Table 2.
Risk inventory – group and impacts
| Risk impact | |||||||
|---|---|---|---|---|---|---|---|
| Risk | Risk group | Short description | Patient | Financial | Reputation | Legal | Social |
| Board governance – poor communication or lack of direction | Financial | Relationship with shareholders and the board of the organization; transparency in the information and results, capacity to prosecute governance. Mergers and Acquisitions. Conflict of Interest | x | x | |||
| Business Interruption Due to Natural Catastrophe | Operational | Occurrence of internal or external events, which make it impossible for an organization to maintain its critical activities. Natural disasters must be allocated to this event. Earthquake or Hurricane. | x | x | x | ||
| Clinical batch claim | Clinical | With the increase of technologies and multiples techniques applied to patient to treat diseases, the batch claims have increased in size and frequency. Batch claims are frequently related to poor delivery of clinical service. | x | x | x | x | |
| Conflicts due to organizational hierarchy | People | Responsibilities, leadership and respect among the employees and functions. The relationship between the decision-making process and hierarchy. The medical hierarchy needs to be balanced in favor of teaching, learning and patient safety rather than the exercise of power (WALTON, 2006). | x | ||||
| Cyber security | Information Technology | Invasion of an internal or external hacker that causes damage to the information security of the organization or its operational capacity. The use of ransomware is frequently present. | x | x | x | x | x |
| Deficiency in development of technology and innovation | Clinical | Lack of technologic innovation or development of innovations that do not meet the organization’s needs. It is related organization’s ability to possess, dominate and use technological resources that have an effect on its operations. Effects on the quality of clinical procedures and patient experience, as well as valuation of the institution towards insurers can be perceived. | x | x | x | ||
| Dependence on insurance companies | Financial | Negotiations with one health insurance company that accounts for 30% of the billing. The insurance company wants to reduce reimbursements for many medical tests and procedures. | x | x | |||
| Dispute with insurance companies on reimbursements | Financial | An insurance company disputes the drugs, devices, or procedures used by the providers and hospital. The insurance company denies coverage. | x | x | x | ||
| Electronic Health Record (EHR) | Information Tecnology | Difficulty in obtaining information due to error in communication, loss of processing power or difficulty in operating the Hospital’s system. | x | x | |||
| Environment Protection Agency or similar | Compliance | Government agency comes to investigate and fines the hospital or a department of the hospital. | x | x | x | x | x |
| External media communication | Information Tecnology | Healthy external marketing and media communication about the hospital and close relations. Organizational information being shared before the formal process and department of the hospital. The information timing can’t be the correct, or the information credibility can cause future problems. | x | x | x | ||
| Financial batch claim emanating from reimbursement reform | Political | Financial risk for healthcare organizations associated with bundled services or healthcare outcomes. | x | x | x | ||
| Fraud committed by a provider | Financial | Insurance plan fraud committed by a doctor or a group of doctors through prescriptions. In addition, important medicines or equipment stolen from the hospital can also be considered like a fraud. | x | x | x | x | x |
| Government instability | Political | Reduction in the country’s healthcare budget | x | x | x | ||
| Loss of accreditation | Compliance | Loss of an important certification or accreditation. | x | x | x | x | |
| Non-compliance with laws and regulations | Compliance | A clinical trial is taking place without the proper Institutional Review Board (IRB) approval. Patients die while part of the research. | x | x | x | x | x |
| Loss of Occupational Safety and Healthcare Administration (OSHA in USA) | Compliance | The effect that working laws represent in how employees are being contracted. Any change in the formal orientations represent an effect for the hospital management. | x | x | x | ||
| Organizational culture | People | The healthcare organization needs to be able to share and implement its culture among all the employees. New and old employees need to work conducted by the same values and principles independently of their own religion or origins. | x | ||||
| Physician wellness | People | 50% rate of burnout amongst physicians discovered after taking a physician wellness survey that measures burnout and professional fulfillment. | x | x | x | ||
| Relation between the School of Medicine or Residency program and hospital | Clinical | Interface between the SoM and the health service that may lead to interference of the university model to the business or, on the other hand, value the institution due to the teaching quality. | x | x | x | ||
| Active Shooter | Operational | Assault and active shooter threats to patients, families and hospital employees. | x | x | x | x | |
| Sentinel events | Clinical | Sentinel events, near miss events, incidents or medical error that can cause lawsuit. | x | x | x | x | |
| Supply chain | Operational | Materials and equipment control and management. Political problems with countries that supply resources for hospitals. | x | x | x | ||
| Talent retention | People | Loss of a team of providers that are specialized in certain types of procedures. It can happen in function of bad recruitment processes, or bad human resources management. | x | x | x | x | |
| Terrorism | Political | Terrorism attack close to the hospital. | x | x | x | x | x |
| Unethical conduct | Operational | Problems related with unethical employee conduct whether or not involving patients. Personal information, images or objects can be used without the approval of patient. Internal problems between employees can result in organization impact. | x | x | x | x | x |
| Union strike | Political | Union strikes among different classes of employees that can affect the hospital capacity to be operated. | x | x | x | x | |
| Use of social communication networks | Information Tecnology | Problems with confidential information being communicated through social media. A VIP: executive, actor, etc. Information is released on Facebook, what’s app or other. | x | x | x | x | |
| Total/impact | 26 | 22 | 18 | 15 | 15 | ||