Business Intelligence In Risk Management: A Case Study Of ACME Medical Device Company

Background of current scenario at ACME

Discuss About The Business Intelligence In Risk Management.

ACME Medical Device company, Australia has been providing solutions for medical device and high-tech concepts. This has included from research and developments to manufacturing, packaging and logistics.

A risk management program is conducted at ACME, for recognizing potential issues prior their occurrences. This is helpful such that activities are invoked and planned as required around the life of the project. This mitigates opposite effects on gaining various aims.

The following study is a consultant’s report. This includes risk analysis including various sectors like organizing workshops, distributing minutes and upgrading multiple status reports.

ACME has been undertaking various decisions that have been affecting the safety and health of people in Australia. Any error on their part has been causing irreversible harms to the life of patients. This has lead to costly lawsuits, many damages and tarnishing reputations permanently. However, this has not been challenging enough and ACME has been needed to cope with risks of health information breaches of security, violations of privacy, internal fraud and regulatory non-compliances. Mitigation of those risks has required an active and robust framework of risk management. However, deploying of such structure has been highly involved as the complexity of the organizational hierarchy of an organization is considered. This has included the rise in the number of regulations and risks.

ACME has needed to determine how the risks could be controlled protecting stakeholders and patients instead of draining various costs. Thus the threats are mitigated and identified before their occurrences. Next, whether risk management system can be flexible and sustainable enough for adapting further risks is required to be found out. Finding these queries about risk has been complicated for the success of the risk management program. However, before this, it has been vital to be aware of primary risks and problems related to various operations of ACME.

Risks		Discussion
Patent Security Risks		The health of patients and lives are put at risk as the diseases are misdiagnosed. Further, wrong treatments are prescribed, and various accidents take place in operating rooms. This has been making the moment of laxity, distraction and ignorance causing severe harm to patients and their families (Card & Klein, 2016).
Fraudulent claim risks		This has been taking place in the form of billing for services that are not rendered, and unnecessary treatments and tests are administered with unbundling services of labs. This exhausts health benefits and draining economies.
Documentation Risks		This takes place as there is an error in data entry. This has been expensive and fatal. For example, this includes any wrongly documented dosages of medicines and allergies for specific drugs reversely affecting the health of patients (Cole, Chaudhary & Bang, 2014). The errors in calculation and billing have been resulting in underpayments or overpayments.
IT Risks	Security Breaches	It is seen from the situations of the previous years that rise in the use of information technology has introduced various levels of threats and complexities. Various security breaches like hacking has leading confidential data to fall into the wrong hands. This has been exposing patients to various challenges like public exposure for private information, stolen identities and illegal altering of information.
Malicious attacks	For instance, as the firewalls are not sufficiently secure, the data cannot be traceable or retrieved.
Internal IT fraud	At ACME, different insiders get extensive access to sensitive data and understand where the system has been present (Mohanna & Chambers, 2018).
System Failure	Here for example, as the ER data systems get suddenly disconnected from the core network, doctors of ACME might be unable to see the record of the patient for making vital decisions regarding treatment.
Business continuity	ACME has required staying up and running while different disasters occur. Here the situations might worsen as a load of patient increases.
Regulatory Risks		At ACME, regulatory scrutiny has been intense, and various penalties of non-compliances have been stiff. This has been not regarding fines and also brand impact.
Ethics and risks of integrity		Incidents of easy money prompt like a rejection of patient referral, changing patient records illegally and stealing confidential data leads to these kinds of threats (Edrees et al., 2016).
Health and environmental risks		For instance, infections can seep out and be a full-blown pandemic. For ACME, this spells high economic losses and shutting down of operations.
Risks in leveraging social media		Social media exposes ACME to reputational, legal and regulatory risks. This ranges from data abuse, theft and violations of privacy.

Standards	Discussions
ISO 31000	It establishes guidelines to make risk management efficient and integrate that to the various sectors of ACME.  This includes overall strategy, policies, cultures, values, reporting practices, governances and so on. It is useful to control any kind of risk incredible, transparent and systematic way (Card, 2017).
ISO 9001	Primarily this standard has been concentrating over quality management system. It is helpful to control risks by deploying patient safety culture and proactively managing efficient organizational processes, fast detection, correcting problems and errors and strengthening record management (Blumenthal et al., 2017).
ISO 27799	It provides various guides and set different controls to manage health information security. This is in accordance to the standard of ISO/IEC 27002. Moreover, ISO 27799:2008, is helpful for ACME to secure protection, integrity and confidentiality of health information and decrease risks related to information security breaches (Murphy, 2015).

