practitioners at 11 hospitals throughout the Netherlands. Participants were approached through purposive sampling to represent a broad range of participant- and hospital characteristics, and included cardiologists, medical residents, medical interns, nurse practitioners and an emergency physician. The Pettigrew and Whipp Framework for strategic change was used as a theoretical basis. Data were initially analysed through open coding to avoid forcing data into categories predetermined by the framework. Cardiac risk score use was dependent on several factors, including IT support, clinical relevance for daily practice, rotation of staff and workload. Both intrinsic and extrinsic drivers for implementation were identified. Reminders, feedback and IT solutions were strategies used to improve and sustain the use of these instruments. The scores were seen as valuable support systems in improving uniformity in treatment practices, educating interns, conducting research and quantifying a practitioner's own risk assessment. However, health care practitioners varied in their perceptions regarding the influence of cardiac risk scores on treatment decisions. Health care practitioners disagree on the value of cardiac risk scores for clinical practice. Practitioners driven by intrinsic motivations predominantly experienced benefits in policy-making, education and research

  15. Intensive Care Management of Patients with Cirrhosis.

    Science.gov (United States)

    Olson, Jody C

    2018-06-01

    Cirrhosis is a major worldwide health problem which results in a high level of morbidity and mortality. Patients with cirrhosis who require intensive care support have high mortality rates of near 50%. The goal of this review is to address the management of common complications of cirrhosis in the ICU. Recent epidemiological studies have shown an increase in hospitalizations due to advanced liver disease with an associated increase in intensive care utilization. Given an increasing burden on the healthcare system, it is imperative that we strive to improve our management cirrhotic patients in the intensive care unit. Large studies evaluating the management of patients in the intensive care setting are lacking. To date, most recommendations are based on extrapolation of data from studies in cirrhosis outside of the ICU or by applying general critical care principles which may or may not be appropriate for the critically ill cirrhotic patient. Future research is required to answer important management questions.

  16. Risk management in nuclear power social aspects

    International Nuclear Information System (INIS)

    Sappa, N.N.

    1996-01-01

    Problems connected with safety evaluation and risk management during operation of nuclear power installations are considered. Social aspects of risk assessment of enterprises with increased danger are discussed

  17. Strategic raw materials. Risk management

    International Nuclear Information System (INIS)

    Bertau, Martin; Matschullat, Joerg; Kausch, Peter

    2014-01-01

    This volume is divided into four chapters: (1) Raw material management, (2) Primary raw materials, (3) Secondary raw materials and recycling, (4). Processing and products. The topics for the chapter ''Raw material management'' are: Substitution of raw materials - framework conditions and implementation; Thales: Strategic raw materials; Time for cooperation between the EU and China in raw materials policy; Availability of elements for the semiconductor industry; Market price risks of raw material-intensive companies - identification and management. The topics on the second item ''Primary raw materials'' are: The supply of economic-critical raw materials - A search and analysis for causes; Lithium extraction from primary raw materials - state and perspectives; The global market of rare earths - A balancing act; Rare earth deposits in Namibia; New technologies in exploration and discovery - Focus on activities in Europe. The third chapter, ''Secondary Raw Materials and Recycling'', covered the topics: Technology metals - Systemic Requirements along the recycling chain; Integrated re-use of high-tech and greentech wastes; From the sewage sludge ash to the phosphorus fertilizer RecoPhos P38 in the stress field of waste, fertilizer and soil protection. In chapter 4. ''Processing and products'' are the topics: Treatment and processing of rare earth metals; Processing of mineral resources - opportunities and challenges; Consequences of modern germanium chemistry; Strategic resources - Risk management. A review and outlook with a pinch of fantasy.. [de

  18. Improving patient adherence to lifestyle advice (IMPALA: a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol

    Directory of Open Access Journals (Sweden)

    Grol Richard

    2008-01-01

    Full Text Available Abstract Background Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on diet, physical exercise, smoking and alcohol, have moderate, but potentially relevant effects in these patients, adherence to lifestyle advice in general practice is not optimal. The IMPALA study intends to improve adherence to lifestyle advice by involving patients in decision making on cardiovascular prevention by nurse-led clinics. The aim of this paper is to describe the design and methods of a study to evaluate an intervention aimed at involving patients in cardiovascular risk management. Methods A cluster-randomised controlled trial in 20 general practices, 10 practices in the intervention arm and 10 in the control arm, starting on October 2005. A total of 720 patients without existing cardiovascular diseases but eligible for cardiovascular risk assessment will be recruited. In both arms, the general practitioners and nurses will be trained to apply the national guideline for cardiovascular risk management. Nurses in the intervention arm will receive an extended training in risk assessment, risk communication, the use of a decision aid and adapted motivational interviewing. This communication technique will be used to support the shared decision-making process about risk reduction. The intervention comprises 2 consultations and 1 follow-up telephone call. The nurses in the control arm will give usual care after the risk estimation, according to the national guideline. Primary outcome measures are self-reported adherence to lifestyle advice and drug treatment. Secondary outcome measures are the patients' perception of risk and their motivation to change their behaviour. The measurements will take place at baseline and after 12 and 52

  19. Improving Obesity Prevention and Management in Primary Care in Canada.

    Science.gov (United States)

    Campbell-Scherer, Denise; Sharma, Arya Mitra

    2016-09-01

    Obesity is a major risk factor for chronic diseases with significant morbidity, mortality and health care cost. There is concern due to the dramatic increase in overweight and obesity in Canada in the last 20 years. The causes of obesity are multifactorial, with underestimation by patients and healthcare providers of the long-term nature of the condition, and its complexity. Solutions related to prevention and management will require multifaceted strategies involving education, health policy, public health and health systems across the care continuum. We believe that to support such strategies we need to have a strong primary care workforce equipped with appropriate knowledge, skills and attitudes to support persons at risk for, or with, obesity. To achieve this end, significant skills building is required to improve primary care obesity prevention and management efforts. This review will first examine the current state, and then will outline how we can improve.

  20. [Managed care. Its impact on health care in the USA, especially on anesthesia and intensive care].

    Science.gov (United States)

    Bauer, M; Bach, A

    1998-06-01

    Managed care, i.e., the integration of health insurance and delivery of care under the direction of one organization, is gaining importance in the USA health market. The initial effects consisted of a decrease in insurance premiums, a very attractive feature for employers. Managed care promises to contain expenditures for health care. Given the shrinking public resources in Germany, managed care seems attractive for the German health system, too. In this review the development of managed care, the principal elements, forms of organisation and practical tools are outlined. The regulation of the delivery of care by means of controlling and financial incentives threatens the autonomy of physicians: the physician must act as a "double agent", caring for the interest for the individual patient and being restricted by the contract with the managed care organisation. Cost containment by managed care was achieved by reducing the fees for physicians and hospitals (and partly by restricting care for patients). Only a fraction of this cost reduction was handed over to the enrollee or employer, and most of the money was returned with profit to the shareholders of the managed care organisations. The preeminent role of primary care physicians as gatekeepers of the health network led to a reduced demand for specialist services in general and for university hospitals and anesthesiologists in particular. The paradigm of managed care, i.e., to guide the patient and the care giver through the health care system in order to achieve cost-effective and high quality care, seems very attractive. The stress on cost minimization by any means in the daily practice of managed care makes it doubtful if managed care should be an option for the German health system, in particular because there are a number of restrictions on it in German law.

  1. Value at Risk models for Energy Risk Management

    OpenAIRE

    Novák, Martin

    2010-01-01

    The main focus of this thesis lies on description of Risk Management in context of Energy Trading. The paper will predominantly discuss Value at Risk and its modifications as a main overall indicator of Energy Risk.

  2. Evaluating managed care's special telecommunications needs.

    Science.gov (United States)

    Harrison, P; Schenk, D

    1993-11-01

    Right now, managed care is a vast cosmic soup. But whether its ultimate form is the result of a bureaucratic big bang or a series of small industry explosions, one thing seems clear: telecommunications is the framework upon which managed care will be built. Managed care's primary players--purchasers, providers and payors--have already discovered the unifying power of telecommunications within their respective worlds. However, as the three worlds collide, an entirely new set of special telecommunications needs arises. And most of these needs can be distilled into three basic requirements: bigger networks, faster networks and smarter networks.

  3. Risk factors, ulcer grade and management outcome of diabetic foot ...

    African Journals Online (AJOL)

    Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a Tropical Tertiary Care Hospital. ... Data documented included age, gender, type of DM, duration of DM, risk factors of DFU, duration of DFU ... 85.2% had type 2 DM.

  4. They're Suing Us? Liability and Risk Management.

    Science.gov (United States)

    Hollander, Patricia A.

    1982-01-01

    Legal issues in liability for and prevention of injuries through negligence are discussed: proving negligence, who is owed a duty of care, who may be sued, remedies, risk management (shifting risk, insurance, indemnification, waivers and releases), and preventing claims (warning of known danger, proper supervision, school maintenance, security,…

  5. Human System Risk Management for Space Flight

    Science.gov (United States)

    Davis, Jeffrey

    2015-01-01

    This brief abstract reviews the development of the current day approach to human system risk management for space flight and the development of the critical components of this process over the past few years. The human system risk management process now provides a comprehensive assessment of each human system risk by design reference mission (DRM) and is evaluated not only for mission success but also for long-term health impacts for the astronauts. The discipline of bioastronautics is the study of the biological and medical effects of space flight on humans. In 1997, the Space Life Sciences Directorate (SLSD) initiated the Bioastronautics Roadmap (Roadmap) as the "Critical Path Roadmap", and in 1998 participation in the roadmap was expanded to include the National Space Biomedical Research Institute (NSBRI) and the external community. A total of 55 risks and 250 questions were identified and prioritized and in 2000, the Roadmap was base-lined and put under configuration control. The Roadmap took into account several major advisory committee reviews including the Institute of Medicine (IOM) "Safe Passage: Astronaut care for Exploration Missions", 2001. Subsequently, three collaborating organizations at NASA HQ (Chief Health and Medical Officer, Office of Space Flight and Office of Biological & Physical Research), published the Bioastronautics Strategy in 2003, that identified the human as a "critical subsystem of space flight" and noted that "tolerance limits and safe operating bands must be established" to enable human space flight. These offices also requested a review by the IOM of the Roadmap and that review was published in October 2005 as "A Risk Reduction Strategy for Human Exploration of Space: A Review of NASA's Bioastronautics Roadmap", that noted several strengths and weaknesses of the Roadmap and made several recommendations. In parallel with the development of the Roadmap, the Office of the Chief Health and Medical Officer (OCHMO) began a process in

  6. Organizing and managing care in a changing health system.

    Science.gov (United States)

    Kohn, L T

    2000-04-01

    To examine ways in which the management and organization of medical care is changing in response to the shifting incentives created by managed care. Site visits conducted in 12 randomly selected communities in 1996/ 1997. Approximately 35-60 interviews were conducted per site with key informants in healthcare and community organizations; about half were with providers. A standardized interview protocol was implemented across all sites, enabling cross-site comparisons. Multiple respondents were interviewed on each issue. A great deal of experimentation and apparent duplication exist in efforts to develop programs to influence physician practice patterns. Responsibility for managing care is being contested by health plans, medical groups and hospitals, as each seeks to accrue the savings that can result from the more efficient delivery of care. To manage the financial and clinical risk, providers are aggressively consolidating and reorganizing. Most significant was the rapid formation of intermediary organizations, such as independent practice arrangements (IPAs), physician-hospital organizations (PHOs), or management services organizations (MSOs), for contracting with managed care organizations. Managed care appears to have only a modest effect on how healthcare organizations deliver medical care, despite the profound effect that managed care has on how providers are organized. Rather than improving the efficiency of healthcare organizations, provider efforts to build large systems and become indispensable to health plans are exacerbating problems of excess capacity. It is not clear if new organizational arrangements will help providers manage the changing incentives they face, or if their intent is to blunt the effects of the incentives by forming larger organizations to improve their bargaining power and resist change.

  7. Risk management in product innovation projects

    NARCIS (Netherlands)

    Halman, J.I.M.; Keizer, J.A.

    1993-01-01

    In product innovation projects risk management has become increasingly important. Technological and commercial developments ask for effective and efficient product innovation. Systematic diagnosing and management of risks can help to make product innovation projects successful. In this paper a

  8. Operational Risk Management and Military Aviation Safety

    National Research Council Canada - National Science Library

    Ashley, Park

    1999-01-01

    .... The Army's Class A aviation mishap rate declined after it implemented risk management (RM) principles in 1987. This reduction caught the attention of Air Force leadership who have since stated that the application of operational risk management...

  9. Managed care aspects of managing multiple sclerosis.

    Science.gov (United States)

    Owens, Gary M

    2013-11-01

    Multiple sclerosis (MS) is a chronic disease of the central nervous system usually diagnosed in the second or third decade of life; MS is more common among women than men by a ratio of 3 to 1. With its relatively early age of onset and symptoms that impair patients' quality of life, MS requires lifelong, dynamic treatment, and places a substantial economic burden on individuals, healthcare systems, and society. The costs associated with providing benefits for MS therapy are growing rapidly and the increasing complexity of the MS market is impacting disease management for payers. Employers are also increasingly aware of the costs associated with MS and are asking health plans to advise on the most appropriate and cost-effective ways to manage both pharmacologic and non-pharmacologic therapies for MS. Health plans, by necessity, must therefore balance appropriate access to treatments for MS with the need to manage rising treatment costs. To meet this goal, payers require population-based solutions, guidelines, and treatment algorithms for the management of MS that can be used in clinical and formulary management decision making in the context of an evolving therapeutic landscape. Further, comparative studies are necessary for payers to determine which agents may work best on a population basis. Due to the current lack of appropriate clinical guidance and insufficient head-to-head data on disease-modifying drugs, strategies for health plans and clinical management have been designed using the best available evidence. Undoubtedly, management of this class will continue to evolve with the launch of newer agents.

  10. Optimizing cardiothoracic surgery information for a managed care environment.

    Science.gov (United States)

    Denton, T A; Matloff, J M

    1995-11-01

    The rapid change occurring in American healthcare is a direct response to rising costs. Managed care is the fastest growing model that attempts to control escalating costs through limitations in patient choice, the active use of guidelines, and placing providers at risk. Managed care is an information intensive system, and those providers who use information effectively will be at an advantage in the competitive healthcare marketplace. There are five classes of information that providers must collect to be competitive in a managed care environment: patient satisfaction, medical outcomes, continuous quality improvement, quality of the decision, and financial data. Each of these should be actively used in marketing, assuring the quality of patient care, and maintaining financial stability. Although changes in our healthcare system are occurring rapidly, we need to respond to the marketplace to maintain our viability, but as physicians, we have the singular obligation to maintain the supremacy of the individual patient and the physician-patient relationship.

  11. Treatment in a Preventive Cardiology Clinic Utilizing Advanced Practice Providers (APPs) Effectively Closes Atherosclerotic Cardiovascular Disease (ASCVD) Risk Management Gaps Amongst a Primary Prevention Population Compared with a Propensity-Matched Primary Care Cohort: A Team Based Care Model and its Impact on Lipid and Blood Pressure Management.

    Science.gov (United States)

    Fentanes, Emilio; Vande Hei, Anthony G; Holuby, R Scott; Suarez, Norma; Slim, Yousif; Slim, Jennifer N; Slim, Ahmad M; Thomas, Dustin

    2018-04-17

    Advanced Practice Providers (APPs) can fill access to care gaps created by physician shortages and improve adherence/compliance with preventive atherosclerotic cardiovascular disease (ASCVD) interventions. We retrospectively reviewed data on 595 patients enrolled in a preventive cardiology clinic (PCC) utilizing APPs compared with a propensity-matched cohort (PMC) of 595 patients enrolled in primary care clinics alone. PCC patients were risk stratified using Framingham risk scoring (FRS) and coronary artery calcium scoring (CACS) and treated based on published guideline-based algorithms. Baseline demographics were well balanced between the groups. CACS was more commonly obtained in PCC patients (p<0.001) resulting in reclassification of 30.6% patients to a higher risk category, including statin therapy in 26.6% of low FRS PCC patients with CACS ≥75 th MESA percentile. Aspirin initiation was higher for high and intermediate FRS patients in the PCC (p <0.001). Post-intervention mean LDL, non-HDL, and triglycerides (all p<0.05) were lower in the PCC group. Compliance with appropriate lipid treatment was higher in intermediate to high FRS patients (p=0.004) in the PCC group. Aggressive LDL and non-HDL treatment goals <70mg/dL (p=0.005) and <130mg/dL (p<0.001), respectively, were more commonly achieved in high FRS PCC patients. Median post-intervention SBP was lower amongst intermediate and low FRS patients (p=0.001 & p<0.001, respectively). Cumulatively, this resulted in a reduction in median post-intervention PCC FRS across all initial FRS risk categories (p<0.001 for all). APPs within a preventive cardiology clinic effectively risk stratify and aggressively manage ASCVD risk factors resulting in a reduction in post-intervention FRS. This article is protected by copyright. All rights reserved.

  12. THEORETICAL BASIS FOR MANAGEMENT OF PERSONNEL RISKS

    OpenAIRE

    Haliashova, Katsiaryna

    2017-01-01

    Necessity of personnel risks management is based on research results. The authors' approaches to the determination of personnel risks and to their management have been explored. The author's definition of the concept of "personnel risks" is proposed. A classification of personnel risks is developed depending on the stage of origin and the tasks of the personnel policy, as well as the methods of management personnel risks in the organization. The article presents a methodical approach to perso...

  13. 12 CFR 932.1 - Risk management.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 7 2010-01-01 2010-01-01 false Risk management. 932.1 Section 932.1 Banks and Banking FEDERAL HOUSING FINANCE BOARD FEDERAL HOME LOAN BANK RISK MANAGEMENT AND CAPITAL STANDARDS FEDERAL HOME LOAN BANK CAPITAL REQUIREMENTS § 932.1 Risk management. Before its new capital plan may take...

  14. Study of International Standards of Risk Management

    Directory of Open Access Journals (Sweden)

    Dykan Volodymyr L.

    2014-01-01

    Full Text Available The goal of the article lies in the study of existing international standards of risk management, an important factor of improvement of risk management in domestic corporations and enterprises and development of recommendations on application of international standards in Ukraine, in particular, within the framework of building corporate systems of risk management. The conducted study shows that approaches on organisation of the process of risk management, used in standards of risk management, are of general character and differ with the degree of detailing. Their undoubted value in development of risk management in Ukraine is identification of a general direction of building corporate systems of risk management in practice. The said approaches at the national and corporate levels of standardisation in Ukraine within the framework of building corporate systems of risk management would allow improvement of risk management in corporations and enterprises. The prospect of further studies of domestic specialists in the field of risk management is development of the domestic standard of risk management with consideration of modern domestic specific features of development of risk management in Ukraine and leading foreign experience.

