Ana Paula Beck da Silva Etges

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.

A proposed enterprise risk management model for health organizations

Abstract Health care organizations are environments with high management complexity and subject to a constant exposure to risks. Enterprise risk management (ERM) has been studied and applied in different economic environments with the aim of improving organizational performance. However, the health sector still suffers from a lack of attention in this context, in particular with regard to the need for a high degree of financial transparency and for the establishment of process-orientated management, and this provides the motivation for the study described in this paper. An ERM model for health organizations is proposed, based on a systematic literature review and on seven case studies in Brazilian hospitals. An approach to economic risk assessment using indicators such as the cash flow at risk and the variability of costs and receipts from the proposed model is suggested. The health organizations involved in the case studies all interpret ERM as a source of information contributing to corporate governance, and the indicators listed provide constructive data for improvement-driven decision-making. Given the interest expressed by the organizations involved, further application and validation of the proposed model in subsequent studies is suggested.

Activity-Based Costing and Time-Driven Activity-Based Costing for Assessing the Costs of Cancer Prevention, Diagnosis, and Treatment: A Systematic Review of the Literature

BACKGROUND A review of the literature on economic analyses in cancer (prevention, diagnosis, and treatment) using activity-based costing (ABC) or time-driven activity-based costing (TDABC) for measuring costs and to examine how these approaches have been applied to assess and manage cancer costs. METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We conducted a search for studies that used ABC or TDABC to calculate the cost of cancer in prevention, diagnosis, and treatment. Only English- and Portuguese-language articles were retrieved from Medline, Lilacs, ScieLO, and Embase (January 1990 to August 2016). RESULTS In total, 421 studies were evaluated. However, only 27 papers were included. The first publications were from the early 2000s, but most of the studies were published in 2016 (n = 10). Most of the studies were carried out in the United States (n = 6) and Belgium (n = 6). Cancer treatment was the major focus of all studies (n = 20), followed by screening programs evaluations (n = 4) and diagnosis (n = 3). Among treatment modalities, economic analysis of radiotherapy was the most common topic of study. Retrospective clinical data represented 57.6% of the studies. More than 50% of the studies presented unspecified economic analysis. The hospital perspective was the most prevalent perspective among the studies (46.1%). CONCLUSIONS ABC and TDABC economic analyses are a promising area of studies in oncology costs.

Development of an enterprise risk inventory for healthcare

BackgroundThe first phase of an enterprise risk management (ERM) program is the identification of risks. Accurate identification is essential to a proactive and effective ERM function. The authors identified a lack of such risk identification in the literature and in practical cases when interviewing the chief risk officers from healthcare organizations. A risk inventory specific to healthcare organizations that includes detailed risk scenarios and risk impacts currently does not exist. Thus, the objective of this research is to develop an enterprise risk inventory for healthcare organizations to create a common understanding of how each type of risk impacts a healthcare organization.MethodERM guidelines and data from 15 interviews with chief risk officers were analyzed to create the risk inventory. The identified risks were confirmed through a survey of risk managers from a range of global healthcare organizations during the ASHRM conference in 2017. Descriptive statistics were developed and cluster analysis was performed using the survey results.ResultsThe risk inventory includes 28 risks and their specific risk scenarios. Cyberattack was ranked as the principal risk by the participants, followed by sentinel events and risks associated with human capital management (organizational culture, use of electronic medical records and physician wellness). The data analysis showed that the specific characteristics of the survey participants, such as the length of time working in risk management, the size of the organization, and the presence of a school of medicine, do not impact an individual’s opinion of the importance of the risks identified. A personal background in risk management (clinical or enterprise) was a characteristic that showed a small difference in the perceived importance of the risks from the proposed risk inventory.ConclusionsIn addition to defining specific risk scenarios, the enterprise risk inventory presented in this research can contribute to guiding the risk identification phase of an ERM program and thereby support the development of a risk culture. Patient data security in hospitals that operate with high levels of technology is fundamental to delivering high quality and safe care to patients. At the top of the risk ranking, the identification of cyberattacks reflects the importance that healthcare risk managers place on this risk by allocating time and other resources. Exploring opportunities to improve cyber risk management and evaluating the benefits of using the risk inventory at the beginning of the risk identification phase in an ERM program are suggestions for future studies.

Risk management for companies focused on innovation processes

Risk is inherent to the activities of technology and innovation companies and to manage them represent an opportunity to improve the company capability to achieve its goals. The use of ERM models has been studied since the Committee of Sponsoring Organizations of the Treadway Commission guides. This article adapted the MIGGRI model for the context of an innovation company from a TSP in Brazil. Using a case study and a review from previous ERM literature, the article show that is possible to measure the risks that an innovation company faces, and that they may be managed with a view to supporting a company’s strategy. Were applied an economic analysis based on a MCS and an indicator of CFaR were applied to measure innovation risks. A strategic performance model for innovation companies are proposed and the benefit to implement Risk Management practices in innovation organizations was validated.

A systematic review of risk management in innovation-oriented firms

Abstract Innovation and risk are inseparable. In fact, literature on innovation management often recommends that innovation-oriented firms must actively monitor, evaluate, analyze and treat future events in order to mitigate risks whenever possible. This approach is particularly important in emergent economies characterized by unstructured national innovation systems and constant economic and market instability. However, there has been no systematic effort to identify and categorize risks that potentially impact businesses based on innovation. Thus, we propose an interpretative framework of risk events with potential financial impact in innovation-oriented firms constructed and tested by means of a mixed studies review. The risk events were identified through a comprehensive systematic search and review of the published literature on risk and innovation. From the 115 works that were analyzed, it was possible to identify nine categories of risk events frequently associated with innovation-oriented businesses that may generate financial impacts. The proposed interpretative framework was tested in an empirical study with 13 innovation-oriented firms located in six Brazilian technological parks. Results from the empirical study suggest that managers found the proposed interpretative framework complete and comprehensive. Moreover, the empirical study signaled which risk events are more relevant for the Brazilian context. The proposed framework is a first necessary step for future development of ERM models applicable in innovation-intensive contexts.

Diretrizes para a medição de desempenho de processo logístico em uma empresa de sistemas pré-fabricados que adota a filosofia Lean Production

O crescimento acelerado do setor da construcao civil em relacao ao resto da economia brasileira tende a manter seu ritmo de desenvolvimento em constante evolucao. Contudo, o nivel de maturidade dos sistemas de gestao deste setor nao acompanha o mesmo ritmo da elevada demanda de empreendimentos presente no mercado brasileiro. O aumento da competitividade tambem contribui para a especializacao das empresas em processos que viabilizem produtos especificos que atendam as necessidades dos clientes. Neste contexto, surgem as empresas engineer-to-order (ETO) que projetam, fabricam e montam estruturas pre-fabricadas em obra. Este trabalho busca propor diretrizes para o sistema de medicao de desempenho do processo logistico para empresas ETO de sistemas construtivos. O estudo foi realizado em parceria com uma empresa focada no desenvolvimento de sistemas construtivos de estrutura metalica, incluso em um projeto de pesquisa mais amplo que visa o desenvolvimento do seu processo logistico. A analise realizada dos indicadores permitiu a compreensao de alguns pressupostos do sistema de gestao. A falta de conexao entre os indicadores e os objetivos estrategicos demonstrava a falta de transparencia, causando um vies no desenvolvimento de acoes de melhoria. Desta forma, foram propostas cinco diretrizes que buscam facilitar a relacao dos indicadores com os objetivos estrategicos genericos da empresa.