These are demonstrated hereafter.

The healthcare executives are to be enabled to set a tone at the top efficiently. This must be done by facilitating a collaborative and systematic process to create, review and approve different policies of risk management. Here, the flexibility of underpinning data model must permit risks to be linked clearly with various organizational objectives and corresponding strategies (Card, Ward & Clarkson, 2014). A centralized repository has been enabling systems to get stores, organized and then accessed ineffective convenient and straightforward way. This also provides powers to facilitate awareness and training of procedures and policies and simplify tracking and delivering training.

Primary risks at ACME

ACME must assign various risk management roles and responsibilities from experience and skill sets.     Here the system alerts multiple responsible personnel as soon as the policies get upgraded, different levels of threshold get breached or any remedial action is needed (Wu, Chen & Olson, 2014). This is also helpful to define criteria regarding performance measurements. Besides, the solution has been facilitating effective allocation of managing resources. This has comprised detailed reports of resource utilization. It includes resources requested, assigned resources and budgeted efforts.

Every risk must be mapped closely to similar procedures and policies, compliance regulations, controls, analysis, action plans, issues and standards. Further, it can also be assigned to complex organizational hierarchies. This can be adapted easily to make risk management the integral part of business process and development of a strategy (Kavaler & Alexander, 2014).

A centralized framework is needed to be deployed to define various parameters like methods, responsibilities, criteria, scopes and objectives of risk management. This is also helpful to capture regulatory events and alerts from different sources like CMS and OIG. Then they are to be assimilated by various industry guidelines and best practices that must be embedded. This must include internal policies for ACME to create sound and robust risk management strategy.

The risk management strategy must be made in such a way that an integrated system must be there to determine the full range of risks witnessed by ACME. This must include IT risks, patient safety risks, fraud detection, regulatory risks and documentation risks (Sadgrove, 2016). Every chance must be documented within the centralized library with related and upgraded data as the source, impacting areas, potential outcomes and causes. Thus, the managers of ACME can retrieve a focused and comprehensive view of every enterprise-wide risk.

From configurable algorithms and methodologies, the risk managers must analyse and investigate threats of finding causes, adverse and favorable effects and likelihoods. This makes the impact of taking place. Moreover, it is developed through the ability to analyse risks from different qualitative and quantitative scenarios and factors.

As the risks are prioritized and determined, a flexible framework like COSO must be leveraged for helping managers to implement and define sets of controls. The constant control analysis is supported from checklists and predefined criteria having the mechanism to score and tabulate and report outcomes (Huntink et al., 2015). Here the consequences are stored in a central repository with searching capabilities and easy access. It is helpful for ACME managers to assure that organizational problems stay every time under the limits of acceptable risks.

Discussion of critical risk management standards

Numerous powerful role-based dashboards, heat maps and charts maps within the solution deliver ACME with real-time data over risk management around the enterprise. This involves near-misses, successes, trends, failures, and risk-control analysis. In this way, the managers can consistently keep in touch with progress over programs of risk management, determine changes, learn lessons and recognize rising risks. The abilities of flexible reporting help standard,  various scheduled reports to get created for fetching risk metrics through multiple parameters. This includes status, business units and processes (Runciman, Merry & Walton, 2017). It is helpful for ACME to continually upgrade external and internal stakeholders and help them to know why particular decisions are made. Here, every reports and dashboard are drilled down to access data at more exceptional levels of details. Further, automated alerts for events like failures and exceptions have been eradicating unintended events and making the overall process a predictable one.

Various problems determined while controlling or risk analysis are to be routed flawlessly. This triggers a precise mechanism of remediation and issue investigation. ACME can track the status of issues as they move automatically from one stage to next. It must be reminded that automatic alerts have been keeping processes at a track (Lelardeux et al., 2018). Furthermore, this has been assuring the proper personnel have been addressing issues within time.

A rise in collaboration:

The investigation is helpful to establish an integrated and single framework helping ACME to streamline different end-to-end risk management methods around the healthcare. This can transcend operational and functional silos and facilitate flawless collaboration around locations, departments and processes. In this way, duplicate activities and redundancies are eradicated (Haimes, 2015).

Flexible data model:

The solution is developed over a flexible data model. This must be embedded in the program on risk management to organizational process. This is helpful to map policies, units or departments, controls and procedures helping ACME to deploy a systematic approach to risk management.

The solutions are used to integrate every data regarding risk management in one reusable library of remediation plans, issues, analysis, controls and risks with easy and quick searching abilities.

