Enterprise Risk Management (ERM) Strategies for Mitigating Key Business Risks
Enterprise Risk Management (ERM) is a crucial strategic discipline that involves prospectively identifying, managing, and mitigating risks to reduce uncertainties and ensure organizational objectives are met. Risk rankings, mitigation strategies, and lead roles are outlined in the SJIEMS 2017 ERM Report, focusing on people, management systems, and financial risks. Key concerns include burnout, structure effectiveness, emergency preparedness, and financial management. By implementing appropriate partnerships, training, policies, and reserves, organizations can address these risks proactively.
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Enterprise Risk Management (ERM) What business risks keep you awake at night? 1
Enterprise Risk Management Plan Enterprise Risk Management is a strategic discipline, a defined ongoing process and a leadership commitment that; 1. Prospectively identifies risks, hazards and errors 2. Determines systemic issues of concern 2. Manages risks to reduce uncertainty 3. Ultimately provides reasonable assurance that the organization s objectives will be met 2
SJIEMS ERM Plan - Risk Ranking Impact Likelihood #1 Rare #2 #3 #4 #5 Unlikely 10-35% Possible 36-65% Likely 66-90% Very likely 90% + Impact Less 10% #1 1 1 2 3 3 Insignificant #2 1 2 3 3 4 Minor #3 2 3 4 4 5 Moderate #4 3 4 4 5 5 Major #5 4 4 5 5 5 Great Vulnerability #1 #2 Low #3 #4 High #5 Plan in place Possible No plan Concern Impact score Vulnerability Low concern 09-14 High concern 15-19 Highest concern 20-25 X score = 3|
SJIEMS t 2017 ERM Report - Risk rankings, mitigation R 25 25 25 25 25 20 16 15 15 14 14 14 P People Risk Mitigation One Team strategies Appropriate partnership between Commissioners and Chief Unclear roles and responsibilities Effective organization structure Burnout and fatigue Avoidable injury, preventable death Loss of key personnel Reductions in EMT pool Commissioner teamwork Commissioner continuing education New commissioner orientation Us and They - EMT and the organization Succession plan 4|
SJIEMS 2017 ERM Report - Risk rankings, mitigation, lead t R 25 25 23 23 22 22 22 20 20 12 12 12 P Management Systems Risk Implementing and sustaining framework Breaking down the barriers to change Embedding in all policies and procedures Training & coaching Behaviors creep ICS and MCI training Communication up, down and all around Response times Disaster preparedness Safety training Mitigation Management Systems Strategies Current operational policies and procedures Current administrative policies and procedures 5|
SJIEMS 2017 ERM Report - Risk rankings, mitigation, lead t R 24 24 22 20 20 20 P Financial Risk Mitigation Financial Strategies Expense creep Contingency reserves Revenue risks; Medicare, valuations, etc. Planned capital reserves CID exposure Clear A/R picture 6|
Framework content The planning process, purpose and objectives Where we are today Where we need to be, how we intent to get there Our Framework Vision and Mission Strategies and Tactics Values Goals, objectives and a dashboard Board guidance, oversight and support 7
Framework for continuous improvement Vision; what we aspire to be in 3 years Mission; our purpose, why we exist Strategies; actions to fulfill mission, achieve vision Values; actions people take that enable success Framework; a picture of organization s direction 8
Framework for continuous improvement We exceed the expectations of our unique Island community DRAFT We serve our community before, during and after an emergency Patient Centric Community Engagement Financial Stewardship One Team Management Systems Respect Trust Commitment Teamwork Safety
Framework for continuous improvement We exceed the expectations of our unique Island community DRAFT We serve our community before, during and after an emergency Patient Centric Community Engagement Financial Stewardship One Team Management Systems Respect Trust Commitment Teamwork Safety
Framework for continuous improvement We exceed the expectations of our unique Island community DRAFT We serve our community before, during and after an emergency Patient Centric Community Engagement Financial Stewardship One Team Management Systems Respect Trust Commitment Teamwork Safety
Culture defined An organization s personality The way we do things around here Engage with the community we serve Board works collaboratively together Board and Chair partner with Chief Chief supports each individual and the team All work together as one EMS team All provide patient care and services 12
