Final Project Part 2 Instructions

As outlined in the syllabus we have a course project. We have broken this project into two pieces Project Part 1 (due in module 2) and Project Part 2 (due in module 3). See the schedule and syllabus for more information.

The overall theme of the course project is to create a risk management plan and to think critically about the risk management process. As outlined in the text on page 6, a risk management process involves four steps: 1. Risk identification 2. Risk analysis 3. Risk control/treatment 4. Risk financing

The idea is to put parts 1 and 2 into an assignment in module 2 and then follow-up with parts 3 and 4 in module 3. Part 3 of a risk management plan is Risk Control/treatment.

The textbook defines this as, the organizations response to significant risk areas, as well as its rejoinder to limit the liability associated with incidents that have occurred.1 As a part of a risk management plan the control/treatment of risks is associated with possibly a combination of methods: risk acceptance, exposure avoidance, loss prevention, loss reduction, exposure segregation, and contractual transfer (this includes risk financing). Notice that part 4 risk financing- is considered part of contractual transfer. 2 In Part 2 of the project, we will build on what you have done for Part 1.

In Part 1 you identified potential risks and analyzed the risks for frequency and severity.

In Part 2, you will suggest for each identified potential risk a risk control policy or treatment. The extent to which the policy is appropriate should be a function of your analysis in the part 1 submission. For example, if you said that a particular risk was of a high frequency and a high severity then the suggested controls for such a risk should be more pronounced than if the risk was considered low in frequency and low in severity. Notice that the last process, risk financing, can and should be also considered in assigning risk controls/treatments.

The student is tasked with reviewing this clinical sequence and their initial risk identification/analysis to,

1. Refine the risk identification and risk analysis process (i.e. to include risks not formerly considered in part 1 of this project)

2. Propose a (or more than one if appropriate) risk control policy for each identified potential risk. The proposal of controls should use the analysis of the risk to justify the controls suggested.

3. For each policy proposed, state and justify its assignment to a method (i.e. risk acceptance, exposure avoidance, loss prevention, loss reduction, exposure segregation, and/or contractual transfer) and justify this assignment.

The student must submit this evaluation in a Microsoft Word document in Blackboard. When writing the document, the student should write this assignment like she is presenting a risk assessment report to the CEO of the hospital.

Clinical Sequence

A 53-year-old man with long-standing history of rectal prolapse presented for elective sigmoid resection with rectopexy. The patient underwent a pre-operative surgical office consultation weeks prior to surgery and was apprised of the surgical risks, including bleeding, infection, injury to organs, anastomotic leak, need for temporary (or permanent) ostomy, pain or injury to nerves affecting urinary or sexual function. There was no documented discussion of potential use of an experimental device or the associated risks of such mechanical devices to be utilized during the surgery. A day before the surgery, the patient was admitted for bowel prep. The morning of the surgery, the surgeon again reviewed how the procedure would be performed and described the associated risks. Meanwhile, two representatives of a stapling device vendor requested access to the OR to oversee the trial of a new stapler. The hospitals policy for vendor access to the OR required approval by the Materials Department for use of trial devices, after which the representatives could be provided ID badges for access to the OR suite. In this case, the attending surgeon informed the vendors that they must obtain an ID badge to gain access to the OR without clearly articulating the steps for approval of trial devices. When the vendors returned to the OR with ID badges, the surgeon granted them access to the OR. As the surgeon applied the trial stapler in performing the anastomosis, it closed around the distal sigmoid colon and rectum, but would not re-open. After 45 minutes of trouble-shooting with the vendor representativesincluding replacing batteriesthe surgical team elected to re-open the sigmoid colon and resect the rectum to remove the stapler. During this process, part of the rectum was torn and multiple staples were lost in the operative space. These complications required that the patient undergo a diverted loop colostomy, requiring surgical reversal. The surgeon disclosed this event to the patient, who underwent an uncomplicated recovery and surgical reversal seven months later.