Healthcare supply chain risk management in Rio de Janeiro, Brazil: What is the current situation?

BACKGROUND: Public hospital managers in Rio de Janeiro must deal with severe budget costs, which is the only source of income of public hospitals. In this sense, systematic supply chain risk management can contribute to identifying such risks, assessing their severity, and developing mitigating plans, or even revealing the lack of such plans. Private hospital networks must also map their risks since they are facing a diminishing of demand given that unemployment in Brazil, which is growing in the past years, generates an impossibility of affording private healthcare. OBJECTIVE: The purpose of this paper is to investigate how supply chain risk management is being applied in healthcare supply chains from Rio de Janeiro - Brazil. This study considers supply chains located in the state of Rio de Janeiro. To accomplish this objective, we provide answers to two Research Questions: RQ1 - Is SCRM known as a concept among Rio de Janeiro healthcare supply chains? RQ2 - How are risk identification, risk assessment, and risk mitigation being implemented by companies from the healthcare supply chains in Rio de Janeiro - Brazil? METHOD: Our research design is based on four steps: i) Research design; ii) Case selection: iii) Data collection (11 cases selected); iv) Data analysis. RESULTS: The interviews revealed that SCRM is an entirely unknown concept among healthcare supply chains from Rio de Janeiro - Brazil. Managers have empirical knowledge of the risks, and they can identify the most hazardous risks and can come up with solutions to mitigate them, nevertheless, in many situations they do not have the authority or the manpower to implement the solutions, at most, managers implement local risk mitigation initiatives that do not consider the supply chains broader context. CONCLUSION: The healthcare organizations studied by this paper do not apply SCRM. They only apply local isolated solutions not considering a supply chain scope. This can become hazardous since isolated risk mitigation initiatives are often innocuous and have the potential to generate other risks.

ERM for Health Care Organizations: An Economic Enterprise Risk Management Innovation Program (E2RMhealth care).

BACKGROUND: In recent years, health care organizations have looked to enterprise risk management (ERM) for novel systems to obtain more accurate data on which to base risk strategies. OBJECTIVE: This study proposes a conceptual ERM framework specifically designed for health care organizations. METHODS: We explore how hospitals in the United States and Brazil are structuring and implementing ERM processes within their management structure. This study incorporates interviews with 15 chief risk officers (8 from the United States and 7 from Brazil) with qualitative data analysis using NVivo (QSR International software). RESULTS: The interviews confirm that adopting ERM for health care organizations has gained momentum and become a priority, and that the demand for risk economic assessment orientation is common among health care risk managers. CONCLUSION: We propose an ERM model for health care (Economic Enterprise Risk Management in Health Care) divided into four maturity levels and complemented by an implementation timeline. The model is accompanied by guidelines to orient the gradual implementation of ERM, including orientation to perform risk economic assessment.

Technological iatrogenesis: the manifestation of inadequate organizational planning and the integration of health information technology.

The Institute of Medicine (IOM) views Health Information Technology (HIT) as an essential organizational prerequisite for the delivery of safe, reliable, and cost-effective health services. However, HIT presents the proverbial double-edged sword in generating solutions to improve system performance while facilitating the genesis of novel iatrogenic problems. Incongruent organizational processes give rise to technological iatrogenesis or the unintended consequences to system integrity and the resulting organizational outcomes potentiated by incongruent organizational-technological interfaces. HIT is a disruptive innovation for health services organizations but remains an overlooked organizational development (OD) concern. Recognizing the technology-organizational misalignments that result from HIT adoption is important for leaders seeking to eliminate sources of system instability. The Health Information Technology Iatrogenesis Model (HITIM) provides leaders with a conceptual framework from which to consider HIT as an instrument for organizational development. Complexity and Diffusion of Innovation theories support the framework that suggests each HIT adoption functions as a technological change agent. As such, leaders need to provide operational oversight to managers undertaking system change via HIT implementation. Traditional risk management tools, such as Failure Mode Effect Analysis and Root Cause Analysis, provide proactive pre- and post-implementation appraisals to verify system stability and to enhance system reliability. Reconsidering the use of these tools within the context of a new framework offers leaders guidance when adopting HIT to achieve performance improvement and better outcomes.

Protección social una sombrilla / Social protection... a parasol

El presente artículo hace inicialmente una cordial invitación a asumirlo como un insumo más a la hora de dar la discusión en lo que respecta al montaje del Sistema de Protección Social en Colombia. Plantea el panorama mundial que lleva a proponer al Banco Mundial a través de la OPS/OMS, la formulación de la protección social como la estrategia más poderosa, según ellos, para la reducción de la exclusión social y la injusticia. Describe y analiza las características de la extensión de la protección social en salud y a continuación retoma las principales normas emanadas con dicho fin en Colombia y su aplicación, y en forma simultánea hace el análisis desde el concepto mismo de la protección social en comparación con el de seguridad social, argumentando que se trata de un retroceso conceptual y práctico...

Willingness-to-pay for reducing fatal accident risk in urban areas: an Internet-based Web page stated preference survey.

Contemporary transport project evaluation requires the ability to value reductions in the number of estimated fatal and non-fatal accidents after project implementation. In this quest, we designed a stated preference (SP) experiment to estimate willingness-to-pay (WTP) for reducing fatal accident risk in urban areas. The survey was implemented in a Web page allowing rapid turnover and a complete customisation of the interview. The sample was presented with a series of route choice situations based on travel time, cost and number of car fatal accidents per year. With this data we estimated Multinomial Logit (MNL) and Mixed Logit (ML) models based on a consistent microeconomic framework; the former with linear and non-linear utility specifications and allowing for various stratifications of the data. The more flexible ML models also allow to treat the repeated observations problem common to SP data and, as expected, gave a better fit to the data in all cases. Based on these models, we estimated subjective values of time, that were consistent with previous values obtained in the country, and also sensible values for the WTP for reductions in fatal accident risk. Thus, the Internet appears as a potentially very interesting medium to carry out complex stated choice surveys.

Participatory risk management: promoting physician compliance with practice guidelines.

BACKGROUND: Claims that result from at-risk medical practices, especially those involving medical records and systems failure-related problems, cost significantly more than the average claim to resolve, primarily due to additional defense costs required for expert witnesses. An analysis of these claims areas has pinpointed specific problems that can be addressed and corrected. OBTAINING PHYSICIAN PARTICIPATION IN RISK MANAGEMENT: A participatory risk management program requires all physicians applying for insurance to comply with established general and specialty-specific practice guidelines. Additionally, physicians and their staff receive premium-credit points by attending regularly scheduled continuing education programs on reducing liability risk. If a claim arises in which there is some question about whether the physician followed the guidelines, the circumstances are thoroughly reviewed with the physician after defense of the claim has been completed. Additionally, a medical records consultation program helps individual practices audit their records and identify and correct any at-risk problems. REWARDING PARTICIPATING PHYSICIANS: Based on the success of the program, a new premium program has been instituted in which all physicians are placed in the lowest premium group, but they must participate regularly in risk management activities and avoid adverse actions to maintain the low premium rate.