Values importance Values do eat strategies for lunch Often largest barrier to best intended strategies Can be your greatest opportunity for success Value statements are just words on wall Behavior actions must demonstrate the commitment When expectations are clear you can select, coach, train, evaluate, recognize & insist on accountability 13
Effective values must Guide how stakeholders work together and provide expected level of care and service Include behaviors that demonstrate the commitment Enable mission accomplishment, vision achievement Support strategies and tactics Address challenges/opportunities Be measurable and coachable Be led and exemplified at the top 14
Trust: we are open and transparent and always act with honesty and integrity. Actions that demonstrate Trust: Actions that undermine Trust: I recognize trust is earned through actions I withhold information I establish clear expectations I have a hidden agenda I am responsible and accountable I blame others I do what I say I say one thing, and do another I act with integrity I say what others want to hear I provide open, timely, effective communication I simply say no without providing a reason I support a respectful work environment I gossip and spread rumors I draw conclusions before facts known I listen, ensure I understand & close the loop I invite and accept feedback I am fair and consistent I honor confidentiality Orca Partners LLC 15
Respect: we show respect for all beliefs, perspectives & contributions Actions that demonstrate Respect: Actions that undermine Respect: I ignore or belittle others I earn respect by demonstrating trust I raise my voice, use rude language I treat others as I want to be treated I interrupt while others are speaking I seek out others input I bully, intimidate and undermine I consider viewpoints and interests of others I use inappropriate behaviors I recognize all have something to add I use inappropriate non-verbal communication I am available and approachable I praise in public I coach in private I honor confidential information Orca Partners LLC 16
Teamwork: we work together and support one collaborative team Actions that demonstrate Teamwork: Actions that undermine Teamwork: I understand I am one voice of many I consider it is us and they I embrace we are one integrated team I focus upon personal interests I support the value of working together I take the position it s not my job/problem I actively participate in teamwork I am close minded I share knowledge and information I complain without offering solutions I identify challenges and offer solutions I appreciate team member input I bad mouth team decisions I disregard team decisions I support the team and my teammates I share my opinions & support team decisions I follow the chain of command Orca Partners LLC 17
Safety: we place safety at the forefront of all the decisions we make Actions that demonstrate Safety: Actions that undermine safety: I am complacent I support 3 to go, 1 to say no I rely on the way its always been done I place safety first in the decisions I make I think I know it all I coach others to place safety first I resist change I plan and organize my work I am concerned about asking for help I embrace continuous improvement I blame others for my performance I ensure I have the right resources I adhere to processes, procedures & practices I wear appropriate safety gear I readily ask for guidance & help when needed I acknowledge and learn from mistakes I am accountable for my work Orca Partners LLC 18
Commitment: we are responsible, accountable and supportive Actions that demonstrate Commitment: Actions that undermine Commitment : I compromise our organization's interests I acknowledge all have areas for improvement I make unreasonable excuses I focus on future challenges and opportunities I am negative and defensive I embrace continuous improvement I disregard policies and procedures I promote our organization s best interest I am indifferent, disengaged and apathetic I am self motivated and persistent I waste resources I demonstrate a positive attitude I am responsible for my personal learning I am fiscally responsible, use resources wisely I self assess my actions I take responsibility for mission readiness Orca Partners LLC 19
Framework for continuous improvement We exceed the expectations of our unique Island community DRAFT We serve our community before, during and after an emergency Patient Centric Community Engagement Financial Stewardship One Team Management Systems Respect Trust Commitment Teamwork Safety