A rise in accountability:

The solution must help in analysis controls and risks at the process level and additional entity-level individually (Kruse et al., 2017). On the other hand, at the same time, it has been rolling information back upstream to be seen at the enterprise level. This has been giving an overall perspective of the risk profile for ACME and assuring rise in accountability.  

Key capabilities of risk management solution of ACME

Risk intelligence at real-time:

Powerful charts and dashboards have been developing transparency to risks of ACME through delivering real-time data. This includes how risks are controlled around the enterprise. Thus the mangers of ACME can make confident and well-informed strategic decisions.

Rise in cost-efficiency:

The current solution would automate complex risk management workflows. In this, the necessity of significant spreadsheet or any manual process can be eliminated. Thus the resources can be freed up for activities that are value-added regarding risk management (Baddour et al., 2015).

• Flexibility in meeting particular requirements and adapt to the change in business processes.
• Quick implementation with different kinds of escalation paths, alerts, notifications, information flow and configuration forms.
• Various secured web-based access can be generated with proper views. There must also be tans to initiate actions against events and managing to-do lists and different tasks, dashboards and fetching reports.
• A built-in reporting for business intelligence and analytics have a tool for creating custom reports can be emailed. This can be exported to various formats such as Adobe PDF and MA Excel.
• Different executive role-based dashboards must be delivering views of data that can be expertly drilled down.
• Easy integration with various external systems for delivering, storing, and retrieving information.
• Supporting electronic signatures and proper audit trails that are time=spammed regarding regulatory compliances (Coronado & Wong, 2014).

At ACME an integrated Enterprise Risk Management can be effectively deployed. It would look around ACME for risks and embedded in every part of the company. This must also include decision-making process of the organization. It must be reminded that this must not replace ERM. Conventional risk management has been present exclusively within the risk management department. It has been focusing on decreasing risks through secured insurance. This has been more reactive and considering how vital the threat has been regarding meeting higher strategic objectives.

Here, the concept to control uncertainty through developing and protecting values at business and strategic levels has the appeal for risk managers and top leaders at ACME. Thus turning out to be familiar with this integrated innovation has been complicated to know the advantages of their healthcare setting (Goodman et al., 2017).

The commonly referred advantages to adopting the tool have been including increased compliances, resilience to change, effective decision making and quality patient care.  These benefits have been originating from a multitude of ways. Here, for example, ACME can shift from volume-based to value-based payment models. This switching is not easy and merely adjusting various invoicing and payment practices. It has been involving tweaking and overhauling multiple processes and practices stretched around different ERM risk domains. It must be reminded that this has not been a new method of payment (Zadow et al., 2017). This can genuinely refer to as the latest method to care. Hence conserving the view of integrated ERM of the move towards value-based care has been vital. Controlling risks are vacuum has been causing ACME to overlook their complex risks. This has been expensive and refraining from considering risks consisting of high upsides that are even more costly. As ACME has lacked tools, processes, data and mission to consider integrated ERM approach can face greater failure as a form of financial loss and business disruption.

Establishing a Risk Management Policy

The risks to an overall organization, staff and patients have been prevalent in ACME. Hence, it has been needed for ACME for having expert healthcare risk managers. They must analyze, develop, implement and control plans for risk management with the aim of minimizing exposures. Here, various priorities have existed primarily like patient cares. Other priorities involve safety and finance (Shirley, 2016).

The risk managers are to be trained in handling different challenges in numerous settings. Here various duties that are undertaken by risk managers are to be found out ultimately by ACME. Moreover, those professionals must be working typically in multiple areas. This includes emergency preparedness, human and psychological healthcare, clinical research, incident and event management and claim, insurance and financing management.

The managers must evaluate and determine risks as the ways to decrease injury to visitors, staff members and patients under ACME (Olson & Wu, 2015). Further, they must work reactively and proactively for preventing incidents and reduced hazards followed by any event.

Conclusion: 

As a part of overall clinical risk analysis, the above study has highlighted action plans for ACME. This is helpful to implement strategies addressing potential risks. The high action plans help in prioritizing risks, determining immediate steps that are designed for reducing risks and measure whether those strategies has been active. The report has included issues and analyzed solutions and identified the role of project managers responsible for follow-up, tracking, timelines and actions. The study has demonstrated resources helpful to develop processes, policies, best practices, procedures, plans with sample documents and forms. The above comprehensive risk management plans at ACME would facilitate initiatives of patient safety and reducing readmissions. This robust risk management has needed qualified project managers and high-level of preparation for monitoring, implementing and creating ACME’s plan. Moreover, it has been advantageous for complete patient satisfaction and considering bottom-line priorities and healthcare organizations.

References:

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Ensuring Accountability

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