This is the first in a series of articles for EMS managers from MONOC Mobile Health Services. MONOC is New Jersey's largest provider of EMS and medical transportation and its first CAAS-accredited agency. The goal of this series is to provide insight and solutions for the different managerial and operational challenges facing the EMS leaders of tomorrow. For more, see www.monoc.org.
There is risk in everything we do. There is risk in ambulance operations, both 9-1-1 and nonemergency services, each having their own peculiarities. The goal of any risk management program is to reduce an agency's exposure to risk and provide a safe environment for its employees, visitors and patients. The results of a well-functioning risk management plan should be a reduction in hazards that add to the bottom-line costs of doing business and protection of the physical and financial assets of the organization.
The five steps to any risk management process are:
- Identifying the risk;
- Quantifying the risk potential;
- Prioritizing the risk;
- Implementing controls and mitigation strategies;
- Evaluating and revising the process.
One of the first steps in risk management is to identify the risks faced, also know as exposures. The simplest way to do this is to make a list of potential problems in each section of the company. Include all departments--billing, operations, communications and administration. Examine incident reports and quality assurance audits. Talk with your insurance carriers, as they have developed a risk profile for you and used the data to determine your rates.
Risk assessment takes into account two dimensions: the probability of an occurrence (frequency) and its impact on the work environment and employees (severity). In other words, how often can it happen, and how bad can it be? To consider these questions, utilize the following scales:
Frequency: How often will it happen?
- Very often: A near-certainty to occur;
- Often: May occur regularly or periodically;
- Not often: Rare, or unlikely to occur;
- Almost never: Zero or near-zero probability.
Severity: What happens if it happens?
- Catastrophe: Death or permanently disabling injury or loss of work facility;
- Serious consequences: Severe debilitating injury or interruption of operations;
- Moderate impact: Significant injury or illness requiring more than first aid;
- Minor impact: bNo injury, lost work time or interruption of work.
Construct a simple table like Table 1 and enter each risk into the appropriate section. Focus first on those categorized as high frequency/high severity, as these will have the greatest financial impact on your agency. Typically, you will find motor vehicle collisions, worker's comp cases, stretcher drops, patient injuries and lawsuits in this section.
Once issues have been identified, the risk manager, in conjunction with the rest of the management team, needs to develop mitigation strategies. These can include both pre- and post-loss activities. Pre-loss strategies include development of protocols that will define the system's standard of care by detailing things like how operations are to be conducted. This may include driving standards, dispatch protocols, hiring practices and clinical competency standards. Operations and clinical departments should attempt to track infectious-exposure reports, incident reports, customer complaints, protocol violations, medication errors, near-miss events and equipment malfunctions. Work to identify trends and patterns to predict future occurrences. As an example, there may be several complaints from crew members that the safety devices on the angiocatheters do not lock closed, resulting in potential needlestick exposures.