  15. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

    Science.gov (United States)

    Ramirez, Pedro T.; Pareja, Rene; Rendón, Gabriel J.; Millan, Carlos; Frumovitz, Michael; Schmeler, Kathleen M.

    2014-01-01

    The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size <2 cm, stromal invasion <10mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. PMID:24041877

  16. [The role of management in health care].

    Science.gov (United States)

    Güntert, Bernhard J

    2007-01-01

    The situation in the health care sector is affected by a shortage of public funds on the one hand and, on the other hand, by rapid developments in medicine and nursing with an enormous expansion of both diagnostic and therapeutic possibilities. This and the aging population are generating a steadily increasing demand for health care services. The result is an increased cost consciousness in society calling for more professional management in health care organizations. However, the traditional administration of health care organizations, which is closely aligned with health professionals and production processes, was not able to cope with these dynamics or did so only unsatisfactorily. An improved management would surely lead to an optimization of health care delivery processes and a more effective use of resources. The question, however, is whether the effectiveness of the total system can be improved and whether patients' and society's needs can actually be met by classical management approaches.

  17. Construction Management Risk System (CMRS for Construction Management (CM Firms

    Directory of Open Access Journals (Sweden)

    Kyungmo Park

    2017-02-01

    Full Text Available After the global financial crisis of 2008, the need for risk management arose because it was necessary to minimize the losses in construction management (CM firms. This was caused by a decreased amount of orders in the Korean CM market, which intensified order competition between companies. However, research results revealed that risks were not being systematically managed owing to the absence of risk management systems. Thus, it was concluded that it was necessary to develop standard operating systems and implement risk management systems in order to manage risks effectively. Therefore, the purpose of this study was to develop a construction risk management system (CRMS for systematically managing risks. For this purpose, the field operation managers of CM firms were interviewed and surveyed in order to define risk factors. Upon this, a risk assessment priority analysis was performed. Finally, a risk management system that comprised seven modules and 20 sub-modules and was capable of responding systematically to risks was proposed. Furthermore, the effectiveness of this system was verified through on-site inspection. This system allows early response to risks, accountability verification and immediate response to legal disputes with clients by managing risk records.

  18. Home Care Nursing Improves Cancer Symptom Management

    Science.gov (United States)

    Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.

  19. Medicare Managed Care plan Performance, A Comparison...

    Data.gov (United States)

    U.S. Department of Health & Human Services — The study evaluates the performance of Medicare managed care, Medicare Advantage, Plans in comparison to Medicare fee-for-service Plans in three states with...

  20. Participatory management in today's health care setting

    International Nuclear Information System (INIS)

    Burnham, B.A.

    1987-01-01

    As the health care revolution progresses, so must the management styles of today's leaders. The authors must ask ourselves if we are managing tomorrow's work force or the work force of the past. Participatory management may better meet the needs of today's work force. This paper identifies the reasons participatory management is a more effective management style, the methods used to implement a participatory management program, its benefits (such as higher productivity and more efficient, effective implementation and acceptance of change), and the difficulties experienced

  1. Development of funding project risk management tools.

    Science.gov (United States)

    2013-11-01

    Funding project risk management is a process for identifying, assessing, and prioritizing project funding risks. To plan to : minimize or eliminate the impact of negative events, one must identify what projects have higher risk to respond to potentia...

  2. Applying the lessons of high risk industries to health care.

    Science.gov (United States)

    Hudson, P

    2003-12-01

    High risk industries such as commercial aviation and the oil and gas industry have achieved exemplary safety performance. This paper reviews how they have managed to do that. The primary reasons are the positive attitudes towards safety and the operation of effective formal safety management systems. The safety culture provides an important explanation of why such organisations perform well. An evolutionary model of safety culture is provided in which there is a range of cultures from the pathological through the reactive to the calculative. Later, the proactive culture can evolve towards the generative organisation, an alternative description of the high reliability organisation. The current status of health care is reviewed, arguing that it has a much higher level of accidents and has a reactive culture, lagging behind both high risk industries studied in both attitude and systematic management of patient risks.

  3. Risk management and audit | IDRC - International Development ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... a well defined strategic and program framework and sound management processes; and ... A Risk Management Committee supports and monitors the Centre's ... placed on our highly qualified staff in our management of human resources.

  4. Managing risk with renewable resources

    International Nuclear Information System (INIS)

    Brower, M.C.; Bernow, S.; Duckworth, M.; Spinney, P.; Bell, K.

    1997-01-01

    One approach to managing risk is for a utility company to invest in diverse power sources such as wind power plants. Since wind plants consume no fuel, can be built in relatively small increments with short construction lead times, and generate no pollutants, it is often said that they offer significant protection from risks associated with conventional fossil-fuel power plants. With assistance from Convergence Research, Charles River Associates, and the Tellus Institute, the authors tested this hypothesis by conducting an in-depth analysis of the risk implications of a decision to build a 1,600 MW wind power plant instead of a 400 MW gas-fired combined cycle plant. (The two plants were assumed to have equal firm capacity.) The case study utility was Texas Utilities Electric, a very large investor-owned company serving an area with substantial, high-quality wind resources. The uncertain inputs included fuel prices, environmental regulations (specifically, CO 2 and air pollution controls), wind plant output, conventional plant availability, and load growth. Two different market scenarios were examined: traditional regulation and an unregulated wholesale market characterized either by a power pool or fixed-price contracts of varying duration. Conclusions are striking: under traditional regulation, wind energy provides a net present-value risk-reduction benefit of $3.4 to $7.8/MWh

  5. Managing risks: Seveso and Harrisburg

    International Nuclear Information System (INIS)

    Conrads-Herzog, A.; Krebsbach-Gnath, C.

    1980-01-01

    The publications dealing with the technical, organisation-relevant, and social preconditions for risk strategies rely on second-hand information, i.e. the conclusions which are drawn from the production accident in Seveso and the TMI-accident. A comparison results in common facts as well as in fundamental differences. In contrast to the authorities in Italy the authorities in the United States intervened more rapidly; the management of necessary measures was taken over by the authorities and very good information was given. (DG) [de

  6. Participative management in health care services

    Directory of Open Access Journals (Sweden)

    M. Muller

    1995-03-01

    Full Text Available The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalisation of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management.

  7. Primary care quality management in Slovenia.

    NARCIS (Netherlands)

    Boerma, W.G.W.; Kringos, D.S.; Verschuuren, M.; Pellny, M.; Bulc, M.

    2008-01-01

    Of all GPs in Slovenia 86% are not interested in activities to systematically improve care. A clear national quality policy, further education for care managers and financial incentives for GPs could change the picture, as NIVEL research – done on the initiative of the World Health Organisation

  8. Attachment Theory and Neuroscience for Care Managers.

    Science.gov (United States)

    Blakely, Thomas J; Dziadosz, Gregory M

    2016-09-01

    This article describes a model for care managers that is based on attachment theory supplemented by knowledge from neuroscience. Together, attachment theory and basic knowledge from neuroscience provide for both an organizing conceptual framework and a scientific, measureable approach to assessment and planning interventions in a care plan.

  9. Achieving a competitive advantage in managed care.

    Science.gov (United States)

    Stahl, D A

    1998-02-01

    When building a competitive advantage to thrive in the managed care arena, subacute care providers are urged to be revolutionary rather than reactionary, proactive rather than passive, optimistic rather than pessimistic and growth-oriented rather than cost-reduction oriented. Weaknesses must be addressed aggressively. To achieve a competitive edge, assess the facility's strengths, understand the marketplace and comprehend key payment methods.

  10. Improving patient adherence to lifestyle advice (IMPALA): a cluster-randomised controlled trial on the implementation of a nurse-led intervention for cardiovascular risk management in primary care (protocol).

    NARCIS (Netherlands)

    Koelewijn-van Loon, M.S.; Steenkiste, B.C. van; Ronda, G.; Wensing, M.J.P.; Stoffers, H.E.; Elwyn, G.; Grol, R.P.T.M.; Weijden, G.D.E.M. van der

    2008-01-01

    BACKGROUND: Many patients at high risk of cardiovascular diseases are managed and monitored in general practice. Recommendations for cardiovascular risk management, including lifestyle change, are clearly described in the Dutch national guideline. Although lifestyle interventions, such as advice on

  11. Fibromyalgia: management strategies for primary care providers.

    Science.gov (United States)

    Arnold, L M; Gebke, K B; Choy, E H S

    2016-02-01

    Fibromyalgia (FM), a chronic disorder defined by widespread pain, often accompanied by fatigue and sleep disturbance, affects up to one in 20 patients in primary care. Although most patients with FM are managed in primary care, diagnosis and treatment continue to present a challenge, and patients are often referred to specialists. Furthermore, the lack of a clear patient pathway often results in patients being passed from specialist to specialist, exhaustive investigations, prescription of multiple drugs to treat different symptoms, delays in diagnosis, increased disability and increased healthcare resource utilisation. We will discuss the current and evolving understanding of FM, and recommend improvements in the management and treatment of FM, highlighting the role of the primary care physician, and the place of the medical home in FM management. We reviewed the epidemiology, pathophysiology and management of FM by searching PubMed and references from relevant articles, and selected articles on the basis of quality, relevance to the illness and importance in illustrating current management pathways and the potential for future improvements. The implementation of a framework for chronic pain management in primary care would limit unnecessary, time-consuming, and costly tests, reduce diagnostic delay and improve patient outcomes. The patient-centred medical home (PCMH), a management framework that has been successfully implemented in other chronic diseases, might improve the care of patients with FM in primary care, by bringing together a team of professionals with a range of skills and training. Although there remain several barriers to overcome, implementation of a PCMH would allow patients with FM, like those with other chronic conditions, to be successfully managed in the primary care setting. © 2016 John Wiley & Sons Ltd.

  12. Managing project risks and uncertainties

    Directory of Open Access Journals (Sweden)

    Mike Mentis

    2015-01-01

    Full Text Available This article considers threats to a project slipping on budget, schedule and fit-for-purpose. Threat is used here as the collective for risks (quantifiable bad things that can happen and uncertainties (poorly or not quantifiable bad possible events. Based on experience with projects in developing countries this review considers that (a project slippage is due to uncertainties rather than risks, (b while eventuation of some bad things is beyond control, managed execution and oversight are still the primary means to keeping within budget, on time and fit-for-purpose, (c improving project delivery is less about bigger and more complex and more about coordinated focus, effectiveness and developing thought-out heuristics, and (d projects take longer and cost more partly because threat identification is inaccurate, the scope of identified threats is too narrow, and the threat assessment product is not integrated into overall project decision-making and execution. Almost by definition, what is poorly known is likely to cause problems. Yet it is not just the unquantifiability and intangibility of uncertainties causing project slippage, but that they are insufficiently taken into account in project planning and execution that cause budget and time overruns. Improving project performance requires purpose-driven and managed deployment of scarce seasoned professionals. This can be aided with independent oversight by deeply experienced panelists who contribute technical insights and can potentially show that diligence is seen to be done.

  13. Managing diversity in the health care workplace.

    Science.gov (United States)

    Davidhizar, R; Dowd, S; Newman Giger, J

    1999-03-01

    Cultural diversity is increasing in the United States as increasing numbers of minorities enter the United States from abroad, and cultural diversity is especially prevalent in the health care workplace. In fact, the health care professions are particularly interested in the presence of minorities among caregivers because this often enhances the cultural competence of care delivery. Nevertheless, subtle discrimination can still be found, and managers must be alert that such behavior is not tolerated. Use of the Giger-Davidhizar Cultural Assessment Model can provide managers with information needed to respond to diversity among staff appropriately.

  14. Simulation modeling for the health care manager.

    Science.gov (United States)

    Kennedy, Michael H

    2009-01-01

    This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

  15. Enterprise Content Management Implementation and Risk

    Directory of Open Access Journals (Sweden)

    Jaroslava Klegová

    2015-01-01

    Full Text Available Enterprise Content Management (ECM solutions are commonly used in many areas such as document management, record management, digital asset management, etc. Key features of ECM systems are capturing, indexing, preserving and retrieving of digital information. The state-of-the- art ECM solution can help revolutionize document management and further automated business processes which can lead to better decisions and competitive advantage. Risk management can reduce project failure and that is why controlling risk in ECM implementation projects is considered to be a major contributor to project success. To manage software risk, the first step is to identify a list of ECM projects’ risks. The present paper provides an overview of ECM implementation risks and contains findings from a small survey on experience of ECM implementation and risk in Czech enterprises. Risk of implementation in the public sector is discussed more deeply with case study examples.

  16. Child and Youth Care Approaches to Management

    Science.gov (United States)

    Gharabaghi, Kiaras

    2008-01-01

    This article explores the themes and issues related to child and youth care approaches to management. The profession is significantly underrepresented at the management level. To some extent, this reflects the challenges of being recognized in the broader human services sector as a profession, but perhaps more so, it reflects an underdevelopment…

  17. Risk management and energy systems

    International Nuclear Information System (INIS)

    Carlevaro, F.; Romerio, F.

    1992-01-01

    In five sessions the following topics were dealt with: risk problems, risk analysis and evaluation tools, risks in industrial societies, risks of energy production, technological risks, ethics and political-social consensus. figs., tabs., refs

  18. PERFORMANCE IN INTERNAL CONTROL AND RISK MANAGEMENT

    Directory of Open Access Journals (Sweden)

    JELER (POPA IOANA

    2017-06-01

    Full Text Available The purpose of this article is to highlight the importance of internal control and risk management. In practice, economic entities meet a variety of risks that have the origins from the internal environment or the external one. Although there are different of views on addressing the concept of risk - threats or opportunities, event or action, accordingly uncertain, proposed by specialists in risk management in this article we try to present these issues and identify techniques to counter risks occurrence. In this article we present also means managing risk and why needs to be implemented at institutional level a risk management. The paper concludes by highlight the role of efficient risk management in the company’s management and company's activities.

  19. Calysto: Risk Management for Commercial Manned Spaceflight

    Science.gov (United States)

    Dillaman, Gary

    2012-01-01

    The Calysto: Risk Management for Commercial Manned Spaceflight study analyzes risk management in large enterprises and how to effectively communicate risks across organizations. The Calysto Risk Management tool developed by NASA's Kennedy Space Center's SharePoint team is used and referenced throughout the study. Calysto is a web-base tool built on Microsoft's SharePoint platform. The risk management process at NASA is examined and incorporated in the study. Using risk management standards from industry and specific organizations at the Kennedy Space Center, three methods of communicating and elevating risk are examined. Each method describes details of the effectiveness and plausibility of using the method in the Calysto Risk Management Tool. At the end of the study suggestions are made for future renditions of Calysto.

  20. The risks of innovation in health care.

    Science.gov (United States)

    Enzmann, Dieter R

    2015-04-01

    Innovation in health care creates risks that are unevenly distributed. An evolutionary analogy using species to represent business models helps categorize innovation experiments and their risks. This classification reveals two qualitative categories: early and late diversification experiments. Early diversification has prolific innovations with high risk because they encounter a "decimation" stage, during which most experiments disappear. Participants face high risk. The few decimation survivors can be sustaining or disruptive according to Christensen's criteria. Survivors enter late diversification, during which they again expand, but within a design range limited to variations of the previous surviving designs. Late diversifications carry lower risk. The exception is when disruptive survivors "diversify," which amplifies their disruption. Health care and radiology will experience both early and late diversifications, often simultaneously. Although oversimplifying Christensen's concepts, early diversifications are likely to deliver disruptive innovation, whereas late diversifications tend to produce sustaining innovations. Current health care consolidation is a manifestation of late diversification. Early diversifications will appear outside traditional care models and physical health care sites, as well as with new science such as molecular diagnostics. They warrant attention because decimation survivors will present both disruptive and sustaining opportunities to radiology. Radiology must participate in late diversification by incorporating sustaining innovations to its value chain. Given the likelihood of disruptive survivors, radiology should seriously consider disrupting itself rather than waiting for others to do so. Disruption entails significant modifications of its value chain, hence, its business model, for which lessons may become available from the pharmaceutical industry's current simultaneous experience with early and late diversifications. Copyright

  1. Perceptions of Risk Stratification Workflows in Primary Care

    Directory of Open Access Journals (Sweden)

    Rachel L. Ross

    2017-10-01

    Full Text Available Risk stratification (RS in primary care is frequently used by policy-makers, payers, and health systems; the process requires risk assessment for adverse health outcomes across a population to assign patients into risk tiers and allow care management (CM resources to be targeted effectively. Our objective was to understand the approach to and perception of RS in primary care practices. An online survey was developed, tested, and administered to 148 representatives of 37 primary care practices engaged in RS varying in size, location and ownership. The survey assessed practices’ approach to, perception of, and confidence in RS, and its effect on subsequent CM activities. We examined psychometric properties of the survey to determine validity and conducted chi-square analyses to determine the association between practice characteristics and confidence and agreement with risk scores. The survey yielded a 68% response rate (100 respondents. Overall, participants felt moderately confident in their risk scores (range 41–53.8%, and moderately to highly confident in their subsequent CM workflows (range 46–68%. Respondents from small and independent practices were more likely to have higher confidence and agreement with their RS approaches and scores (p < 0.01. Confidence levels were highest, however, when practices incorporated human review into their RS processes (p < 0.05. This trend was not affected by respondents’ professional roles. Additional work from a broad mixed-methods effort will add to our understanding of RS implementation processes and outcomes.

  2. Commercializing fuel cells: managing risks

    Science.gov (United States)

    Bos, Peter B.