1. Community engagement strategy A task B task A. Establish community engagement programs Lead Goal #1 PRIORITY Identify community stakeholders Lights and Sirens Newsletter - routine updates, once a quarter Establish 2018 Engagement Plan Establish EMS newspaper(s) column for time sensitive updates Make performance metrics public - signage on building, etc. Communicate benefits for residents Utilize patient stories to focus our work Determine frequency and topics for Town Halls - strong interest Explore the use of social media Ask community members to volunteer as a patient for training Open house - interest once in a while #2 PRIORITY B. Explore Collaborative Associate Opportunities Lead Goal North Region EMS SJI fire district Orcas fire/EMS Lopez fire/EMS Shaw fire/EMS Airlift NW and Island Air Sheriff s office Peace Health Community associations 21
2. Patient centric strategy EMS capabilities are often only seen when the team is onsite providing advanced or basic life support. In addition to the critically important onsite work there is a great deal of activity and resources dedicated to before and after an incident, ensuring each 911 call is patient centric and care is efficiently and effectively provided. The strategies and tactics associated with before- during-after a call are being reviewed in depth with respect to the cost/value added of each service. 22
2. Patient centric strategy #1 PRIORITY A. Before an event C. After an event B. During an event ALS training initial 3300 hrs. Advanced Life Support Advanced Life Support UW Med Program OTEP 1/ mon. Advanced wilderness Marine Rescue - WA State Infectious disease ACLS & ACLS XP PALS Neonatal Rescue ATLS SAR Critical Certifications Patient engagement Family engagement Utilize ALS training Assist to ER Fit for jail blood draw Run reviews Quality Assurance Quality Improvement Remedial training Death notification Referral for EMS resources Referral for other services: --DVSAS, CPS, APS, Mental --Health, senior services Patient follow-up BLS training initial 250 hrs. Basic Life Support Basic Life Support Initial EMT course OTEP 2/mon. WEMT Marine Rescue - WA State CPR plus AED ACLS PEARS PHTLS SAR Patient engagement Family engagement Utilize BLS training Assist to ER Assist ALS as needed Run Reviews Quality Assurance Quality Improvement Remedial training Referral for EMS resources Referral for other services Patient follow-up 23
2. Patient centric strategy - continued A. Before an event - con. B. During an event - con. C. After an event - con. ALS & BLS drills ALS Skills ALS & BLS patient assistance Active shooter Skills and abilities MCI Rescue SAR Regulatory checks All BLS plus ALS Advanced airway Flutter valves IV - 10 Cardioversion Advanced medications Family & friend referrals Child care Pet and animal care Transportation arrangements Safety hazards House marker installation ALS & BLS classes BLS Skills FEMA ICS 100, 200, 700 WA State Paramedic WA State EMT Rig checks CPR AED Wound care IV tech Splinting Radio communications Choking Driving ambulance Advanced skills preparation BLS approved medications 24
2. Patient centric strategy - continued A. Before an event - con. B. During an event - con. C. After an event - con. Education - classes in-house Education & Outreach Education & Outreach CPR and 1st aid Wilderness 1st Responder, Aid Wilderness EMT module Infectious disease Safe sitter Advanced Cardio Life Support Pediatric Advanced Life Experienced provider PEARS and PHTLS Poison Board and Box 1st Aid during events Fall prevention 1/1 BP Clinic follow-up Safe Sitter 1/1 Fall prevention 1/1 Car seats and bike helmets Outreach Kid s don t float program Every 15 minutes; driving Fall prevention Blood pressure clinic Safety Fair Touch a Truck Car seats and bike helmets 25
3. One team strategy A task B task #2 PRIORITY Lead Measure A. Continually enhance governance effectiveness Align work with Strategic Framework - build into annual work plan Establish governance role, management responsibility compact Commissioner position descriptions, annual evaluations New commissioner orientation Commissioner continuous learning program #1 PRIORITY B. Align organization structure with Framework Lead Measure Establish a structure renewal team Identify current structure challenges and opportunities Identify current roles and responsibilities Align functions with strategic framework Establish draft organization structure alternatives Align personnel with selected alternative Engage all stakeholders, communicate #1 PRIORITY C. Align roles and responsibilities Lead Measure Superintendent, Chief, opns/admin staff, med staff, medics, EMT s,LT s Establish position descriptions Train and coach Conduct 3 month evaluations in roles Prepare succession plans 26
