Building a Speaking Up culture: Risk management in hospitals

We speak to Ms Pang Nguk Lan, Chief Risk Officer of KK Women’s and Children’s Hospital in Singapore, about the role that risk management plays in a healthcare organisation.

Many in Singapore would still remember the SARS outbreak in 2003, which infected 238 people and claimed 33 lives, according to Singapore’s health ministry. It was perhaps the first major viral disease outbreak in decades in the small city state; and it brought to light the importance of emergency planning and risk management in the healthcare sector.

A comprehensive response plan would require preparations on many fronts. A host of considerations – from the type of infrastructure needed, the capacity of the healthcare facilities, to the supply chain of medical supplies and the chain of communications between the health ministry and the individual hospitals, amongst others – would have to be made for a robust coordinated effort that would effectively contain any outbreaks. Although the scale of the COVID-19 pandemic is unprecedented, the plans developed and refined in the wake of SARS have helped to serve as a basis for the country’s response to COVID-19.

The role of risk management in hospitals

“The risk management function in the healthcare sector was established quite recently, maybe in the past two decades, and thus perhaps not many people realise the opportunities and benefits it brings,” said Ms Pang Nguk Lan, Chief Risk Officer at KK Women’s and Children’s Hospital (KKH).

The level of risk is high in the healthcare setting, where clinical treatment procedures all carry a level of risk of potential adverse events that can cause harm to patients. The risk management role is hence critical in looking at ways to mitigate these risks and help ensure the highest level of quality patient care.

In addition, in today’s context, hospitals have had to evolve quickly to the substantial changes in the wider environment. The COVID-19 pandemic has dealt a financial impact to hospitals around the world, and many have begun their digital transformation initiatives or incorporated digital health technologies in their operations. With all these changes happening at a rapid pace, there are increased complexities to be managed, for example to ensure that staff are on-board with adopting the new technologies. Risk Officers thus have to anticipate the possible issues and implications, then assist the organisation in adapting to the changes, without compromising on the level of care and service.

mrs pang
Mrs Pang Nguk Lan

Key elements in a risk management plan

Ms Pang sees her role as ensuring that effective risk management policies are in place, including setting up systems and processes to identify potential risks and mitigate them, in addition to establishing a strong risk management culture in the hospital.

She highlighted that in KKH, there is a strong risk awareness and reporting culture, where staff members proactively alert the Quality, Safety and Risk Management (QSRM) department on potential risk areas discovered in their day-to-day work, and suggest improvements or seek advice on control measures that can be put in place. Rather than looking at these risk areas merely as problems, these are regarded as opportunities to work collaboratively to improve.

In building this culture, the hospital holds the ‘Speak Up for Safety’ training programme for all its staff, aimed at encouraging staff to voice any safety concerns they notice. Commitment from the hospital’s management was crucial. Underpinning the psychological safety aspect for staff to speak up, senior leaders filmed videos assuring staff that all concerns will be heard. The hospital’s Risk Reporting System also encourages supervisors to highlight the importance of reporting near-incidents to their staff, as concerns gone unreported or unnoticed may lead to serious consequences in the future.

Besides a risk management culture, Ms Pang listed strong governance, in the accountability and reporting of risk issues, and comprehensive data collection as other key elements in a robust risk management system. The QSRM accesses a dashboard of data sets, which enables them to look out for, anticipate and respond to trends.

Building trust and buy-in

The feedback from KKH staff was that they are now more proactive in voicing their views on care management with each other or with the doctors in their teams. With more open sharing of opinions, there is a greater sense of collaboration both within and between the care teams that can include multiple disciplines.

Ms Pang shared that the buy-in from the staff in adopting a risk management mindset was demonstrated in the hospital’s COVID-19 workplace safety compliance. In ensuring compliance with the workplace safety management measures laid out by the health ministry (such as the 1m safety distance between each individuals, and wearing of protective gear appropriate to their work setting), the hospital had appointed risk management representatives in each department to communicate these measures and check that they are adhered to. She noted that checks so far, including audits conducted by the SingHealth cluster, have indicated full compliance by hospital staff. She attributes this to the staff’s trust and buy-in into the safety measures – as they understand the rationale behind these measures, which are designed to keep patients, themselves and their families safe; they are thus more inclined to practise them.

A risk-conscious staff base will be invaluable to any healthcare organisation, as they constantly seek ways to mitigate risks in their own work areas, and work together as an organisation to co-create solutions. In today’s fast-evolving world, implementing or strengthening risk management in hospitals should no longer be an option, but a priority.