    Commercialization of fuel cells, like any other product, entails both financial and technical risks. Most of the fuel cell literature has focussed upon technical risks, however, the most significant risks during commercialization may well be associated with the financial funding requirements of this process. Successful commercialization requires an integrated management of these risks. Like any developing technology, fuel cells face the typical 'Catch-22' of commercialization: "to enter the market, the production costs must come down, however, to lower these costs, the cumulative production must be greatly increased, i.e. significant market penetration must occur". Unless explicit steps are taken to address this dilemma, fuel cell commercialization will remain slow and require large subsidies for market entry. To successfully address this commercialization dilemma, it is necessary to follow a market-driven commercialization strategy that identifies high-value entry markets while minimizing the financial and technical risks of market entry. The financial and technical risks of fuel cell commercialization are minimized, both for vendors and end-users, with the initial market entry of small-scale systems into high-value stationary applications. Small-scale systems, in the order of 1-40 kW, benefit from economies of production — as opposed to economies to scale — to attain rapid cost reductions from production learning and continuous technological innovation. These capital costs reductions will accelerate their commercialization through market pull as the fuel cell systems become progressively more viable, starting with various high-value stationary and, eventually, for high-volume mobile applications. To facilitate market penetration via market pull, fuel cell systems must meet market-derived economic and technical specifications and be compatible with existing market and fuels infrastructures. Compatibility with the fuels infrastructure is facilitated by a

  3. Managing Risks in Dry Port Operations

    OpenAIRE

    Ciortescu Cezar-Gabriel; Pãvãla?cu Narcis Sebastian

    2012-01-01

    The purpose of this paper is to have an in-depth look into the phenomenon of risk assessment and risk management strategies in managing dry port operations as an integrated part into international containerized freight trade. The fact that world crises take the form of disruptions, bankruptcies, breakdowns, macroeconomic and political changes, and disasters leads to higher risks and makes risk management more and more difficult. This paper aims to discuss the theory behind the dry port concep...

  4. BEHAVIOURAL INSIGHTS INTO SUPPLY CHAIN RISK MANAGEMENT

    OpenAIRE

    Alexandra-Codruta Popescu (Bîzoi); Cristian-Gabriel Bîzoi

    2015-01-01

    Literature has focused largely on the field of supply chain risk management. Numerous risks occur within supply chain management. Until lately, behavioural risks (implying large amount of losses) have been neglected and considered not relevant. In this paper we provide an analysis of the importance of including behavioural research in logistics and supply chain risk management, what has been written so far and potential future research directions. Until now, literature on logistics and supply...

  5. Probability concepts in quality risk management.

    Science.gov (United States)

    Claycamp, H Gregg

    2012-01-01

    Essentially any concept of risk is built on fundamental concepts of chance, likelihood, or probability. Although risk is generally a probability of loss of something of value, given that a risk-generating event will occur or has occurred, it is ironic that the quality risk management literature and guidelines on quality risk management tools are relatively silent on the meaning and uses of "probability." The probability concept is typically applied by risk managers as a combination of frequency-based calculation and a "degree of belief" meaning of probability. Probability as a concept that is crucial for understanding and managing risk is discussed through examples from the most general, scenario-defining and ranking tools that use probability implicitly to more specific probabilistic tools in risk management. A rich history of probability in risk management applied to other fields suggests that high-quality risk management decisions benefit from the implementation of more thoughtful probability concepts in both risk modeling and risk management. Essentially any concept of risk is built on fundamental concepts of chance, likelihood, or probability. Although "risk" generally describes a probability of loss of something of value, given that a risk-generating event will occur or has occurred, it is ironic that the quality risk management literature and guidelines on quality risk management methodologies and respective tools focus on managing severity but are relatively silent on the in-depth meaning and uses of "probability." Pharmaceutical manufacturers are expanding their use of quality risk management to identify and manage risks to the patient that might occur in phases of the pharmaceutical life cycle from drug development to manufacture, marketing to product discontinuation. A probability concept is typically applied by risk managers as a combination of data-based measures of probability and a subjective "degree of belief" meaning of probability. Probability as

  6. Risk management frameworks for human health and environmental risks.

    Science.gov (United States)

    Jardine, Cindy; Hrudey, Steve; Shortreed, John; Craig, Lorraine; Krewski, Daniel; Furgal, Chris; McColl, Stephen

    2003-01-01

    A comprehensive analytical review of the risk assessment, risk management, and risk communication approaches currently being undertaken by key national, provincial/state, territorial, and international agencies was conducted. The information acquired for review was used to identify the differences, commonalities, strengths, and weaknesses among the various approaches, and to identify elements that should be included in an effective, current, and comprehensive approach applicable to environmental, human health and occupational health risks. More than 80 agencies, organizations, and advisory councils, encompassing more than 100 risk documents, were examined during the period from February 2000 until November 2002. An overview was made of the most important general frameworks for risk assessment, risk management, and risk communication for human health and ecological risk, and for occupational health risk. In addition, frameworks for specific applications were reviewed and summarized, including those for (1)contaminated sites; (2) northern contaminants; (3) priority substances; (4) standards development; (5) food safety; (6) medical devices; (7) prescription drug use; (8) emergency response; (9) transportation; (10) risk communication. Twelve frameworks were selected for more extensive review on the basis of representation of the areas of human health, ecological, and occupational health risk; relevance to Canadian risk management needs; representation of comprehensive and well-defined approaches; generalizability with their risk areas; representation of "state of the art" in Canada, the United States, and/or internationally; and extent of usage of potential usage within Canada. These 12 frameworks were: 1. Framework for Environmental Health Risk Management (US Presidential/Congressional Commission on Risk Assessment and Risk Management, 1997). 2. Health Risk Determination: The Challenge of Health Protection (Health and Welfare Canada, 1990). 3. Health Canada Decision

  7. Quality management in Irish health care.

    Science.gov (United States)

    Ennis, K; Harrington, D

    1999-01-01

    This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

  8. Credit Risk Evaluation : Modeling - Analysis - Management

    OpenAIRE

    Wehrspohn, Uwe

    2002-01-01

    An analysis and further development of the building blocks of modern credit risk management: -Definitions of default -Estimation of default probabilities -Exposures -Recovery Rates -Pricing -Concepts of portfolio dependence -Time horizons for risk calculations -Quantification of portfolio risk -Estimation of risk measures -Portfolio analysis and portfolio improvement -Evaluation and comparison of credit risk models -Analytic portfolio loss distributions The thesis contributes to the evaluatio...

  9. RISK MANAGEMENT OF GERMAN FRUIT PRODUCERS

    Directory of Open Access Journals (Sweden)

    Annkatrin PORSCH

    2018-03-01

    Full Text Available Horticultural farms in Germany face substantial business risks. However, fruit farms often struggle to implement appropriate risk management processes, and the risk management literature widely has ignored this farm type. The aim of the study was to improve the assessment of risks by farmers and the choice of suitable risk management instruments. Therefore, a risk management process based on subjective probabilities and suitable for small and medium-sized farms was developed, considering the specific needs of family run businesses. An online survey was conducted to achieve a comprehensive view of the risk perception and risk management practices of German fruit producers. Price and production risks are the most relevant risk categories for fruit farmers. However, among single risk sources, those in the people risk category were seen as the most important. Results show significant interactions among risk categories and a significant correlation between loss experience and the rating of risk categories. The assumption that risk averse farmers generally rate risks higher than risk neutral or risk seeking farmers cannot be confirmed. Diversification seems to be the most important risk management instrument for many fruit producers, especially diversification of marketing channels, farm income, and production activities. Further research should focus on the apparent inconsistency between the satisfaction with instruments reported by farmers and the actual implementation of many of them (e.g., hail insurance and anti-hail net. Furthermore, there is a need for research, to develop decision models considering the interactions of risks and risk management instruments, loss experience and risk seeking attitudes.

  10. CEA - Assessment of risk management 2013

    International Nuclear Information System (INIS)

    Bigot, Bernard; Bonnevie, Edwige; Maillot, Bernard

    2014-06-01

    After some introducing texts by CEA managers, this report proposes a rather detailed overview and presentation of CEA activities, objectives and obtained results in different fields: protection and control of the environment, installation safety, health, safety and radiation protection, transports of hazardous materials, waste management, protection of sites, installations and heritage, management of emergency situations, management of legal risks, internal controls and audits, activity of the risk management department, CEA activities from research to industry

  11. Contradictions Between Risk Management and Sustainable Development

    Energy Technology Data Exchange (ETDEWEB)

    Olsen, Odd Einar; Langhelle, Oluf; Engen, Ole A. [Univ. of Stavanger (Norway). Dept. of Media, Culture and Social Science

    2006-09-15

    The aim of this paper is to discuss how risk management as a methodology and mindset influence on priorities and decisions concerning sustainable development. Management of risks and hazards often rely on partial analysis with a limited time frame. This may lead to a paradoxical situation where risk management and extended use of risk analysis could hamper long term sustainable development. The question is: Does the use of risk and vulnerability analysis (RaV-analysis) hamper or contribute to sustainable development? Because risk management and assessment has a more narrow scope and a limited time perspective based on well established methodologies, the tangible impacts of risk reducing measures in a project is easier to calculate than long-term and intangible impacts on global development. Empirical evidence is still scarce, but our preliminary conclusion is that mainstream risk management and assessments is counterproductive to sustainable development.

  12. Contradictions Between Risk Management and Sustainable Development

    International Nuclear Information System (INIS)

    Olsen, Odd Einar; Langhelle, Oluf; Engen, Ole A.

    2006-01-01

    The aim of this paper is to discuss how risk management as a methodology and mindset influence on priorities and decisions concerning sustainable development. Management of risks and hazards often rely on partial analysis with a limited time frame. This may lead to a paradoxical situation where risk management and extended use of risk analysis could hamper long term sustainable development. The question is: Does the use of risk and vulnerability analysis (RaV-analysis) hamper or contribute to sustainable development? Because risk management and assessment has a more narrow scope and a limited time perspective based on well established methodologies, the tangible impacts of risk reducing measures in a project is easier to calculate than long-term and intangible impacts on global development. Empirical evidence is still scarce, but our preliminary conclusion is that mainstream risk management and assessments is counterproductive to sustainable development

  13. Risk management with options and futures under liquidity risk

    OpenAIRE

    Adam-Müller, A F A; Panaretou, A

    2009-01-01

    Futures hedging creates liquidity risk through marking to market. Liquidity risk matters if interim losses on a futures position have to be financed at a markup over the risk-free rate. This study analyzes the optimal risk management and production decisions of a firm facing joint price and liquidity risk. It provides a rationale for the use of options on futures in imperfect capital markets. If liquidity risk materializes, the firm sells options on futures in order to partly cover this liqui...

  14. Do competition and managed care improve quality?

    Science.gov (United States)

    Sari, Nazmi

    2002-10-01

    In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright 2002 John Wiley & Sons, Ltd.

  15. Cattle farmers’ perceptions of risk and risk management strategies

    DEFF Research Database (Denmark)

    Bishu, Kinfe G.; O'Reilly, Seamus; Lahiff, Edward

    2018-01-01

    This study analyzes cattle farmers’ perceptions of risk and risk management strategies in Tigray, Northern Ethiopia. We use survey data from a sample of 356 farmers based on multistage random sampling. Factor analysis is employed to classify scores of risk and management strategies, and multiple...... utilization were perceived as the most important strategies for managing risks. Livestock disease and labor shortage were perceived as less of a risk by farmers who adopted the practice of zero grazing compared to other farmers, pointing to the potential of this practice for risk reduction. We find strong...... evidence that farmers engage in multiple risk management practices in order to reduce losses from cattle morbidity and mortality. The results suggest that government strategies that aim at reducing farmers’ risk need to be tailored to specific farm and farmer characteristics. Findings from this study have...

  16. Hazard evaluation and risk management

    International Nuclear Information System (INIS)

    Fritzsche, A.F.

    1986-01-01

    The eigth chapter deals with the actual handling of hazards. The principal issue concerns man's behaviour towards hazards as an individual formerly and today; the evaluation of expected results of both a positive and a negative kind as determined by the individual's values which may differ and vary greatly from one individual to the next. The evaluation of benefit and hazard as well as the risk management resulting from decision-taking are political processes in the democratic state. Formal decision-taking tools play a major role in this process which concerns such central issues like who will participate; how the decision is arrived at; the participation of citizens; specialist knowledge and participation of the general public. (HSCH) [de

  17. Quality Risk Management: Putting GMP Controls First.

    Science.gov (United States)

    O'Donnell, Kevin; Greene, Anne; Zwitkovits, Michael; Calnan, Nuala

    2012-01-01

    This paper presents a practical way in which current approaches to quality risk management (QRM) may be improved, such that they better support qualification, validation programs, and change control proposals at manufacturing sites. The paper is focused on the treatment of good manufacturing practice (GMP) controls during QRM exercises. It specifically addresses why it is important to evaluate and classify such controls in terms of how they affect the severity, probability of occurrence, and detection ratings that may be assigned to potential failure modes or negative events. It also presents a QRM process that is designed to directly link the outputs of risk assessments and risk control activities with qualification and validation protocols in the GMP environment. This paper concerns the need for improvement in the use of risk-based principles and tools when working to ensure that the manufacturing processes used to produce medicines, and their related equipment, are appropriate. Manufacturing processes need to be validated (or proven) to demonstrate that they can produce a medicine of the required quality. The items of equipment used in such processes need to be qualified, in order to prove that they are fit for their intended use. Quality risk management (QRM) tools can be used to support such qualification and validation activities, but their use should be science-based and subject to as little subjectivity and uncertainty as possible. When changes are proposed to manufacturing processes, equipment, or related activities, they also need careful evaluation to ensure that any risks present are managed effectively. This paper presents a practical approach to how QRM may be improved so that it better supports qualification, validation programs, and change control proposals in a more scientific way. This improved approach is based on the treatment of what are called good manufacturing process (GMP) controls during those QRM exercises. A GMP control can be considered

  18. Benchmarking Outdoor Expeditionary Program Risk Management Strategies

    Science.gov (United States)

    Meerts-Brandsma, Lisa; Furman, Nate; Sibthorp, Jim

    2017-01-01

    In 2003, the University of Utah and the National Outdoor Leadership School (NOLS) completed a study that developed a risk management taxonomy in the outdoor adventure industry and assessed how different outdoor expeditionary programs (OEPs) managed risk (Szolosi, Sibthorp, Paisley, & Gookin, 2003). By unifying the language around risk, the…

  19. Information risk management a practitioner's guide

    CERN Document Server

    Sutton, David

    2014-01-01

    Information risk management (IRM) is about identifying, assessing and prioritising risks to keep information secure and available. This accessible book provides practical guidance to the principles and development of a strategic approach to an IRM programme. The only textbook for the BCS Practitioner Certificate in Information Risk Management.

  20. Active Risk Management and Banking Stability

    NARCIS (Netherlands)

    Silva Buston, C.F.

    2013-01-01

    Abstract: This paper analyzes the net impact of two opposing effects of active risk management at banks on their stability: higher risk-taking incentives and better isolation of credit supply from varying economic conditions. We present a model where banks actively manage their portfolio risk by

  1. Risk Management and Financial Derivatives: An Overview

    NARCIS (Netherlands)

    S.M. Hammoudeh (Shawkat); M.J. McAleer (Michael)

    2012-01-01

    textabstractRisk management is crucial for optimal portfolio management. One of the fastest growing areas in empirical finance is the expansion of financial derivatives. The purpose of this special issue on “Risk Management and Financial Derivatives” is to highlight some areas in which novel

  2. Risk management at Lawrence Livermore National Laboratory

    International Nuclear Information System (INIS)

    Cummings, G.E.; Strait, R.S.

    1993-10-01

    Managing risks at a large national laboratory presents a unique set of challenges. These challenges include the management of a broad diversity of activities, the need to balance research flexibility against management control, and a plethora of requirements flowing from regulatory and oversight bodies. This paper will present the experiences of Lawrence Livermore National Laboratory (LLNL) in risk management and in dealing with these challenges. While general risk management has been practiced successfully by all levels of Laboratory management, this paper will focus on the Laboratory's use of probabilistic safety assessment and prioritization techniques and the integration of these techniques into Laboratory operations

  3. Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial.

    Science.gov (United States)

    Peiris, David; Usherwood, Tim; Panaretto, Kathryn; Harris, Mark; Hunt, Jennifer; Redfern, Julie; Zwar, Nicholas; Colagiuri, Stephen; Hayman, Noel; Lo, Serigne; Patel, Bindu; Lyford, Marilyn; MacMahon, Stephen; Neal, Bruce; Sullivan, David; Cass, Alan; Jackson, Rod; Patel, Anushka

    2015-01-01

    Despite effective treatments to reduce cardiovascular disease risk, their translation into practice is limited. Using a parallel arm cluster-randomized controlled trial in 60 Australian primary healthcare centers, we tested whether a multifaceted quality improvement intervention comprising computerized decision support, audit/feedback tools, and staff training improved (1) guideline-indicated risk factor measurements and (2) guideline-indicated medications for those at high cardiovascular disease risk. Centers had to use a compatible software system, and eligible patients were regular attendees (Aboriginal and Torres Strait Islander people aged ≥ 35 years and others aged ≥ 45 years). Patient-level analyses were conducted using generalized estimating equations to account for clustering. Median follow-up for 38,725 patients (mean age, 61.0 years; 42% men) was 17.5 months. Mean monthly staff support was improved overall risk factor measurements (62.8% versus 53.4% risk ratio; 1.25; 95% confidence interval, 1.04-1.50; P=0.02), but there was no significant differences in recommended prescriptions for the high-risk cohort (n=10,308; 56.8% versus 51.2%; P=0.12). There were significant treatment escalations (new prescriptions or increased numbers of medicines) for antiplatelet (17.9% versus 2.7%; Pquality improvement intervention, requiring minimal support, improved cardiovascular disease risk measurement but did not increase prescription rates in the high-risk group. Computerized quality improvement tools offer an important, albeit partial, solution to improving primary healthcare system capacity for cardiovascular disease risk management. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336630. Australian New Zealand Clinical Trials Registry No. 12611000478910. © 2015 American Heart Association, Inc.

  4. Participative management in health care services.

    Science.gov (United States)

    Muller, M

    1995-03-01

    The need and demand for the highest-quality management of all health care delivery activities requires a participative management approach. The purpose with this article is to explore the process of participative management, to generate and describe a model for such management, focusing mainly on the process of participative management, and to formulate guidelines for operationalization of the procedure. An exploratory, descriptive and theory-generating research design is pursued. After a brief literature review, inductive reasoning is mainly employed to identify and define central concepts, followed by the formulation of a few applicable statements and guidelines. Participative management is viewed as a process of that constitutes the elements of dynamic interactive decision-making and problem-solving, shared governance, empowerment, organisational transformation, and dynamic communication within the health care organisation. The scientific method of assessment, planning, implementation and evaluation is utilised throughout the process of participative management. A continuum of interactive decision-making and problem-solving is described, the different role-players involved, as well as the levels of interactive decision-making and problem-solving. The most appropriate decision-making strategy should be employed in pro-active and reactive decision-making. Applicable principles and assumptions in each element of participative management is described. It is recommended that this proposed model for participative management be refined by means of a literature control, interactive dialogue with experts and a model case description or participative management, to ensure the trustworthiness of this research.

