Navigating the Complexities of HSE Enterprise Risk Management: A Guide for Healthcare Professionals

Introduction

Managing risks in healthcare is not just a regulatory requirement but a cornerstone of ensuring patient safety and operational efficiency. Enterprise Risk Management (ERM) emerges as a critical, best practice framework that empowers organisations to foresee, evaluate, and mitigate risks effectively. The Health Service Executive (HSE) has outlined a comprehensive approach to ERM in the HSE Enterprise Risk Management Policy and Procedures 2023.  Their best practice approach is aligned to the ISO 31000:2018 Risk Management – Guidelines.

This article dives into the nuances of the HSE’s Enterprise Risk Management Policy and Procedures, demonstrating how healthcare providers can integrate these principles to enhance their risk management strategies, ensure compliance, and improve overall healthcare outcomes.

What is Enterprise Risk Management (ERM)?

The HSE document states that “Enterprise Risk Management (ERM) in healthcare promotes a comprehensive framework for making risk-based decisions that guide the protection and development of high-quality services and their contribution to improving healthcare outcomes. It enables better management of uncertainty and associated risks and opportunities. In particular, it guides the organisation to address risks comprehensively and coherently, instead of trying to manage them individually.”

ERM is a proactive risk management process that aims to identify and manage risk on an enterprise-wide basis, that is, inclusive of all risks whether to do with management or service delivery processes. Integrating ERM not only assists in complying with stringent regulatory obligations, such as those set by HIQA and the MHC, but also helps to drive improvements in patient care and service delivery.

The Scope of the HSE Enterprise Risk Management Framework

The HSE’s Enterprise Risk Management framework is designed to be comprehensive and adaptable across various levels of healthcare from national health services, including Hospital Groups and Community Health Organisations (CHOs), the National Ambulance Services (NAS) and other national services. This extensive scope ensures that the ERM framework is not only applicable to strategic risks but also operational risks that healthcare entities face daily. Central to this framework is the alignment of local risk policies with the HSE Enterprise Risk Management Policy and Procedure, thereby promoting consistency and ensuring that every unit aligns with broader healthcare objectives.

Key Components of the ERM Process

The Enterprise Risk Management process outlined by the HSE is aligned with the ISO 31000:2018. It consists of several crucial steps:

• Scope, Context, and Criteria: This foundational step involves identifying the internal and external contexts which the HSE and its services must consider when they manage risk.
• Risk Assessment: Risk Assessment involves identifying, analysing, and evaluating risks that could potentially impact the organisation’s ability to achieve its objectives.
• Risk Treatment: This involves identifying controls to manage or mitigate the identified risks.
• Recording and Reporting of Risk: A risk register should be utilised to ensure transparency, accountability, and continuous monitoring of risk management activities across the organisation.
• Communication and Consultation: This stage emphasises the importance of sharing risk-related information across teams, to ensure risks are better understood, systemic risks are identified, and effective plans are developed to manage risks.
• Monitoring and Review: This step ensures that risks recorded in the risk register are subject to ongoing monitoring and that risk treatment measures are effective and adjusted as needed to respond to changing circumstances.

Each of these steps is integral to building a robust Enterprise Risk Management system that not only complies with regulatory requirements but also enhances your organisation’s capacity to deliver safe and high-quality healthcare. For more detail on the HSE ERM process read our blog here.

Roles and Responsibilities in ERM

The effectiveness of an Enterprise Risk Management (ERM) framework significantly depends on the clear definition and distribution of roles and responsibilities among your healthcare organisation’s staff. At the heart of the HSE’s ERM policy is a collaborative approach, where every individual, from board members to front-line staff, plays a crucial role in the risk management process.

Risk roles common to each level of the health service include:

• Risk Owner: The risk owner is accountable for ensuring the risk is managed appropriately including ensuring the correct controls and actions are in place, that actions identified to manage the risk have been assigned to an action owner and a completed date agreed and that that there is notification, escalation or de-escalation of the risk or actions where appropriate.
• Risk Lead: The role of the Risk Lead is to support the Risk Owner by facilitating and advising on the technical aspects of the risk management process.
• Risk Coordinator: The role of the Risk Coordinator is to assist the Risk Owner and Risk Lead with the initial assessment, ongoing review, monitoring and reporting of an individual risk.
• Subject Matter Experts (SME): The role of the Subject Matter Expert (SME) is to assist the Risk Owner and Risk Lead with the initial assessment of the risk by providing expertise on the subject matter of the risk being assessed and following this, to assist the Risk Owner with the risks’ ongoing review and monitoring.
• Action Owner: The Action Owner is accountable to the Risk Owner and is responsible for ensuring delivery of an action assigned to them and reporting on progress relating to the achievement of that action.
• Control Owner: The Control Owner is the person responsible for performing the control. It is the responsibility of the Risk Owner to identify the Control Owner and set a future date to review the control as relevant to the risk to ensure that the control remains effective.

Tools and Techniques for Effective Risk Management

To support the systematic approach to risk management outlined in the HSE’s ERM policy, several tools and techniques are recommended to facilitate the identification, analysis, and monitoring of risks:

• Risk Registers: A dynamic tool that provides a comprehensive view of all identified risks, their risk assessment, and treatments. It serves as a living document or tool that is regularly updated as new risks emerge and old risks are mitigated. For information on HCI’s Risk Register click here.
• PESTLE Analysis: This tool helps in identifying external risks that could impact the organisation by analysing Political, Economic, Social, Technological, Legal, and Environmental factors.
• Bow-tie Analysis: Useful for visualizing the pathways of a risk, from causes to consequences, this tool helps in clearly understanding the risk controls in place and identifying any gaps in risk management.
• Horizon Scanning: An anticipatory tool used to detect early signs of potential threats and opportunities, allowing organisations to prepare better for future risks.

These tools not only enhance your healthcare organisation’s ability to manage risks effectively but also foster a culture of continuous improvement and vigilance against potential threats. By adopting and adapting these techniques, you can strengthen your risk management framework, thereby enhancing your resilience and capacity to deliver safe and effective healthcare services.

Conclusion

Enterprise Risk Management is emerging as a critical component in the healthcare sector, not just to support compliance with regulatory standards but as a cornerstone of high-quality patient care. ERM is beneficial because it provides a holistic view of all risks facing your organisation, rather than managing risks individually within silos. This approach helps you to manage risk proactively and can lead to better resource allocation, strategic planning, improved care, and ultimately, enhanced decision-making and organisational resilience.

As detailed within the HSE Enterprise Risk Management Policy and Procedures 2023, HSE services are required to align their local policies to the ERM. Implementing the ERM framework not only protects against adverse outcomes but also enhances your service’s ability to pursue opportunities with a clear understanding of risk exposure. Embarking on this change can be daunting and time consuming on internal resources. However, HCI is expertly positioned to assist you in reviewing and aligning their local risk policies with the broader HSE Enterprise Risk Management framework. By leveraging HCI’s extensive expertise in policy and procedure development, along with their deep understanding of healthcare regulatory compliance and risk management, HCI can provide invaluable guidance in ensuring that local policies not only meet the necessary standards but also integrate seamlessly with the overarching ERM framework.

For more information on HCI’s Risk Management support services contact info@hci.care or call 01 629 2559.