3. One team strategy A task B task D. Enhance EMT engagement - one team Lead Measure #1 PRIORITY Renew organization structure, with EMT input Establish varied interests, needs and aspirations of each EMT Determine how to build upon diversity to create a collaborate team Establish appropriate resources to enhance and retain the EMT team Develop a program to recruit new EMT s E. Ensure SJI EMS is a competitive, supportive, fun place to work Lead Measure Competitive compensation Reasonable work hours and work shifts Competitive benefits Clear roles and responsibilities Selection policies Evaluation policies Recognition policies Accountability policies Retention policies Training policies Coaching opportunities Safety policy adherence Burn out recognition and support #2 PRIORITY Task priorities TBD 27
4. Management system strategy A task B task A. Support change Lead Measure #1 PRIORITY Be clear about the need Understand the barriers Identify the opportunities Prioritize the work Pick the low hanging fruit Deploy learnings to other priorities #1 PRIORITY B. Implement the strategic framework Lead Measure Prepare visual tools; posters, work area placards, badges? Utilize the framework routinely Make critical decisions with framework in-hand Embed framework components in all policies and procedures Support embedding values with training C. Enhance internal communication effectiveness Lead Measure #2 PRIORITY Determine communication challenges and opportunities Establish a communication policy Utilize the policy routinely 28
4. Management system strategy - cont. A task B task Lead Measure #3 PRIORITY D. Renew critical policies and procedures Incident Command System Contingency planning Disaster preparedness Compliance policies Administration policies #1 PRIORITY Lead Time E. Establish tactics, goals, objectives Review and finalize tactics for each strategy Establish responsibility, goals and objectives for each strategy Establish performance goals and objectives Develop a simple, high level performance dashboard Provide dashboard as a key Board oversight and support tool Go public with you measures and performance 29
5. Financial stewardship strategy A task B task #3 PRIORITY A. Enhance financial reporting system Lead Measure 2017 Budget format for monthly and quarterly reporting - complete Address reconciliation issues with County and State #3 PRIORITY B. Optimize financial partnership Lead Measure Optimize financial partnership Develop performance metrics Establish routine performance reviews C. Pursue revenue enhancements Lead Measure #1 PRIORITY Continue aggressive pursuit of grant programs Other revenue sources Audit billable calls Ground Emergency Medical Transport reimbursement opportunities Community Paramedicine program funding 30
5. Financial stewardship strategy - cont. A task B task #1 PRIORITY D. Pursue operating expense efficiencies Lead Measure Prevent expense creep Labor agreement Civil Investigative Demand management Legal and consulting fees - review contracts and value added Retirement system review - transition to LEAF Conduct an expense comparison to like organizations/services #1 PRIORITY E. Pursue non-operating efficiencies Lead measure Establish operating contingency Accounts receivable - summarize history, current state, expectations Develop five year capital plan Inter Island Medical Center Building - keep pressure on to sell Educate the staff on financial statements Establish the strategic framework resource needs, wants, nice-to-have 31
Framework priorities summary #1 Enhance community engagement Align organization structure with Framework Ensure One Team EMT engagement Clarify roles, responsibilities, accountability Set training priorities, ensure program effectiveness Embed values in daily work Establish patient centric strategic priorities Establish financial reserve Prevent expense creep 32
Framework priorities summary #2 Align Framework and budget Establish operating contingency Maximize revenues, minimize costs, build reserves Pursue collaborative association opportunities Align governance work with Framework Prioritize policy renewal work 33
Framework goals - being developed SJI EMS Operational Key Performance Indicators SJC EMS Key Performance Indicators Education and training Financial performance 34
EMS Dashboard - will be developed Goal Target Time Trend Objective Target Time Trend 35
Orca perspective of EMS organization ... -- Committed -- Shown during planning process --------- Dedicated --------- Demonstrated during very demanding period Really Good/Great To Exceptional 2017-2020 Critical Jan 2016 Stable Aug 2016 Healthy Aug 2017 36
Thanks you for your input Tom Van Dawark Orca Partners LLC 206-786-1127 tom@orcapartnersllc.com 37
Framework report format Introduction; Chief and Board Chair About us Planning process, purpose and objectives Where we are currently; challenges and opportunities Where we re going; Vision and Mission How we re going to get there; Strategies and Values How we measure; Goals, Objectives and Dashboard Resource requirements; Budget, Capital, Reserves Appendices 38