  5. Risk assessment and management of radiofrequency radiation exposure

    Energy Technology Data Exchange (ETDEWEB)

    Dabala, Dana [Railways Medical Clinic Cluj-Napoca, Occupational Medicine Department, 16-20 Bilascu Gheorghe St., 400015 Cluj-Napoca (Romania); Surducan, Emanoil; Surducan, Vasile; Neamtu, Camelia [National Institute for Research and Development of Isotopic and Molecular Technologies, 65-103 Donath St., 400293 Cluj-Napoca (Romania)

    2013-11-13

    Radiofrequency radiation (RFR) industry managers, occupational physicians, security department, and other practitioners must be advised on the basic of biophysics and the health effects of RF electromagnetic fields so as to guide the management of exposure. Information on biophysics of RFR and biological/heath effects is derived from standard texts, literature and clinical experiences. Emergency treatment and ongoing care is outlined, with clinical approach integrating the circumstances of exposure and the patient's symptoms. Experimental risk assessment model in RFR chronic exposure is proposed. Planning for assessment and monitoring exposure, ongoing care, safety measures and work protection are outlining the proper management.

  6. Risk assessment and management of radiofrequency radiation exposure

    International Nuclear Information System (INIS)

    Dabala, Dana; Surducan, Emanoil; Surducan, Vasile; Neamtu, Camelia

    2013-01-01

    Radiofrequency radiation (RFR) industry managers, occupational physicians, security department, and other practitioners must be advised on the basic of biophysics and the health effects of RF electromagnetic fields so as to guide the management of exposure. Information on biophysics of RFR and biological/heath effects is derived from standard texts, literature and clinical experiences. Emergency treatment and ongoing care is outlined, with clinical approach integrating the circumstances of exposure and the patient's symptoms. Experimental risk assessment model in RFR chronic exposure is proposed. Planning for assessment and monitoring exposure, ongoing care, safety measures and work protection are outlining the proper management

  7. Strategies for successful software development risk management

    Directory of Open Access Journals (Sweden)

    Marija Boban

    2003-01-01

    Full Text Available Nowadays, software is becoming a major part of enterprise business. Software development is activity connected with advanced technology and high level of knowledge. Risks on software development projects must be successfully mitigated to produce successful software systems. Lack of a defined approach to risk management is one of the common causes for project failures. To improve project chances for success, this work investigates common risk impact areas to perceive a foundation that can be used to define a common approach to software risk management. Based on typical risk impact areas on software development projects, we propose three risk management strategies suitable for a broad area of enterprises and software development projects with different amounts of connected risks. Proposed strategies define activities that should be performed for successful risk management, the one that will enable software development projects to perceive risks as soon as possible and to solve problems connected with risk materialization. We also propose a risk-based approach to software development planning and risk management as attempts to address and retire the highest impact risks as early as possible in the development process. Proposed strategies should improve risk management on software development projects and help create a successful software solution.

  8. Risk and/or resilience management

    Directory of Open Access Journals (Sweden)

    Jean-Paul Louisot

    2015-06-01

    Full Text Available Risk management aims at managing all the uncertainties that may interfere with the objectives and missions of the organization. Resilience engineering aims at building its capacity to get over disturbances or stress while keeping the functionalities needed to survive, and possibly thrive. A recently open debate on an Internet blog launched by the risk managers of the Scottish Widows Bank seems to arise from what some professionals see as two competing branches of the management sciences. Whereas through the development of ERM – Enterprise-wide Risk Managementrisk management is emerging at last to become a science, as well as an art and a practice, the mentioned above centered on the role of a newly forged name “resilience management”. This opens a new front of the many debates that could derail the path to maturity of Risk Management as a science and reopen new silos much as Business Impact Analysis, BIA, or continuity management, might do if a clear distinction is not made between science, objectives and tools. However, because organizations are so interconnected today in the supply cloud that it is inevitable that they will face catastrophic risk and this is why resilience needs to be a core objective of any risk management plan? Whereas traditional risk management techniques alone may not be adequate to deal with such pervasive and insipient risk scenarios, resilience is ingrained into ERM

  9. Physician fees and managed care plans.

    Science.gov (United States)

    Zwanziger, Jack

    2002-01-01

    One of the objectives of managed care organizations (MCOs) has been to reduce the rate of growth of health care expenditures, including that of physician fees. Yet, due to a lack of data, no one has been able to determine whether MCOs have been successful in encouraging the growth of price competition in the market for physician services in order to slow the growth in physician fees. This study uses a unique, national-level data set to determine what factors influenced the physician fees that MCOs negotiated during the 1990-92 period. The most influential characteristics were physician supply and managed care penetration, which suggest that the introduction of competition into the health care market was an effective force in reducing physician fees.

  10. Risk of Carotid Stroke after Chiropractic Care

    DEFF Research Database (Denmark)

    Cassidy, J. David; Boyle, Eleanor; Côté, Pierre

    2017-01-01

    Background Chiropractic manipulation is a popular treatment for neck pain and headache, but may increase the risk of cervical artery dissection and stroke. Patients with carotid artery dissection can present with neck pain and/or headache before experiencing a stroke. These are common symptoms seen...... by both chiropractors and primary care physicians (PCPs). We aimed to assess the risk of carotid artery stroke after chiropractic care by comparing association between chiropractic and PCP visits and subsequent stroke. Methods A population-based, case-crossover study was undertaken in Ontario, Canada. All...... incident cases of carotid artery stroke admitted to hospitals over a 9-year period were identified. Cases served as their own controls. Exposures to chiropractic and PCP services were determined from health billing records. Results We compared 15,523 cases to 62,092 control periods using exposure windows...

  11. Multiple sclerosis care: an integrated disease-management model.

    Science.gov (United States)

    Burks, J

    1998-04-01

    A disease-management model must be integrated, comprehensive, individual patient focused and outcome driven. In addition to high quality care, the successful model must reduce variations in care and costs. MS specialists need to be intimately involved in the long-term care of MS patients, while not neglecting primary care issues. A nurse care manager is the "glue" between the managed care company, health care providers and the patient/family. Disease management focuses on education and prevention, and can be cost effective as well as patient specific. To implement a successful program, managed care companies and health care providers must work together.

  12. Quality of care, risk management, and technology in obstetrics to reduce hospital-based maternal mortality in Senegal and Mali (QUARITE): a cluster-randomised trial.

    Science.gov (United States)

    Dumont, Alexandre; Fournier, Pierre; Abrahamowicz, Michal; Traoré, Mamadou; Haddad, Slim; Fraser, William D

    2013-07-13

    Maternal mortality is higher in west Africa than in most industrialised countries, so the development and validation of effective interventions is essential. We did a trial to assess the effect of a multifaceted intervention to promote maternity death reviews and onsite training in emergency obstetric care in referral hospitals with high maternal mortality rates in Senegal and Mali. We did a pragmatic cluster-randomised controlled trial, with hospitals as the units of randomisation and patients as the unit of analysis. 46 public first-level and second-level referral hospitals with more than 800 deliveries a year were enrolled, stratified by country and hospital type, and randomly assigned to either the intervention group (n=23) or the control group with no external intervention (n=23). All women who delivered in each of the participating facilities during the baseline and post-intervention periods were included. The intervention, implemented over a period of 2 years at the hospital level, consisted of an initial interactive workshop and quarterly educational clinically-oriented and evidence-based outreach visits focused on maternal death reviews and best practices implementation. The primary outcome was reduction of risk of hospital-based mortality. Analysis was by intention-to-treat and relied on the generalised estimating equations extension of the logistic regression model to account for clustering of women within hospitals. This study is registered with ClinicalTrials.gov, number ISRCTN46950658. 191,167 patients who delivered in the participating hospitals were analysed (95,931 in the intervention groups and 95,236 in the control groups). Overall, mortality reduction in intervention hospitals was significantly higher than in control hospitals (odds ratio [OR] 0·85, 95% CI 0·73-0·98, p=0·0299), but this effect was limited to capital and district hospitals, which mainly acted as first-level referral hospitals in this trial. There was no effect in second

  13. Risk Management in Mergers and Acquisitions

    Directory of Open Access Journals (Sweden)

    Dmitry O. Verdiev

    2015-01-01

    Full Text Available M&A statistics show that less than a third of newly merged companies has realized their planned synergistic effects and increased shareholder value. According to the author, such disgusting situation is due to improper planning and failure of corporate management to understand the importance of risk management in M&A. Lack of practice in identification, evaluation, mitigation and regular monitoring of risks leads to the situation when many companies merge despite the fact that the merger bears substantial risks. Corporate management fails to include risk mitigation expenses in merger costs. In many cases, risk mitigation expenses may be so substantive that the merger loses its attractiveness. Only few companies implement risk management methodology while planning M&A activity. This methodology may anticipate and minimize the consequences of various risk factors that negatively influence integration process. The article suggests an implementation of risk management best practice. This risk management best practice may act as an effective tool of successful realization of synergistic effects in M&A and may be helpful in increasing shareholder value in post-merger period. Risk management is conducted throughout the stages of merger and includes identification, analysis, assessment, management and monitoring of risks. Implementation of risk management at early stages of merger planning significantly decreases uncertainty in relation to achievement of financial and operational goals of newly merged company. The article provides with typical M&A risk matrix that may be adapted for specific M&A project. Risk matrix includes a register of risks sorted by stages of M&A deal, quality assessment of their probability, influence and impact on merger as well as risk mitigation methods.

  14. 77 FR 13585 - Electricity Subsector Cybersecurity Risk Management Process Guideline

    Science.gov (United States)

    2012-03-07

    ... DEPARTMENT OF ENERGY Electricity Subsector Cybersecurity Risk Management Process Guideline AGENCY... Electricity Subsector Cybersecurity Risk Management Process guideline. The guideline describes a risk... Cybersecurity Risk Management Process Guideline. The primary goal of this guideline is to describe a risk...

  15. Hybrid Risk Management Methodology: A Case Study

    Directory of Open Access Journals (Sweden)

    Jacky Siu-Lun Ting

    2009-10-01

    Full Text Available Risk management is a decision-making process involving considerations of political, social, economic and engineering factors with relevant risk assessments relating to a potential hazard. In the last decade, a number of risk management tools are introduced and employed to manage and minimize the uncertainty and threats realization to the organizations. However, the focus of these methodologies are different; in which companies need to adopt various risk management principles to visualize a full picture of the organizational risk level. Regarding to this, this paper presents a new approach of risk management that integrates Hierarchical Holographic Modeling (HHM, Enterprise Risk Management (ERM and Business Recovery Planning (BCP for identifying and assessing risks as well as managing the consequences of realized residual risks. To illustrate the procedures of the proposed methodology, a logistic company ABC Limited is chosen to serve as a case study Through applying HHM and ERM to investigate and assess the risk, ABC Limited can be better evaluated the potential risks and then took the responsive actions (e.g. BCP to handle the risks and crisis in near future.

  16. Managing complaints in health and social care.

    Science.gov (United States)

    Holmes-Bonney, Kathy

    2010-04-01

    An important aspect of allowing patients to take control of their health care is the introduction of new procedures for dealing with complaints. This article examines the concepts that underpin the new Department of Health regulations on complaints management and what they will mean for health and social care professionals. It also explains why these regulations focus on restorative justice rather than blame when adverse events occur.

  17. Continuous Risk Management: A NASA Program Initiative

    Science.gov (United States)

    Hammer, Theodore F.; Rosenberg, Linda

    1999-01-01

    NPG 7120.5A, "NASA Program and Project Management Processes and Requirements" enacted in April, 1998, requires that "The program or project manager shall apply risk management principles..." The Software Assurance Technology Center (SATC) at NASA GSFC has been tasked with the responsibility for developing and teaching a systems level course for risk management that provides information on how to comply with this edict. The course was developed in conjunction with the Software Engineering Institute at Carnegie Mellon University, then tailored to the NASA systems community. This presentation will briefly discuss the six functions for risk management: (1) Identify the risks in a specific format; (2) Analyze the risk probability, impact/severity, and timeframe; (3) Plan the approach; (4) Track the risk through data compilation and analysis; (5) Control and monitor the risk; (6) Communicate and document the process and decisions.

  18. Nurses' Psychosocial Barriers to Suicide Risk Management

    Directory of Open Access Journals (Sweden)

    Sharon Valente

    2011-01-01

    Full Text Available Suicide remains a serious health care problem and a sentinel event tracked by The Joint Commission. Nurses are pivotal in evaluating risk and preventing suicide. Analysis of nurses' barriers to risk management may lead to interventions to improve management of suicidal patients. These data emerged from a random survey of 454 oncology nurses' attitudes, knowledge of suicide, and justifications for euthanasia. Instruments included a vignette of a suicidal patient and a suicide attitude questionnaire. Results. Psychological factors (emotions, unresolved grief, communication, and negative judgments about suicide complicate the nurse's assessment and treatment of suicidal patients. Some nurses (=122 indicated that euthanasia was never justified and 11 were unsure of justifications and evaluated each case on its merits. Justifications for euthanasia included poor symptom control, poor quality of life, incurable illness or permanent disability, terminal illness, and terminal illness with inadequate symptom control or impending death, patient autonomy, and clinical organ death. The nurses indicated some confusion and misconceptions about definitions and examples of euthanasia, assisted suicide, and double effect. Strategies for interdisciplinary clinical intervention are suggested to identify and resolve these psychosocial barriers.

  19. Microbiological risk assessment for personal care products.

    Science.gov (United States)

    Stewart, S E; Parker, M D; Amézquita, A; Pitt, T L

    2016-12-01

    Regulatory decisions regarding microbiological safety of cosmetics and personal care products are primarily hazard-based, where the presence of a potential pathogen determines decision-making. This contrasts with the Food industry where it is a commonplace to use a risk-based approach for ensuring microbiological safety. A risk-based approach allows consideration of the degree of exposure to assess unacceptable health risks. As there can be a number of advantages in using a risk-based approach to safety, this study explores the Codex Alimentarius (Codex) four-step Microbiological Risk Assessment (MRA) framework frequently used in the Food industry and examines how it can be applied to the safety assessment of personal care products. The hazard identification and hazard characterization steps (one and two) of the Codex MRA framework consider the main microorganisms of concern. These are addressed by reviewing the current industry guidelines for objectionable organisms and analysing reports of contaminated products notified by government agencies over a recent 5-year period, together with examples of reported outbreaks. Data related to estimation of exposure (step three) are discussed, and examples of possible calculations and references are included. The fourth step, performed by the risk assessor (risk characterization), is specific to each assessment and brings together the information from the first three steps to assess the risk. Although there are very few documented uses of the MRA approach for personal care products, this study illustrates that it is a practicable and sound approach for producing products that are safe by design. It can be helpful in the context of designing products and processes going to market and with setting of microbiological specifications. Additionally, it can be applied reactively to facilitate decision-making when contaminated products are released on to the marketplace. Currently, the knowledge available may only allow a

  20. Software And Systems Engineering Risk Management

    Science.gov (United States)

    2010-04-01

    RSKM 2004 COSO Enterprise RSKM Framework 2006 ISO/IEC 16085 Risk Management Process 2008 ISO/IEC 12207 Software Lifecycle Processes 2009 ISO/IEC...1 Software And Systems Engineering Risk Management John Walz VP Technical and Conferences Activities, IEEE Computer Society Vice-Chair Planning...Software & Systems Engineering Standards Committee, IEEE Computer Society US TAG to ISO TMB Risk Management Working Group Systems and Software

  1. Understanding performance management in primary care.

    Science.gov (United States)

    Rogan, Lisa; Boaden, Ruth

    2017-02-13

    Purpose Principal-agent theory (PAT) has been used to understand relationships among different professional groups and explain performance management between organisations, but is rarely used for research within primary care. The purpose of this paper is to explore whether PAT can be used to attain a better understanding of performance management in primary care. Design/methodology/approach Purposive sampling was used to identify a range of general practices in the North-west of England. Interviews were carried out with directors, managers and clinicians in commissioning and regional performance management organisations and within general practices, and the data analysed using matrix analysis techniques to produce a case study of performance management. Findings There are various elements of the principal-agent framework that can be applied in primary care. Goal alignment is relevant, but can only be achieved through clear, strategic direction and consistent interpretation of objectives at all levels. There is confusion between performance measurement and performance management and a tendency to focus on things that are easy to measure whilst omitting aspects of care that are more difficult to capture. Appropriate use of incentives, good communication, clinical engagement, ownership and trust affect the degree to which information asymmetry is overcome and goal alignment achieved. Achieving the right balance between accountability and clinical autonomy is important to ensure governance and financial balance without stifling innovation. Originality/value The principal-agent theoretical framework can be used to attain a better understanding of performance management in primary care; although it is likely that only partial goal alignment will be achieved, dependent on the extent and level of alignment of a range of factors.

  2. Implications of Risk Management Practices on Financial ...

    African Journals Online (AJOL)

    Implications of Risk Management Practices on Financial Performance of Sugar ... The respondents were functional heads of the companies under the survey. ... of downside losses in order to minimize the negative impact of risk on returns.

  3. RISK MANAGEMENT MECHANISM OF GRAIN PROCESSING ENTERPRISES

    Directory of Open Access Journals (Sweden)

    I. P. Bogomolova

    2013-01-01

    Full Text Available In article the main characteristics of a control system by risks (the purpose, properties, the principles, requirements are defined, and also the possible mechanism of risk management of the flour-grinding enterprises is considered.

  4. Business managers turn to risk assessment

    International Nuclear Information System (INIS)

    Allen, Frank

    1993-01-01

    Risk assessments have evolved to help technical managers in nuclear and other industries to design and operate plant with safety in mind. However, they are now developing into the area of business management. (author)

  5. Highly Enhanced Risk Management Emergency Satellite

    DEFF Research Database (Denmark)

    Dalmeir, Michael; Gataullin, Yunir; Indrajit, Agung

    HERMES (Highly Enhanced Risk Management Emergency Satellite) is potential European satellite mission for global flood management, being implemented by Technical University Munich and European Space Agency. With its main instrument - a reliable and precise Synthetic Aperture Radar (SAR) antenna...

  6. Business resilience: Reframing healthcare risk management.

    Science.gov (United States)

    Simeone, Cynthia L

    2015-09-01

    The responsibility of risk management in healthcare is fractured, with multiple stakeholders. Most hospitals and healthcare systems do not have a fully integrated risk management system that spans the entire organizational and operational structure for the delivery of key services. This article provides insight toward utilizing a comprehensive Business Resilience program and associated methodology to understand and manage organizational risk leading to organizational effectiveness and operational efficiencies, with the fringe benefit of realizing sustainable operational capability during adverse conditions. © 2015 American Society for Healthcare Risk Management of the American Hospital Association.

  7. Probabilistic risk assessment methodology for risk management and regulatory applications

    International Nuclear Information System (INIS)

    See Meng Wong; Kelly, D.L.; Riley, J.E.

    1997-01-01

    This paper discusses the development and potential applications of PRA methodology for risk management and regulatory applications in the U.S. nuclear industry. The new PRA methodology centers on the development of This paper discusses the time-dependent configuration risk profile for evaluating the effectiveness of operational risk management programs at U.S. nuclear power plants. Configuration-risk profiles have been used as risk-information tools for (1) a better understanding of the impact of daily operational activities on plant safety, and (2) proactive planning of operational activities to manage risk. Trial applications of the methodology were undertaken to demonstrate that configuration-risk profiles can be developed routinely, and can be useful for various industry and regulatory applications. Lessons learned include a better understanding of the issues and characteristics of PRA models available to industry, and identifying the attributes and pitfalls in the developement of risk profiles

  8. THE ANALYSIS OF RISK MANAGEMENT PROCESS WITHIN MANAGEMENT

    Directory of Open Access Journals (Sweden)

    ROMANESCU MARCEL LAURENTIU

    2016-10-01

    Full Text Available This article highlights the risk analysis within management, focusing on how a company could practicaly integrate the risks management in the existing leading process. Subsequently, it is exemplified the way of manage risk effectively, which gives numerous advantages to all firms, including improving their decision-making process. All these lead to the conclusion that the degree of risk specific to companies is very high, but if managers make the best decisions then it can diminish it and all business activitiy and its income are not influenced by factors that could disturb in a negative way .

  9. Economic Exposure and Integrated Risk Management

    OpenAIRE

    Miller, Kent D.

    1994-01-01

    Most corporate risk management research focuses on particular risk exposures to the exclusion of other interrelated exposures. By contrast, this study models corporate risk exposures using a multivariate approach integrating the distinct exposures of interest to finance and strategy researchers. The paper addresses the implications of multivariate modeling for corporate risk management, some key methodological issues arising in empirical estimation of corporate economic exposrues, and direc...

  10. PERFORMANCE IN INTERNAL CONTROL AND RISK MANAGEMENT

    OpenAIRE

    JELER (POPA) IOANA; FOCŞAN ELEONORA IONELA; CORICI MARIAN CĂTĂLIN

    2017-01-01

    The purpose of this article is to highlight the importance of internal control and risk management. In practice, economic entities meet a variety of risks that have the origins from the internal environment or the external one. Although there are different of views on addressing the concept of risk - threats or opportunities, event or action, accordingly uncertain, proposed by specialists in risk management in this article we try to present these issues and identify techniques to ...

  11. APPLIED ISSUES ABOUT BANKING RISK MANAGEMENT

    Directory of Open Access Journals (Sweden)

    Elena Geanina Clipici

    2017-09-01

    Full Text Available The following paper emphasizes the need to deepen the understanding of the notion of banking risk management by explaining the significant risks the bank encounters during financial exercises as well as their additional entries. The study of the paper will focus on UniCredit Bank during the years 2014 and  2015 on all types of risks, in which we will provide comprehensive data on how the UniCredit Bank management applies its risk policies.

  12. CEA - Assessment of risk management for 2012

    International Nuclear Information System (INIS)

    Bonnevie, Edwige

    2013-06-01

    This report proposes an overview of the main events, actions performed by the CEA, and facts for 2012 regarding protection and monitoring of the environment, installation safety, occupational health and safety, radiological protection of workers, transportation of hazardous materials, waste management, protection of sites, installations and heritage, emergency situation management, legal risk management, internal controls and audits. It also presents the organisation and action of the risk management department within the CEA

  13. Management Ownership and Risk-Shifting Investment

    OpenAIRE

    Nobuyuki Teshima

    2012-01-01

    This study analyzes the relationship between management ownership and its risk-shifting incentive. We first present a simple model showing that the risk-shifting incentive of management of financially distressed firms increases as the management ownership of the firm increases. Empirically, we test the hypothesis that under the former Japanese Corporate Reorganization Law, firms with higher management ownership are more likely to use legal rather than private reorganization. Since the reorgan...

  14. Feedback on flood risk management

    Science.gov (United States)

    Moreau, K.; Roumagnac, A.

    2009-09-01

    For several years, as floods were increasing in South of France, local communities felt deprive to assume their mission of protection and information of citizens, and were looking for assistance in flood management. In term of flood disaster, the fact is that physical protection is necessary but inevitably limited. Tools and structures of assistance to anticipation remain slightly developed. To manage repeated crisis, local authorities need to be able to base their policy against flood on prevention, warnings, post-crisis analysis and feedback from former experience. In this objective, after 3 years of test and improvement since 2003, the initiative Predict-Services was developped in South of France: it aims at helping communities and companies to face repeated flood crisis. The principle is to prepare emergency plans, to organize crisis management and reduce risks; to help and assist communities and companies during crisis to activate and adapt their emergency plans with enough of anticipation; and to analyse floods effects and improve emergency plans afterwards. In order to reduce risks, and to keep the benefits of such an initiative, local communities and companies have to maintain the awareness of risk of the citizens and employees. They also have to maintain their safety plans to keep them constantly operational. This is a part of the message relayed. Companies, Local communities, local government authorities and basin stakeholders are the decision makers. Companies and local communities have to involve themselves in the elaboration of safety plans. They are also completely involved in their activation that is their own responsability. This applies to other local government authorities, like districts one's and basin stakeholders, which participle in the financing community safety plans and adminitrative district which are responsible of the transmission of meteorological alert and of rescue actions. In the crossing of the géo-information stemming from the

  15. Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: study protocol of the Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) randomized controlled trial.

    Science.gov (United States)

    Carrington, Melinda J; Zimmet, Paul

    2017-12-06

    Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS. MODERN is a multi-centre, open, parallel group randomized controlled trial in regional Victoria, Australia. Participants were self-selected and individuals aged 40 to 70 years with MetS who had no evidence of CVD or other chronic disease were recruited. Those attending a screening visit with any 3 or more risk factors of central obesity, dyslipidemia (high triglycerides or low high density lipoprotein cholesterol) elevated blood pressure and dysglycemia were randomized to either nurse-led health and lifestyle modification (intervention) or standard care (control). The intervention included risk factor management, health education, care planning and scheduled follow-up commensurate with level of risk. The primary cardio-metabolic end-point was achievement of risk factor thresholds to eliminate MetS or minimal clinically meaningful changes for at least 3 risk factors that characterise MetS over 2 year follow-up. Pre-specified secondary endpoints to evaluate between group variations in cardio-metabolic risk, general health and lifestyle behaviours and new onset CVD and type 2 diabetes will be evaluated. Key outcomes will be measured at baseline, 12 and 24 months via questionnaires, physical examinations, pathology and other diagnostic tests. Health economic analyses will be undertaken to establish the cost-effectiveness of the intervention. The MODERN

  16. Risk Management for the International Space Station

    Science.gov (United States)

    Sebastian, J.; Brezovic, Philip

    2002-01-01

    The International Space Station (ISS) is an extremely complex system, both technically and programmatically. The Space Station must support a wide range of payloads and missions. It must be launched in numerous launch packages and be safely assembled and operated in the harsh environment of space. It is being designed and manufactured by many organizations, including the prime contractor, Boeing, the NASA institutions, and international partners and their contractors. Finally, the ISS has multiple customers, (e.g., the Administration, Congress, users, public, international partners, etc.) with contrasting needs and constraints. It is the ISS Risk Management Office strategy to proactively and systematically manages risks to help ensure ISS Program success. ISS program follows integrated risk management process (both quantitative and qualitative) and is integrated into ISS project management. The process and tools are simple and seamless and permeate to the lowest levels (at a level where effective management can be realized) and follows the continuous risk management methodology. The risk process assesses continually what could go wrong (risks), determine which risks need to be managed, implement strategies to deal with those risks, and measure effectiveness of the implemented strategies. The process integrates all facets of risk including cost, schedule and technical aspects. Support analysis risk tools like PRA are used to support programatic decisions and assist in analyzing risks.

  17. Social Risk and the Management of MNCs

    DEFF Research Database (Denmark)

    Taarup Esbensen, Jacob

    2015-01-01

    Multinational companies (MNCs) are increasing being exposed to risk that originate from local communities in the business environment where they operate. The response has been to implement systems for stakeholder engagement by including social issues into their risk management systems. However......” systems, which are based on the capability to identify frames and sensemaking processes. This paper show how social risk management can be conventionalised using distinct theoretical domains taking its outset in a sociological perspective on risk, linking International Business (IB) risk management...

  18. Risks management in project planning

    OpenAIRE

    Stankevičiūtė, Roberta

    2017-01-01

    Project management consists of two very important aspects – managing the right project and managing the project right. To know that you are managing the right project you need to ensure that your project is based on an actual requirement and that your project goal is relevant and beneficial. And professional project planning assists in managing project the right way. The project planning process is very time consuming and is one of the most important parts of the project management process. T...

  19. The total theory about risk management

    International Nuclear Information System (INIS)

    Furuya, Shunsuke

    2003-01-01

    A general working procedure of risk management, some example of other countries, topics and problems in the future are described. A definition of risk, risk assessment, risk management process, setting of aim and definite policy are explained. As a fundamental way of thinking, risk is controlled by ALARP (As Low As Reasonably Practicable). The upper and lower limit of risk level is called as Quantitative Safety Goal and Target Level of Safety, respectively. These limits in the atomic power and airplane are decided. Evaluation of risk, countermeasure and practice are explained. For example, a permissible range of risk and practical use in England, U.S.A, Holland and Japan are stated. Recently, accountability risk, missing demand risk and control risk are important. (S.Y.)

  20. Development of computerized risk management tool

    International Nuclear Information System (INIS)

    Kil Yoo Kim; Mee Jung Hwang; Seung Cheol Jang; Sang Hoon Han; Tae Woon Kim

    1997-01-01

    The author describes the kinds of efforts for the development of computerized risk management tool; (1) development of a risk monitor, Risk Monster, (2) improvement of McFarm (Missing Cutsets Finding Algorithm for Risk Monitor) and finally (3) development of reliability database management system, KwDBMan. Risk Monster supports for plant operators and maintenance schedulers to monitor plant risk and to avoid high peak risk by rearranging maintenance work schedule. Improved McFarm significantly improved calculation speed of Risk Monster for the cases of supporting system OOS (Out Of Service). KwDBMan manages event data, generic data and CCF (Common Cause Failure) data to support Risk Monster as well as PSA tool, KIRAP (KAERI Integrated Reliability Analysis Package)

  1. VHA Support Service Center Primary Care Management Module (PCMM)

    Data.gov (United States)

    Department of Veterans Affairs — The Primary Care Management Module (PCMM) was developed to assist VA facilities in implementing Primary Care. PCMM supports both Primary Care and non-Primary Care...

  2. Medicare managed care plan performance: a comparison across hospitalization types.

    Science.gov (United States)

    Basu, Jayasree; Mobley, Lee Rivers

    2012-01-01

    The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with 'marker' admissions and 'referral-sensitive' admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)-while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)-of referral-sensitive (versus marker) admissions compared to their FFS counterparts. While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias.

  3. Risk management method for small photovoltaic plants

    Directory of Open Access Journals (Sweden)

    Kirova Milena

    2016-09-01

    Full Text Available Risk management is necessary for achieving the goals of the organization. There are many methods, approaches, and instruments in the literature concerning risk management. However, these are often highly specialized and transferring them to a different field can prove difficult. Therefore, managers often face situations where they have no tools to use for risk management. This is the case with small photovoltaic plants (according to a definition by the Bulgarian State Energy and Water Regulatory Commission small applies to systems with a total installed power of 200 kWp. There are some good practices in the energy field for minimizing risks, but they offer only partial risk prevention and are not sufficient. Therefore a new risk management method needs to be introduced. Small photovoltaic plants offer plenty of advantages in comparison to the other renewable energy sources which makes risk management in their case more important. There is no classification of risks for the exploitation of small photovoltaic systems in the available literature as well as to what degree the damages from those risks could spread. This makes risk analysis and evaluation necessary for obtaining information which could aid taking decisions for improving risk management. The owner of the invested capital takes a decision regarding the degree of acceptable risk for his organization and it must be protected depending on the goals set. Investors in small photovoltaic systems need to decide to what degree the existing risks can influence the goals previously set, the payback of the investment, and what is the acceptable level of damages for the investor. The purpose of this work is to present a risk management method, which currently does not exist in the Bulgaria, so that the risks and the damages that could occur during the exploitation of small photovoltaic plants could be identified and the investment in such technology – justified.

  4. Risk-Based Models for Managing Data Privacy in Healthcare

    Science.gov (United States)

    AL Faresi, Ahmed

    2011-01-01

    Current research in health care lacks a systematic investigation to identify and classify various sources of threats to information privacy when sharing health data. Identifying and classifying such threats would enable the development of effective information security risk monitoring and management policies. In this research I put the first step…

  5. Role of NDT in risk management

    International Nuclear Information System (INIS)

    Porter, Jr. James F.

    2009-01-01

    Risk management is identifying and then managing threats that could severely affect or bring down a company. This involves reviewing the operations of the company to include the process, equipment, procedures and personnel. Potential threats are then identified including their probability of occurrence, and then taking appropriate actions to address the most likely threats. Traditionally, risk management was thought of as mostly getting the right insurance. However, this impression of risk management has changed dramatically. With the recent increase in rules and regulations and optimizing utilization of key resources, risk management is becoming a management practice that is as important as financial or facilities management. In ideal risk management, a prioritization process is followed whereby the risks with the greatest loss and greatest probability of occurring are handled first, and risks with lower probability of occurrence and lower loss are handled in descending order. In practice the process can be very difficult, and balancing between risks with a high probability of occurrence but lower loss versus a risk with high but lower probability of occurrence can often be mishandled. (author)

  6. Using systems science for population health management in primary care.

    Science.gov (United States)

    Li, Yan; Kong, Nan; Lawley, Mark A; Pagán, José A

    2014-10-01

    Population health management is becoming increasingly important to organizations managing and providing primary care services given ongoing changes in health care delivery and payment systems. The objective of this study is to show how systems science methodologies could be incorporated into population health management to compare different interventions and improve health outcomes. The New York Academy of Medicine Cardiovascular Health Simulation model (an agent-based model) and data from the Behavioral Risk Factor Surveillance System were used to evaluate a lifestyle program that could be implemented in primary care practice settings. The program targeted Medicare-age adults and focused on improving diet and exercise and reducing weight. The simulation results suggest that there would be significant reductions projected in the proportion of the Medicare-age population with diabetes after the implementation of the proposed lifestyle program for a relatively long term (3 and 5 years). Similar results were found for the subpopulations with high cholesterol, but the proposed intervention would not have a significant effect in the proportion of the population with hypertension over a time period of Systems science methodologies can be useful to compare the health outcomes of different interventions. These tools can become an important component of population health management because they can help managers and other decision makers evaluate alternative programs in primary care settings. © The Author(s) 2014.

  7. Risk Management and Uncertainty in Infrastructure Projects

    DEFF Research Database (Denmark)

    Harty, Chris; Neerup Themsen, Tim; Tryggestad, Kjell

    2014-01-01

    The assumption that large complex projects should be managed in order to reduce uncertainty and increase predictability is not new. What is relatively new, however, is that uncertainty reduction can and should be obtained through formal risk management approaches. We question both assumptions...... by addressing a more fundamental question about the role of knowledge in current risk management practices. Inquiries into the predominant approaches to risk management in large infrastructure and construction projects reveal their assumptions about knowledge and we discuss the ramifications these have...... for project and construction management. Our argument and claim is that predominant risk management approaches tends to reinforce conventional ideas of project control whilst undermining other notions of value and relevance of built assets and project management process. These approaches fail to consider...

  8. Risk management in a competitive electricity market

    International Nuclear Information System (INIS)

    Liu, Min; Wu, Felix F.

    2007-01-01

    In a competitive electricity market, it is necessary and important to develop an appropriate risk management scheme for trade with full utilization of the multi-market environment in order to maximize participants' benefits and minimize the corresponding risks. Based on the analyses to trading environments and risks in the electricity market, a layered framework of risk management for electric energy trading is proposed in this paper. Simulation results confirmed that trading among multiple markets is helpful to reduce the complete risk, and VaR provides a useful approach to judge whether the formed risk-control scheme is acceptable. (author)

  9. INVENTORY AND RISK MANAGEMENT: DECREASING DELIVERY RISK OF PURCHASERS

    Directory of Open Access Journals (Sweden)

    Grzegorz MICHALSKI

    2008-12-01

    Full Text Available The basic financial purpose of an enterprise is maximization of its value. Inventory management should also contribute to realization of this fundamental aim. The enterprise value maximization strategy is executed with a focus on risk and uncertainty. This article presents the consequences for the recipients firm that can result from operating risk that is related to delivery risk generated by the suppliers. The present article offers a method that uses portfolio management theory to choose the suppliers.

  10. Data Management in Metagenomics: A Risk Management Approach

    Directory of Open Access Journals (Sweden)

    Filipe Ferreira

    2014-07-01

    Full Text Available In eScience, where vast data collections are processed in scientific workflows, new risks and challenges are emerging. Those challenges are changing the eScience paradigm, mainly regarding digital preservation and scientific workflows. To address specific concerns with data management in these scenarios, the concept of the Data Management Plan was established, serving as a tool for enabling digital preservation in eScience research projects. We claim risk management can be jointly used with a Data Management Plan, so new risks and challenges can be easily tackled. Therefore, we propose an analysis process for eScience projects using a Data Management Plan and ISO 31000 in order to create a Risk Management Plan that can complement the Data Management Plan. The motivation, requirements and validation of this proposal are explored in the MetaGen-FRAME project, focused in Metagenomics.

  11. Overview of Risk Management for Engineered Nanomaterials

    International Nuclear Information System (INIS)

    Schulte, P A; Geraci, C L; Hodson, L L; Zumwalde, R D; Kuempel, E D; Murashov, V; Martinez, K F; Heidel, D S

    2013-01-01

    Occupational exposure to engineered nanomaterials (ENMs) is considered a new and challenging occurrence. Preliminary information from laboratory studies indicates that workers exposed to some kinds of ENMs could be at risk of adverse health effects. To protect the nanomaterial workforce, a precautionary risk management approach is warranted and given the newness of ENMs and emergence of nanotechnology, a naturalistic view of risk management is useful. Employers have the primary responsibility for providing a safe and healthy workplace. This is achieved by identifying and managing risks which include recognition of hazards, assessing exposures, characterizing actual risk, and implementing measures to control those risks. Following traditional risk management models for nanomaterials is challenging because of uncertainties about the nature of hazards, issues in exposure assessment, questions about appropriate control methods, and lack of occupational exposure limits (OELs) or nano-specific regulations. In the absence of OELs specific for nanomaterials, a precautionary approach has been recommended in many countries. The precautionary approach entails minimizing exposures by using engineering controls and personal protective equipment (PPE). Generally, risk management utilizes the hierarchy of controls. Ideally, risk management for nanomaterials should be part of an enterprise-wide risk management program or system and this should include both risk control and a medical surveillance program that assesses the frequency of adverse effects among groups of workers exposed to nanomaterials. In some cases, the medical surveillance could include medical screening of individual workers to detect early signs of work-related illnesses. All medical surveillance should be used to assess the effectiveness of risk management; however, medical surveillance should be considered as a second line of defense to ensure that implemented risk management practices are effective.

  12. Overview of Risk Management for Engineered Nanomaterials

    Science.gov (United States)

    Schulte, P. A.; Geraci, C. L.; Hodson, L. L.; Zumwalde, R. D.; Kuempel, E. D.; Murashov, V.; Martinez, K. F.; Heidel, D. S.

    2013-04-01

    Occupational exposure to engineered nanomaterials (ENMs) is considered a new and challenging occurrence. Preliminary information from laboratory studies indicates that workers exposed to some kinds of ENMs could be at risk of adverse health effects. To protect the nanomaterial workforce, a precautionary risk management approach is warranted and given the newness of ENMs and emergence of nanotechnology, a naturalistic view of risk management is useful. Employers have the primary responsibility for providing a safe and healthy workplace. This is achieved by identifying and managing risks which include recognition of hazards, assessing exposures, characterizing actual risk, and implementing measures to control those risks. Following traditional risk management models for nanomaterials is challenging because of uncertainties about the nature of hazards, issues in exposure assessment, questions about appropriate control methods, and lack of occupational exposure limits (OELs) or nano-specific regulations. In the absence of OELs specific for nanomaterials, a precautionary approach has been recommended in many countries. The precautionary approach entails minimizing exposures by using engineering controls and personal protective equipment (PPE). Generally, risk management utilizes the hierarchy of controls. Ideally, risk management for nanomaterials should be part of an enterprise-wide risk management program or system and this should include both risk control and a medical surveillance program that assesses the frequency of adverse effects among groups of workers exposed to nanomaterials. In some cases, the medical surveillance could include medical screening of individual workers to detect early signs of work-related illnesses. All medical surveillance should be used to assess the effectiveness of risk management; however, medical surveillance should be considered as a second line of defense to ensure that implemented risk management practices are effective.

  13. Benchmarking and performance management in health care

    OpenAIRE

    Buttigieg, Sandra; ; EHMA Annual Conference : Public Health Care : Who Pays, Who Provides?

    2012-01-01

    Current economic conditions challenge health care providers globally. Healthcare organizations need to deliver optimal financial, operational, and clinical performance to sustain quality of service delivery. Benchmarking is one of the most potent and under-utilized management tools available and an analytic tool to understand organizational performance. Additionally, it is required for financial survival and organizational excellence.

  14. Implementing comprehensive health care management for sickle ...

    African Journals Online (AJOL)

    2015-05-28

    May 28, 2015 ... adopted as the strategy for the management of SCD and this has resulted in the ... Therefore, there is a need to adapt this form of care for the low-resource settings in ..... Omilola B. Patterns and trends of child and maternal ...

  15. Health care management modelling: a process perspective

    NARCIS (Netherlands)

    Vissers, J.M.H.

    1998-01-01

    Modelling-based health care management ought to become just as popular as evidence based medicine. Making managerial decisions based on evidence by modelling efforts is certainly a step forward. Examples can be given of many successful applications in different areas of decision making: disease

  16. Model risk analysis for risk management and option pricing

    NARCIS (Netherlands)

    Kerkhof, F.L.J.

    2003-01-01

    Due to the growing complexity of products in financial markets, market participants rely more and more on quantitative models for trading and risk management decisions. This introduces a fairly new type of risk, namely, model risk. In the first part of this thesis we investigate the quantitative

  17. Knowledge management: organizing nursing care knowledge.

    Science.gov (United States)

    Anderson, Jane A; Willson, Pamela

    2009-01-01

    Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.

  18. Managing health and safety risks: Implications for tailoring health and safety management system practices.

    Science.gov (United States)

    Willmer, D R; Haas, E J

    2016-01-01

    As national and international health and safety management system (HSMS) standards are voluntarily accepted or regulated into practice, organizations are making an effort to modify and integrate strategic elements of a connected management system into their daily risk management practices. In high-risk industries such as mining, that effort takes on added importance. The mining industry has long recognized the importance of a more integrated approach to recognizing and responding to site-specific risks, encouraging the adoption of a risk-based management framework. Recently, the U.S. National Mining Association led the development of an industry-specific HSMS built on the strategic frameworks of ANSI: Z10, OHSAS 18001, The American Chemistry Council's Responsible Care, and ILO-OSH 2001. All of these standards provide strategic guidance and focus on how to incorporate a plan-do-check-act cycle into the identification, management and evaluation of worksite risks. This paper details an exploratory study into whether practices associated with executing a risk-based management framework are visible through the actions of an organization's site-level management of health and safety risks. The results of this study show ways that site-level leaders manage day-to-day risk at their operations that can be characterized according to practices associated with a risk-based management framework. Having tangible operational examples of day-to-day risk management can serve as a starting point for evaluating field-level risk assessment efforts and their alignment to overall company efforts at effective risk mitigation through a HSMS or other processes.

  19. Takotsubo Cardiomyopathy in Intensive Care Unit: Prevention, Diagnosis and Management

    Directory of Open Access Journals (Sweden)

    Hannah Masoud

    2016-01-01

    Full Text Available Accurate diagnosis of Takotsubo Cardiomyopathy has substantial prognostic implications in an intensive care unit, given its increased mortality risk and association with life-threatening complications. This report seeks to discuss diagnostic modalities that can be useful in accurately differentiating Takotsubo Cardiomyopathy from Acute Coronary Syndrome, and also briefly discuss prevention and management of this cardiomyopathy in an intensive care unit. For critically ill Takotsubo patients, intensive clinicians can consider establishment of diagnosis by specific electrocardiograph changes, distinctive marked release of cardiac enzymes, characteristic echocardiograph findings, as well as invasive coronary angiography or noninvasive cardiac magnetic imaging.

  20. [Does clinical risk management require a structured conflict management?].

    Science.gov (United States)

    Neumann, Stefan

    2015-01-01

    A key element of clinical risk management is the analysis of errors causing near misses or patient damage. After analyzing the causes and circumstances, measures for process improvement have to be taken. Process management, human resource development and other established methods are used. If an interpersonal conflict is a contributory factor to the error, there is usually no structured conflict management available which includes selection criteria for various methods of conflict processing. The European University Viadrina in Frankfurt (Oder) has created a process model for introducing a structured conflict management system which is suitable for hospitals and could fill the gap in the methodological spectrum of clinical risk management. There is initial evidence that a structured conflict management reduces staff fluctuation and hidden conflict costs. This article should be understood as an impulse for discussion on to what extent the range of methods of clinical risk management should be complemented by conflict management.

  1. ANALYSIS AND MANAGEMENT RISK IN INTERNATIONAL AFFAIRS

    OpenAIRE

    Lăpăduşi Mihaela Loredana,; Căruntu Constantin

    2009-01-01

    The risk is one of the most controversial issues for all persons involved both in domestic and international world economic affairs. The need to analyze, understand and effectively manage risk is growing, the ultimate aim being to obtain a higher degree of successThe risk means exposure to an uncertain future, the opportunity to face danger or suffering a loss ( "Risk - possibility of loss or injury", Webster's, 1995) or the chance that things go wrong ( "Risk is the change that something wil...

  2. Cardiac rehabilitation with a nurse case manager (GoHeart) across local and regional health authorities improves risk factors, self-care and psychosocial outcomes. A one-year follow-up study.

    Science.gov (United States)

    Hansen, Vibeke Brogaard; Maindal, Helle Terkildsen

    2014-01-01

    In Denmark, the local and regional health authorities share responsibility for cardiac rehabilitation (CR). The objective was to assess effectiveness of CR across sectors coordinated by a nurse case manager (NCM). A one-year follow-up study. A CR programme (GoHeart) was evaluated in a cohort at Lillebaelt Hospital Vejle, DK from 2010 to 2011. Consecutive patients admitted to CR were included. The inclusion criteria were the event of acute myocardial infarction or stable angina and invasive revascularization (left ventricular ejection fraction (LVEF) ≥45%). Cardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS)) were assessed at admission (phase IIa), at three months at discharge (phase IIb) and at one-year follow-up (phase III). Intention-to-treat and predefined subgroup analysis on sex was performed. Of 241 patients, 183 (75.9%) were included (mean age 63.8 years). At discharge improvements were found in total-cholesterol (p management (p < 0.001), Health status Short Form 12 version (SF12; physical; p < 0.001 and mental; p < 0.01) and in depression symptoms (p < 0.01). At one-year follow-up these outcomes were maintained; additionally there was improvement in body mass index (BMI; p < 0.05), and high density lipoprotein (HDL; p < 0.05). There were no sex differences. CR shared between local and regional health authorities led by a NCM (GoHeart) improves risk factors, self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up.

  3. Managing flood risks in the Mekong Delta

    NARCIS (Netherlands)

    Hoang, Long Phi; Biesbroek, Robbert; Tri, Van Pham Dang; Kummu, Matti; Vliet, van Michelle T.H.; Leemans, Rik; Kabat, Pavel; Ludwig, Fulco

    2018-01-01

    Climate change and accelerating socioeconomic developments increasingly challenge flood-risk management in the Vietnamese Mekong River Delta—a typical large, economically dynamic and highly vulnerable delta. This study identifies and addresses the emerging challenges for flood-risk management.

  4. Hog Producers' Risk Management Attitudes and Desire for Additional Risk Management Education

    OpenAIRE

    Patrick, George F.; Peiter, Amy J.; Knight, Thomas O.; Coble, Keith H.; Baquet, Alan E.

    2007-01-01

    Hog producers in Indiana and Nebraska were surveyed about sources of risk, effectiveness of risk management strategies, and prior participation in and desire for additional risk management education. Ownership of hogs by the producer, size of the operation, and age did have significant effects on ratings of both sources of risk and effectiveness of risk management strategies. Probit analysis found age, prior attendance, knowledge and prior use of the tool, level of integration, and concern ab...

  5. Income statement management in a turbulent health care environment.

    Science.gov (United States)

    Covaleski, M A

    2001-03-01

    This article considers the role of accounting information embedded in the income statement of health care providers in their increasingly difficult economic environment. This turbulent economic environment has resulted from the dramatic shift in power from the seller to the buyer of health care services, with a consequential shift of risks that will mandate that health care providers obtain access to better cost and utilization information. This article looks at the 2 critical components of the income statement--the revenue function and the cost structure-in terms of their importance in the management of enhanced economic performance in both the fee-for-service and the prepaid provision of health care services. Copyright 2001 by W.B. Saunders Company

  6. Large dams and risk management

    International Nuclear Information System (INIS)

    Cazelais, N.

    2003-01-01

    In July 1996, Quebec's Saguenay region was subjected to intensive rainfall which caused severe floods and uncontrolled release of several reservoirs, resulting in extensive damage to dam structures and reservoirs. The probability of occurrence for that disaster was 1:10,000. Following the disaster, the Quebec government established a dam management body entitled the Commission scientifique et technique sur la gestion des barrages, which pointed out several safety shortcomings of existing dams. Many were either very old or had undergone significant function change without being subsequently re-evaluated. A report by the Commission stated that damage following the floods could have been limited if the design and operating standards of the dams had been more stringent. A Dam Safety Act was adopted by the Quebec National Assembly on May 30, 2000 following recommendations to retain safer structures. The Act demands regular reporting of operating procedures. Seismic activity was noted as being a topic that requires in-depth examination since Quebec's St. Lawrence Valley, particularly the Charlevoix region, is one of Canada's largest seismic zones. The other is on the west coast in British Columbia. Earthquakes in Quebec are less intense than the ones in British Columbia, but they have higher frequency content which exerts a quasi-resonance wave effect which impacts roads, bridges, buildings and hydroelectric generating facilities. Hydro-Quebec is a public utility which owns 563 retaining structures, of which 228 are ranked as large dams that measure more than 15 metres high, 400 metres long and with a reservoir capacity of more than 1 million cubic metres of water. Hydro-Quebec addresses hydrological, seismic, technological and human risks through a dam safety procedure that includes structured plans for choosing best alternatives through staged exercises. Hazard levels are minimized through the adoption of emergency, prevention and alleviation measures. The utility

  7. Environmental asset management: Risk management systems

    CSIR Research Space (South Africa)

    Naudé, Brian

    2017-07-01

    Full Text Available bnaude@csir.co.za Charl Petzer Council for Scientific and Industrial Research PO Box 395 Pretoria 0001 South Africa +2712 841 4292 CPetzer1@csir.co.za Copyright © 2017 by B Naudé, C Petzer. Published and used by INCOSE with permission.... Charl Petzer is registered professional engineer with 30 years of programme/project management as well as systems engineering experience in military and other environments. He has been the lead systems engineer, as well as programme manager on several...

  8. RISK MANAGEMENT PROCESSES IN SUPPLY CHAINS

    Directory of Open Access Journals (Sweden)

    Aleksandar Aleksić

    2009-06-01

    Full Text Available One of the keys of successful business last few years is effective dealing with risks in every meaning of that word. At the time when the world economic crisis largely limits business, successful Risk management is the only way of survival for a large number of business systems. This paper will present the processes of risk management in supply chains that are in accordance with the standards ISO 28000 and ISO 31000. By implementing a holistic, enterprise-wide supply chain risk management program, companies also can uphold their commitment to providing strong corporate governance on behalf of stakeholders and increase their market value.

  9. Strategic Risk Management and Corporate Value Creation

    DEFF Research Database (Denmark)

    Andersen, Torben Juul; Roggi, Oliviero

    Major corporate failures, periodic recessions, regional debt crises and volatile markets have intensified the focus on corporate risk management as the means to deal better with turbulent business conditions. Hence, the ability to respond effectively to the often dramatic environmental changes...... is considered an important source of competitive advantage. However, surprisingly little research has analyzed if the presumed advantages of effective risk management lead to superior performance or assessed important antecedents of effective risk management capabilities. Here we present a comprehensive study...... of risk management effectiveness and the relationship to corporate performance based on panel data for more than 3,400 firms accounting for over 33,500 annual observations during the turbulent period 1991-2010. Determining effective risk management as the ability to reduce earnings and cash flow...

  10. Risk, innovation and change : design propositions for implementing risk management in organizations

    NARCIS (Netherlands)

    van Staveren, Martinus Theodorus

    2009-01-01

    This Ph.D. research generated unique design propositions for implementing existing risk management methodologies in organizations. The resulting design propositions incorporate a synthesis of risk management, innovation management and change management. True implementation of risk management is

  11. 78 FR 4848 - Social Media: Consumer Compliance Risk Management Guidance

    Science.gov (United States)

    2013-01-23

    ...: Consumer Compliance Risk Management Guidance AGENCY: Federal Financial Institutions Examination Council... Media: Consumer Compliance Risk Management Guidance'' (guidance). Upon completion of the guidance, and... management practices adequately address the consumer compliance and legal risks, as well as related risks...

  12. Risk assessment and management logistics chains

    Directory of Open Access Journals (Sweden)

    Vladimir Vikulov

    2014-03-01

    Full Text Available Background: In the context of economic globalization and increasing complexity of economic relations enterprises need methods and techniques to improve and sustain their position on the global market. Integration processes offer business new opportunities, but at the same time present new challenges for the management, including the key objectives of the risk management. Method: On the basis of analysis tools known from the pertinent literature (Supply Chain Management and Supply Chain Risk Management methods, methods of probability theory, methods of risk management, methods of statistics the authors of this paper proposed their own risk assessment method and the method of management of logistics chains. The proposed tool is a specific hybrid of solutions known from the literature. Results: The presented method has been successfully used within the frames of economic-mathematical model of industrial enterprises. Indicators of supply chain risks, including risks caused by supplier are considered in this paper. Authors formed a method of optimizing the level of supply chain risk in the integration with suppliers and customers. Conclusion: Every organization, which starting the process of integration with supplier and customers, needs to use tools, methodologies and techniques for identification of "weak links" in the supply chain. The proposed method allows to fix risk origin places in various links of the supply chain and to identify "weak links" of a logistic chain that may occur in the future. The method is a useful tool for managing not only risks and risk situations, but also to improve the efficiency of current assets management by providing the ability to optimize the level of risk in the current assets management of the industrial enterprise.

  13. Internal audit risk management in metropolitan municipalities

    Directory of Open Access Journals (Sweden)

    Christo Ackermann

    2016-07-01

    Full Text Available Internal audit functions (IAFs of organisations are regarded as crucial components of the combined assurance model, alongside the audit committee, management and external auditors. The combined assurance model aims at having integrated and aligned assurance in organisations with the overall aim of maximising risk and governance oversight and control efficiencies. In this regard, internal audit plays a crucial role, insofar as it consists of experts in risk, governance and control consultancy who provide assurance to senior management and the audit committee. Audit committees are dependent on internal audit for information and their effectiveness revolves around a strong and well-resourced internal audit function which is able to aid audit committees to meet their oversight responsibilities. There is thus a growing demand for managing risk through the process of risk management and internal audit is in a perfect position to assist with the improvement of such processes. If internal auditors wish to continue being an important aspect of the combined assurance model, they need to address the critical area, amongst others, of risk management as part of their work. If not, it follows that the board, audit committees and other levels of management will remain uninformed on the status of these matters which, in turn, will negatively impact the ability of these stakeholders to discharge their responsibilities. This study therefore focuses on analysing the functioning of IAFs, with specific reference to their risk management mandate. The study followed a mixed method approach to describe internal audits risk management functioning in the big eight metropolitan municipalities in South Africa. The results show that internal audit provide a broad scope of risk management work which assist senior management in the discharge of their responsibilities. However, in the public eye, internal audits risk management functioning is scant

  14. Managing the unmanageable: risk assessment and risk management in contemporary professional practice.

    Science.gov (United States)

    Raven, J; Rix, P

    1999-07-01

    This study sets out to investigate the theories and practices of risk assessment and management in the context of contemporary mental health practice. Although risk assessment and management policies are well established for those working in the field of community mental health care, there are noticeable anomalies and regional variations, in the criteria, procedures and decision-making strategies used. Focus group taped interviews were conducted with over 100 mental health professionals in one NHS Trust. These were compared with an extensive literature review on the topic. The main theme to emerge was lack of resources, which included time and staff in the context of a changing and increasing workload. Another important theme was the lack of access to centralized and accurate information about mental health service provision. It is essential that professionals, clients, their families and the public feel confident in professional judgements and practices to avoid a 'back to the asylum' lobby, for the care and treatment of seriously mentally ill individuals.

  15. Decisionmaking under risk in invasive species management: risk management theory and applications

    Science.gov (United States)

    Shefali V. Mehta; Robert G. Haight; Frances R. Homans

    2010-01-01

    Invasive species management is closely entwined with the assessment and management of risk that arises from the inherently random nature of the invasion process. The theory and application of risk management for invasive species with an economic perspective is reviewed in this synthesis. Invasive species management can be delineated into three general categories:...

  16. Examining the realities of risk management

    International Nuclear Information System (INIS)

    Garrick, B.J.

    1985-01-01

    Sufficient experience now exists, especially in the nuclear industry, to consider the progress that has been made toward meaningful tools or aids for the control and, hence, management of risk. The considerable activity in the field of probabilistic risk assessment (PRA) suggests a high level of interest and application. It is the purpose of this paper to examine our own experience in this regard and to offer some observations and opinions about current practices in risk management and the requirements for success

  17. Project risk management in complex petrochemical system

    Directory of Open Access Journals (Sweden)

    Kirin Snežana

    2012-01-01

    Full Text Available Investigation of risk in complex industrial systems, as well as evaluation of main factors influencing decision making and implementation process using large petrochemical company as an example, has proved the importance of successful project risk management. This is even more emphasized when analyzing systems with complex structure, i.e. with several organizational units. It has been shown that successful risk management requires modern methods, based on adequate application of statistical analysis methods.

  18. Systems approach to project risk management

    Energy Technology Data Exchange (ETDEWEB)

    Kindinger, J. P. (John P.)

    2002-01-01

    This paper describes the need for better performance in the planning and execution of projects and examines the capabilities of two different project risk analysis methods for improving project performance. A quantitative approach based on concepts and tools adopted from the disciplines of systems analysis, probabilistic risk analysis, and other fields is advocated for managing risk in large and complex research & development projects. This paper also provides an overview of how this system analysis approach for project risk management is being used at Los Alamos National Laboratory along with examples of quantitative risk analysis results and their application to improve project performance.

  19. Risk Management Practices of Multinational and indigenous ...

    African Journals Online (AJOL)

    Construction projects' high uncertainty rates make them unattractive to non-risk takers. Construction companies are therefore necessarily risk takers, albeit, to varying degrees. This study made an inquiry into the risk management (RM) practices of multinational and indigenous construction companies (MCCs and ICCs, ...

  20. RISKS MANAGEMENT. A PROPENSITY SCORE APPLICATION

    Directory of Open Access Journals (Sweden)

    Constangioara Alexandru

    2008-05-01

    Full Text Available Risk management is relatively unexplored in Romania. Although Romanian specialists dwell on theoretical aspects such as the risks classification and the important distinction between risks and uncertainty the practical relevance of the matter is outside existing studies. Present paper uses a dataset of consumer data to build a propensity scorecard based on relevant quantitative modeling.

  1. Risks in hospitals. Assessment and Management

    Directory of Open Access Journals (Sweden)

    Bradea Ioana-Alexandra

    2014-12-01

    Full Text Available In a complex world, characterized by a multitude of risks, managers need to manage the risks they encounter, in an efficient way and in the shortest time possible. In the current economic crisis, the concept of hospital risk management, as the process in which is identified, analyzed, reduced, or avoided a risk that may affect the hospital, gained great importance. The Romanian health system, distinguished by: lack of transparency, poor funding, the loss of the valuable medical staff, lack of hospitals in villages and small towns, inability to engage patients due to the old and poor equipment, lack of research and problems in information privacy and cyber-security, requires an appropriate management, enabling risk managers to take decisions in order to avoid the occurrence of risks. Important for the functioning of every hospital is the perception of patients and their degree of satisfaction, regarding the quality of services, which depend largely on the quality of human resources. But what are the human resources weaknesses and risks from the patient point of view? What are the risk indicators which must be monitored to avoid risks? And also, which is the most useful method for measurement and assessment of risk?

  2. Posttreatment follow-up of radiation oncology patients in a managed care environment

    International Nuclear Information System (INIS)

    Steinberg, Michael L.; Rose, Christopher M.

    1996-01-01

    Purpose: Health care delivery in the United States is in the midst of a structural revolution called managed care. Demands for cost control within the managed care environment force radiation oncologists to defend the need and obligation to follow their patients. Methods and Materials: We have analyzed this follow-up requirement from six potential justifications: patient care, medical-legal, quality assurance, outcome measurement, cost, and improvement of care. Results: Practical recommendations for discussing the need for follow-up with the medical directors and primary care physicians of managed care entities are given. Follow-up without valid documentation of benefit is hard to justify in this era of managed care. Conclusions: Collaborative follow-up between the referring physician, the treating radiation oncologist, and the other oncologic specialists will allow for outcome measurement and improvement in practice without driving up cost or exposing the patient to undue risk.

  3. ESRD in the geriatric population: the crisis of managed care and the opportunity of disease management.

    Science.gov (United States)

    Steinman, Theodore I

    2002-01-01

    The geriatric population with end-stage renal disease (ESRD) is placed at risk with regards to the quality and extent of medical coverage because of the rapidly changing financial environment. Managed care organizations (MCOs) are generally for-profit companies that must focus on the bottom line. While the verbal commitment to quality care is voiced, the financial pressures on MCOs have led to a decrease in coverage of many services and outright denial for some necessary treatments. While denying services, the MCOs have also reduced payments to providers for services rendered. The coverage crisis is compounded by health maintenance organizations (HMOs) quitting Medicare because the reimbursement from the Health Care Financing Administration (HCFA) is less than their costs. Because of the above issues which can potentially impact on the quality of care delivered to the ESRD geriatric population, a new approach to disease management has created the opportunity to improve total patient care to a level not yet achieved in the United States. Disease management encompasses integrated care across all disciplines. Every component of care can be tracked by a dedicated information system. Improvement in outcomes has far exceeded the U.S. Renal Data System (USRDS) benchmark performance measurements with a disease management model approach. The key to success is the health service coordinator (HSC), a senior nurse with many years of ESRD experience. This individual coordinates care across all disciplines and expedites necessary referrals. With rapid attention to patient needs there has been a significant reduction in hospital admissions, hospital length of stay, and emergency room visits. Patient care will steadily improve as the disease management system matures as a consequence of understanding the patients total physical and psychosocial needs.

  4. Pennsylvania: Penn State University Integrated Pest Management Project (A Former EPA CARE Project)

    Science.gov (United States)

    Penn State University (PSU) is the recipient of a Level II CARE cooperative agreement targeting environmental risks in Philadelphia communities. PSU is involved in developing IPM management practices recommendations and policies.

  5. Risk Management and Risk Psychology in Romanian Sme’s

    Directory of Open Access Journals (Sweden)

    Irina Dănciulescu

    2015-12-01

    Full Text Available Risk is one of the biggest and most fascinating challenges of all times for humanity, because of its presence in all fields. Risk management as a component of modern management, has become a main concern for the modern world and one of the “key mechanisms” of economic development, a complex processn that includes a series of activities meant to alleviate the impact of risk over business and planed or foreseen results. This paper wants to bring to attention the importance of risks and their management in today’s economic crisis. The sector presented is the IT& C, especially software, because Romania had a growth in this area for a few years but beginning the crisis this segment in economy had known a serious decrease. This paper tries to connect risk management and risk psychology to Romanian economy, culture and mentality. The paper presents in short some of risk management characteristics, definitions and few opinions; why in Romania this subject is not treated with the appropriate attention. The paper at hand focuses on the psychology of risk and how it affects the life of individuals and the existence of companies, the importance it should have on day to day basis, especially in Romania

  6. Options analysis of managed care contracting and regulation: theory and evidence.

    Science.gov (United States)

    McLean, R A; Magiera, F T

    2000-08-01

    Managed care contracts can be represented as bundles of options. In particular, the managed care provider is short a call option. To hedge the risk involved in such contracts, managed care contractors can construct several types of virtual put options, among them the ownership of facilities. Agency theory and options theory suggest that for-profit managed care plans, in the presence of debt, will engage in less hedging activity than will other managed care plans. Here, the authors test that hypothesis, using data for Florida HMOs in 1995, and they reject the null hypothesis. That managed care organizations act as if they are short a call option raises interesting regulatory issues, including the possibility of using a hedge-based regulatory scheme in place of a net-worth-based scheme.

  7. Nuclear power plant risk assembly and decomposition for risk management

    International Nuclear Information System (INIS)

    Iden, D.C.

    1985-01-01

    The state-of-the-art method for analyzing the risk from nuclear power plants is probabilistic risk assessment (PRA). The intermediate results of a PRA are first assembled to quantify the risk from operating a nuclear power plant in the form of (1) core damage (or core melt) frequency, (2) plant damage state frequencies, (3) release category frequencies, and (4) the frequency of exceeding specific levels of offsite consequences. Once the overall PRA results have been quantified, the next step is to decompose those results into the individual contributors to each of the four forms of risk in some rank order. The way in which the PRA model is set up to assemble and decompose the plant risk determines the ease and usefulness of the PRA model as a risk management tool for evaluating perturbations to the PRA model. These perturbations can take the form of technical specification changes, hardware modifications, procedural changes, etc. The matrix formalism developed by Dr. Stan Kaplan for risk assembly and decomposition represents a significant breakthrough in making the PRA model an effective risk management tool. The key to understanding the matrix formalism and making it a useful tool for managing nuclear power plant risk is the structure of the PRA model. PRA risk model structure and decomposition of the risk results are discussed with the Seabrook PRA as an example

  8. An Examination of Negligence, Assumption of Risk, and Risk Management in Outdoor Recreation.

    Science.gov (United States)

    Teague, Travis L.

    This paper stresses the outdoor recreation and education professionals should understand aspects of liability, negligence, and risk management. There are four elements that must be present if a person or organization is to be considered negligent: the presence of a legal duty of care, a breach of duty, proximate cause, and actual damages. When…

  9. Models for assessing and managing credit risk

    Directory of Open Access Journals (Sweden)

    Neogradi Slađana

    2014-01-01

    Full Text Available This essay deals with the definition of a model for assessing and managing credit risk. Risk is an inseparable component of any average and normal credit transaction. Looking at the different aspects of the identification and classification of risk in the banking industry as well as representation of the key components of modern risk management. In the first part of the essay will analyze how the impact of credit risk on bank and empirical models for determining the financial difficulties in which the company can be found. Bank on the basis of these models can reduce number of approved risk assets. In the second part, we consider models for improving credit risk with emphasis on Basel I, II and III, and the third part, we conclude that the most appropriate model and gives the best effect for measuring credit risk in domestic banks.

  10. [What Surgeons Should Know about Risk Management].

    Science.gov (United States)

    Strametz, R; Tannheimer, M; Rall, M

    2017-02-01

    Background: The fact that medical treatment is associated with errors has long been recognized. Based on the principle of "first do no harm", numerous efforts have since been made to prevent such errors or limit their impact. However, recent statistics show that these measures do not sufficiently prevent grave mistakes with serious consequences. Preventable mistakes such as wrong patient or wrong site surgery still frequently occur in error statistics. Methods: Based on insight from research on human error, in due consideration of recent legislative regulations in Germany, the authors give an overview of the clinical risk management tools needed to identify risks in surgery, analyse their causes, and determine adequate measures to manage those risks depending on their relevance. The use and limitations of critical incident reporting systems (CIRS), safety checklists and crisis resource management (CRM) are highlighted. Also the rationale for IT systems to support the risk management process is addressed. Results/Conclusion: No single tool of risk management can be effective as a standalone instrument, but unfolds its effect only when embedded in a superordinate risk management system, which integrates tailor-made elements to increase patient safety into the workflows of each organisation. Competence in choosing adequate tools, effective IT systems to support the risk management process as well as leadership and commitment to constructive handling of human error are crucial components to establish a safety culture in surgery. Georg Thieme Verlag KG Stuttgart · New York.

  11. Better team management--better team care?

    Science.gov (United States)

    Shelley, P; Powney, B

    1994-01-01

    Team building should not be a 'bolt-on' extra, it should be a well planned, integrated part of developing teams and assisting their leaders. When asked to facilitate team building by a group of NHS managers we developed a framework which enabled individual members of staff to become more effective in the way they communicated with each other, their teams and in turn within the organization. Facing the challenge posed by complex organizational changes, staff were able to use 3 training days to increase and develop their awareness of the principles of teamwork, better team management, and how a process of leadership and team building could help yield better patient care.

  12. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    NARCIS (Netherlands)

    Odusola, A.O.; Stronks, K.; Hendriks, M.E.; Schultsz, C.; Akande, T.; Osibogun, A.; van Weert, H.; Haafkens, J.A.

    2016-01-01

    Background: Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective: We explored perspectives of primary care staff and health insurance managers on enablers and

  13. Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers

    NARCIS (Netherlands)

    Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; Weert, Henk van; Haafkens, Joke A.

    2016-01-01

    Background Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. Objective We explored perspectives of primary care staff and health insurance managers on enablers and

  14. Quality Risk Management of Compliant Excipients

    Directory of Open Access Journals (Sweden)

    Brian Carlin

    2012-12-01

    Full Text Available Raw material compliance and GMP do not eliminate variability. Quality by Design should minimize the risk that raw material variability will adversely affect the finished product Critical Quality Attributes. The sources of technological risk from excipients are reviewed and approaches to excipient risk management are discussed. Supplier involvement throughout the product life-cycle is recommended to minimize excipient-related risk.

  15. FINANCIAL RISK MANAGEMENT IN TRADE BANKS

    Directory of Open Access Journals (Sweden)

    Ms. Tamara Ye. Kononenko

    2016-09-01

    Full Text Available The paper clarifies the concepts of «risk», «financial risk» in banking business, and considers the main problems of financial risk management in trade banks while financing borrowers. The authors single out the most relevant problems, and conduct the analysis of overdue payment in case of OJSC “Sberbank of Russia”. The authors also offer a number of measures to minimize financial risks in trade bank activities in modern conditions.

  16. Cardiac rehabilitation with a nurse case manager (GoHeart across local and regional health authorities improves risk factors, self-care and psychosocial outcomes. A one-year follow-up study

    Directory of Open Access Journals (Sweden)

    Vibeke Brogaard Hansen

    2014-10-01

    Full Text Available Objectives In Denmark, the local and regional health authorities share responsibility for cardiac rehabilitation (CR. The objective was to assess effectiveness of CR across sectors coordinated by a nurse case manager (NCM. Design A one-year follow-up study. Setting A CR programme (GoHeart was evaluated in a cohort at Lillebaelt Hospital Vejle, DK from 2010 to 2011. Participants Consecutive patients admitted to CR were included. The inclusion criteria were the event of acute myocardial infarction or stable angina and invasive revascularization (left ventricular ejection fraction (LVEF ≥45%. Main outcome measures Cardiac risk factors, stratified self-care and self-reported psychosocial factors (SF12 and Hospital Anxiety and Depression Scale (HADS were assessed at admission (phase IIa, at three months at discharge (phase IIb and at one-year follow-up (phase III. Intention-to-treat and predefined subgroup analysis on sex was performed. Results Of 241 patients, 183 (75.9% were included (mean age 63.8 years. At discharge improvements were found in total-cholesterol ( p  < 0.001, low density lipoprotein (LDL; p  < 0.001, functional capacities (metabolic equivalent of tasks (METS, p  < 0.01, self-care management ( p  < 0.001, Health status Short Form 12 version (SF12; physical; p  < 0.001 and mental; p  < 0.01 and in depression symptoms ( p  < 0.01. At one-year follow-up these outcomes were maintained; additionally there was improvement in body mass index (BMI; p  < 0.05, and high density lipoprotein (HDL; p  < 0.05. There were no sex differences. Conclusion CR shared between local and regional health authorities led by a NCM (GoHeart improves risk factors, self-care and psychosocial factors. Further improvements in most variables were at one-year follow-up.

  17. Skin tears: care and management of the older adult at home.

    Science.gov (United States)

    Holmes, Regina F; Davidson, Martha W; Thompson, Bonnie J; Kelechi, Teresa J

    2013-02-01

    Skin tears experienced by older adults require special skills to promote healing. Home healthcare providers are in key positions to manage skin tears and prevent further skin trauma. Several guidelines, risk assessments, classifications, and products exist to manage high-risk patients. Frequent evaluation of the effectiveness of the treatment and prevention strategies in an overall skin care protocol for home care patients is critical to reduce skin tear incidence and promote prompt healing when skin tears are present.

  18. Sustainable Risk Management in the Banking Sector

    Directory of Open Access Journals (Sweden)

    Županović Ivo

    2014-01-01

    Full Text Available The globalization of financial markets and negative consequences of the financial crisis resulted in negative connotations in the operation of many financial institutions, businesses and citizens and imposed the need to implement appropriate risk management measures in the banking sector. Evolution of the financial sector makes a lot of news in the field of risk management and particularly the modelling of market, credit and operational risk. The main methodology for risk management is the value-at-risk, which is used in practice with other techniques such as the capital- at-risk method in order to minimize business risks and achieve optimal results in the banking and, generally, financial operations. Accordingly, at all levels of governance in the banking sector, there are prudential policies in place governing the management of all types of financial and operational risks. Based on the abovementioned, the focus of the examination was on the above postulate, and prompt recognition, control and proper management of banking risks.

  19. The Strategic-Renovation Banks’ Risks Management

    Directory of Open Access Journals (Sweden)

    Yeremeychuk Raisa A.

    2017-04-01

    Full Text Available The article is aimed at developing approaches to implementation of the strategic-renovation risk management. Essence of risk theories was researched, the concept of «risk» in the bank’s management system were analyzed. On the basis of a theoretical generalization of scientific literature and the carried out analysis of existing risk management strategies to ensure the security of banking business, the strategy of renovation management has been selected. Because bank risks are part of the economic risk system, they are complex in their nature. However, given the importance of bank risks, the interpretation of their essence is still a debating matter. In a certain number of cases, their essence is replaced by the cause of occurrence, that is, all the different circumstances, factors that lead to the losses. So today, banks are considering risks, in particular, not only as a source of possible losses, but also as an opportunity to generate additional profits. An algorithm for taking a strategic-renovation decision on the banks’ risks management system has been proposed.

  20. Intentional risk management through complex networks analysis

    CERN Document Server

    Chapela, Victor; Moral, Santiago; Romance, Miguel

    2015-01-01

    This book combines game theory and complex networks to examine intentional technological risk through modeling. As information security risks are in constant evolution,  the methodologies and tools to manage them must evolve to an ever-changing environment. A formal global methodology is explained  in this book, which is able to analyze risks in cyber security based on complex network models and ideas extracted from the Nash equilibrium. A risk management methodology for IT critical infrastructures is introduced which provides guidance and analysis on decision making models and real situations. This model manages the risk of succumbing to a digital attack and assesses an attack from the following three variables: income obtained, expense needed to carry out an attack, and the potential consequences for an attack. Graduate students and researchers interested in cyber security, complex network applications and intentional risk will find this book useful as it is filled with a number of models, methodologies a...

  1. DEPRESSION IN PRIMARY CARE. PART 2: MANAGEMENT

    Directory of Open Access Journals (Sweden)

    XV Pereira

    2007-01-01

    Full Text Available The management of depression in the primary care setting should ideally take a biological, psychological, and sociologicalapproach. Antidepressants are the most commonly used biological agents in the treatment of depression. Psychologicaltherapies and psychosocial interventions improve the outcome of treatment when combined with pharmacotherapy.Clinical depression is treatable and thus efforts should be made to alleviate the suffering of patients with depression.

  2. Risk management; Maitriser le risque

    Energy Technology Data Exchange (ETDEWEB)

    Magne, L

    1999-07-01

    There is always a risk of an accident occurring at a nuclear power plant, however small. The problem lies in estimating the probability of it occurring. The method of probabilistic safety assessment provides this estimate, and by identifying the sources of potential risk, makes it possible to prevent them from occurring. It is not, however, a substitute for other decision-making processes. (author)

  3. Managers facing the climatic risks

    International Nuclear Information System (INIS)

    2003-01-01

    This colloquium aimed to analyze the relations between the climatic changes and extreme meteorological events and on the associated risks. It provides information and knowledge on the state of the art concerning the today scientific knowledge, the prevention measures and the adaptation facing the risks and the difficult estimation of the climatic damages costs. (A.L.B.)

  4. Risk management and safety culture

    International Nuclear Information System (INIS)

    Takano, K.

    2007-01-01

    Paper informs on the efforts to elaborate a feedback system for risk comprehensive evaluation and a system to improve structure safety foreseeing the possibility to control the latent risk, ensuring the qualitative evaluation of the safety level and improvement of safety culture in various branches of industry, first and foremost, in the electricity producing sector including the nuclear power industry [ru

  5. Credit risk management in the power sector

    International Nuclear Information System (INIS)

    Allen, D.

    2002-01-01

    Deregulation of the electric power industry has the potential to put power businesses at market risk particularly when the value of an asset or liability will change with market movements. Market risk gives rise to credit risk where a contract cannot be fulfilled. This presentation describes how credit risks can be identified and measured. Most practitioners use some variant of value-at-risk (VAR) technology for measuring market risk. Under this approach, risk is determined by the volatility implied by the market. Volatility of electricity prices and natural gas prices has increased significantly in Alberta in recent years. The consequence is an increase in both market and credit risk. The author described the difference between the two risks and their significance. An overview of credit risk management with derivatives, an over-the counter contract, was also presented. The author also discusses issue of protection buyers in the event of a failed contract. 9 figs

  6. Risk management in Swedish hedge funds

    OpenAIRE

    Fri, Samuel; Nilsson, Joakim

    2011-01-01

    Background: Risk management has always been a complex topic, especially when it comes to hedge funds. Since hedge funds are able to utilize many kinds of financial instruments it is difficult to find a risk management strategy that goes well with them. Not much research regarding the Swedish hedge fund industry and its risk management has been done; hence we find it an interesting topic to focus this thesis on. Purpose: The purpose of this thesis is to increase the knowledge of how Swedish he...

  7. Evaluating risk management strategies in resource planning

    International Nuclear Information System (INIS)

    Andrews, C.J.

    1995-01-01

    This paper discusses the evaluation of risk management strategies as a part of integrated resource planning. Value- and scope-related uncertainties can be addressed during the process of planning, but uncertainties in the operating environment require technical analysis within planning models. Flexibility and robustness are two key classes of strategies for managing the risk posed by these uncertainties. This paper reviews standard capacity expansion planning models and shows that they are poorly equipped to compare risk management strategies. Those that acknowledge uncertainty are better at evaluating robustness than flexibility, which implies a bias against flexible options. Techniques are available to overcome this bias

  8. Improving risk management: from lame excuses to principled practice.

    Science.gov (United States)

    Paté-Cornell, Elisabeth; Cox, Louis Anthony

    2014-07-01

    The three classic pillars of risk analysis are risk assessment (how big is the risk and how sure can we be?), risk management (what shall we do about it?), and risk communication (what shall we say about it, to whom, when, and how?). We propose two complements as important parts of these three bases: risk attribution (who or what addressable conditions actually caused an accident or loss?) and learning from experience about risk reduction (what works, and how well?). Failures in complex systems usually evoke blame, often with insufficient attention to root causes of failure, including some aspects of the situation, design decisions, or social norms and culture. Focusing on blame, however, can inhibit effective learning, instead eliciting excuses to deflect attention and perceived culpability. Productive understanding of what went wrong, and how to do better, thus requires moving past recrimination and excuses. This article identifies common blame-shifting "lame excuses" for poor risk management. These generally contribute little to effective improvements and may leave real risks and preventable causes unaddressed. We propose principles from risk and decision sciences and organizational design to improve results. These start with organizational leadership. More specifically, they include: deliberate testing and learning-especially from near-misses and accident precursors; careful causal analysis of accidents; risk quantification; candid expression of uncertainties about costs and benefits of risk-reduction options; optimization of tradeoffs between gathering additional information and immediate action; promotion of safety culture; and mindful allocation of people, responsibilities, and resources to reduce risks. We propose that these principles provide sound foundations for improving successful risk management. © 2014 Society for Risk Analysis.

  9. Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

    Science.gov (United States)

    Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

    2018-05-01

    Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

  10. Risk management and analysis: risk assessment (qualitative and quantitative)

    OpenAIRE

    Valentin Mazareanu

    2007-01-01

    We use to define risk as the possibility of suffering a loss. Starting this, risk management is defined as a business process whose purpose is to ensure that the organization is protected against risks and their effects. In order to prioritize, to develop a response plan and after that to monitor the identified risks we need to asses them. But at this point a question is born: should I choose a qualitative approach or a quantitative one? This paper will make a short overview over the risk eva...

  11. Risk perception as a driver for risk management policies

    Science.gov (United States)

    Carmona, María; Mañez, María

    2016-04-01

    Risk is generally defined as the "combination of the probability of the occurrence of an event and its negative consequences" ( UNISDR, 2009). However, the perception of a risk differs among cultures regarding different features such as the context,causes, benefits or damage. Risk perception is the subjective valuation of the probability of an event happening and how concerned individuals or groups are with the consequences (Sjöberg, 2004). Our study is based on an existing framework for risk perception (Rehn and Rohrmann, 2000). We analyse the characteristics of the risk perception regarding extreme events (e.g.droughts) and how the perception of the group drives the action to manage the risk. We do this to achieve an overview of the conditions that let stakeholders join each other to improve risk management especially when governments are not reacting properly. For our research, attention is paid on risk perception of Multi-Sector Partnerships not taking into account the individual level of risk perception. We focus on those factors that make risk management effective and increase resilience. Multi-Sector Partnerships, considered as significant governance structures for risk management, might contribute to reduce vulnerability in prone areas to natural hazards and disasters. The Multi-Sector Partnerships used for our research are existing partnerships identified in the cases studies of the European project ENHANCE. We implement a survey to analyse the perception of risk in the case studies. That survey is based on the Cultural Theory (Douglas and Wildavsky, 1982)and the Protection Motivation Theory (Rogers, 1975). We analyse the results using the Qualitative-Comparative Analysis proposed by Ragin in 1987. The results show the main characteristics of a risk culture that are beneficial to manage a risk. Those characteristics are shaped by the perception of risk of the people involved in the partnership, which in turn shapes their risk management. Nevertheless, we

  12. Practical Risk Management for the CIO

    CERN Document Server

    Scherling, Mark

    2007-01-01

    The growing complexity of today's interconnected systems has not only increased the need for improved information security, but also helped to move information from the IT backroom to the executive boardroom as a strategic asset. And, just like the tip of an iceberg is all you see until you run into it, the risks to your information are mostly invisible until disaster strikes. Detailing procedures that will help your team perform better risk assessments and aggregate results into more meaningful metrics, Practical Risk Management for the CIO approaches information risk management through impro

  13. Practical Methods for Information Security Risk Management

    Directory of Open Access Journals (Sweden)

    Cristian AMANCEI

    2011-01-01

    Full Text Available The purpose of this paper is to present some directions to perform the risk man-agement for information security. The article follows to practical methods through question-naire that asses the internal control, and through evaluation based on existing controls as part of vulnerability assessment. The methods presented contains all the key elements that concurs in risk management, through the elements proposed for evaluation questionnaire, list of threats, resource classification and evaluation, correlation between risks and controls and residual risk computation.

  14. Managing risk in statistics - "Relative risk" | Durrheim | South African ...

    African Journals Online (AJOL)

    South African Family Practice. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 45, No 8 (2003) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register. Managing risk in statistics - "Relative risk". DN Durrheim ...

  15. The application of holistic risk management in the banking industry

    Directory of Open Access Journals (Sweden)

    J. Chibayambuya

    2007-12-01

    Full Text Available Purpose: The application of holistic risk management is fast becoming a standard measure of good governance in the business arena. What role can holistic risk management play in the management of risk in the financial services industry? The aim of this paper is to propose a holistic risk management framework for the management of risk. Design/Methodology/Approach: A comprehensive framework that covers the holistic view risk management is proposed/developed out of an extensive literature review. Findings: Given the deliberations of various frameworks, a holistic risk management is proposed. The proposed framework ensures that all components of risk management are taken into account when strategizing for risk management in general and holistic risk management in particular; thereby improving the management of risk in the banking industry. Implications: The article proposes a holistic approach to risk management which takes into account all the facets of risk management, e.g. analyzing, planning, strategy, communication, implementation, motivation, systems review and plan modification. This holistic approach, when implemented in the banking industry, can have a significant impact on the improved management of risk. Originality/Value: The new proposed holistic risk management framework offers a fresh perspective of strategizing for risk management in terms of risk analysis, risk planning, risk strategy, risk communication, risk implementation, risk motivation, risk review and risk plan modification.

  16. Contract Design: Risk Management and Evaluation.

    Science.gov (United States)

    Mühlbacher, Axel C; Amelung, Volker E; Juhnke, Christin

    2018-01-12

    Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The risk structure of the providers plays a vital role in Pay for Performance. A prerequisite for optimal incentive-based service models is a (partial) dependence of the agent's returns on the provider's gain level. Integrated care systems as well as accountable care organisations (ACOs) in the US and similar concepts in other countries are advocated as an effective method of improving the performance of healthcare systems. These systems outline a payment and care delivery model that intends to tie provider reimbursements to predefined quality metrics. By this the total costs of care shall be reduced. Little is known about the contractual design and the main challenges of delegating "accountability" to these new kinds of organisations and/or contracts. The costs of market utilisation are highly relevant for the conception of healthcare contracts; furthermore information asymmetries and contract-specific investments are an obstacle to the efficient operation of ACOs. A comprehensive literature review on methods of designing contracts in Integrated Care was conducted. The research question in this article focuses on how reimbursement strategies, evaluation of measures and methods of risk adjustment can best be integrated in healthcare contracting. Each integrated care contract includes challenges for both payers and providers without having sufficient empirical data on both sides. These challenges are clinical, administrative or financial nature. Risk adjusted contracts ensure that the reimbursement roughly matches the true costs resulting from the morbidity of a population. If reimbursement of care provider corresponds to the actual expenses for an individual/population the problem of risk selection is greatly reduced. The currently used methods of risk adjustment have widely differing model and forecast

  17. Contract Design: Risk Management and Evaluation

    Directory of Open Access Journals (Sweden)

    Axel C. Mühlbacher

    2018-01-01

    Full Text Available Introduction: Effective risk adjustment is an aspect that is more and more given weight on the background of competitive health insurance systems and vital healthcare systems. The risk structure of the providers plays a vital role in Pay for Performance. A prerequisite for optimal incentive-based service models is a (partial dependence of the agent’s returns on the provider’s gain level. Integrated care systems as well as accountable care organisations (ACOs in the US and similar concepts in other countries are advocated as an effective method of improving the performance of healthcare systems. These systems outline a payment and care delivery model that intends to tie provider reimbursements to predefined quality metrics. By this the total costs of care shall be reduced.  Methods: Little is known about the contractual design and the main challenges of delegating “accountability” to these new kinds of organisations and/or contracts. The costs of market utilisation are highly relevant for the conception of healthcare contracts; furthermore information asymmetries and contract-specific investments are an obstacle to the efficient operation of ACOs. A comprehensive literature review on methods of designing contracts in Integrated Care was conducted. The research question in this article focuses on how reimbursement strategies, evaluation of measures and methods of risk adjustment can best be integrated in healthcare contracting.  Results: Each integrated care contract includes challenges for both payers and providers without having sufficient empirical data on both sides. These challenges are clinical, administrative or financial nature. Risk adjusted contracts ensure that the reimbursement roughly matches the true costs resulting from the morbidity of a population. If reimbursement of care provider corresponds to the actual expenses for an individual/population the problem of risk selection is greatly reduced. The currently used methods

  18. Management of dizziness in primary care.

    Science.gov (United States)

    Sloane, P D; Dallara, J; Roach, C; Bailey, K E; Mitchell, M; McNutt, R

    1994-01-01

    We sought to determine the types of dizziness problems that are commonly seen in primary care practices, and to bring to light clinical and demographic factors that predict management decisions. We undertook a prospective cohort study with a 6-month follow-up using data gathered in nine primary care practices in two North Carolina counties. Subjects were 144 dizziness patients examined by primary care physicians. Data collected included demographic characteristics, a standardized dizziness history, physician estimation of symptom severity and diagnostic certainty, and physician "worry" about arrhythmia, transient ischemic attack, and brain tumor. Physicians reported their management decisions and diagnosis (or differential diagnosis) by responding to a questionnaire after completing the patient encounter. A 6-month follow-up chart review and physician interview were completed on 140 patients (97.2 percent); information obtained included changes in diagnosis and patient mortality. The most common diagnoses were labyrinthitis, otitis media, benign positional vertigo, unspecified presyncope, sinusitis, and transient ischemic attack. The initial diagnosis changed during the 6-month follow-up period in 34 (24.3 percent) of patients. The overall course of these patients was benign, however, with only one death occurring during the 6-month follow-up period. Patients' dizziness tended to be managed using a combination of strategies, including office laboratory testing (33.6 percent), advanced testing (11.4 percent), referral to a specialist (9.3 percent), medication (61.3 percent), observation (71.8 percent), reassurance (41.6 percent), and behavioral recommendations (15.0 percent). Office laboratory testing was associated with younger patient age, a suspected metabolic or endocrine disorder, and physician worry about a cardiac arrhythmia; advanced laboratory testing was associated with suspected cardiovascular or neurologic disorders. Medication tended to be prescribed

  19. Fundamentals of pain management in wound care.

    Science.gov (United States)

    Coulling, Sarah

    Under-treated pain can result in a number of potentially serious sequelae (Australian and New Zealand College of Anaesthetists, 2006), including delayed mobilization and recovery, cardiac complications, thromboses, pulmonary complications, delayed healing, psychosocial problems and chronic pain syndromes. This article considers pain management in the context of painful wounds. An international comparative survey on wound pain (European Wound Management Association, 2002) found that practitioners in the wound care community tend to focus on healing processes rather than the patient's total pain experience involving an accurate pain assessment and selection of an appropriate pain management strategy. Procedural pain with dressing removal and cleansing caused the greatest concerns. An overview of simple, evidence-based drug and non-drug techniques is offered as potential strategies to help minimize the experience of pain.

  20. How can health care organisations make and justify decisions about risk reduction? Lessons from a cross-industry review and a health care stakeholder consensus development process

    International Nuclear Information System (INIS)

    Sujan, Mark A.; Habli, Ibrahim; Kelly, Tim P.; Gühnemann, Astrid; Pozzi, Simone; Johnson, Christopher W.

    2017-01-01

    Interventions to reduce risk often have an associated cost. In UK industries decisions about risk reduction are made and justified within a shared regulatory framework that requires that risk be reduced as low as reasonably practicable. In health care no such regulatory framework exists, and the practice of making decisions about risk reduction is varied and lacks transparency. Can health care organisations learn from relevant industry experiences about making and justifying risk reduction decisions? This paper presents lessons from a qualitative study undertaken with 21 participants from five industries about how such decisions are made and justified in UK industry. Recommendations were developed based on a consensus development exercise undertaken with 20 health care stakeholders. The paper argues that there is a need in health care to develop a regulatory framework and an agreed process for managing explicitly the trade-off between risk reduction and cost. The framework should include guidance about a health care specific notion of acceptable levels of risk, guidance about standardised risk reduction interventions, it should include regulatory incentives for health care organisations to reduce risk, and it should encourage the adoption of an approach for documenting explicitly an organisation's risk position. - Highlights: • Empirical description of industry perceptions on making risk reduction decisions. • Health care consensus development identified five recommendations. • Risk concept should be better integrated into safety management. • Education and awareness about risk concept are required. • Health systems need to start a dialogue about acceptable levels of risk.