Enterprise Risk Management Project

Anonymous
timer Asked: Feb 5th, 2019
account_balance_wallet $9.99

Question Description

ERM Project has 2 requirements. You will take on the role of a consulting risk manager for the Phoenix VA Health Care System (PVAHCS) to address the Office of Inspector General’s report. You begin by identifying and analyzing risk issues embedded within a real-world scenario. You will use enterprise risk management (ERM) concepts to create and define implementation strategies for an ERM plan to mitigate and manage the risks identified. Finally, you will recommend a new system model.

Unformatted Attachment Preview

Instructions This worksheet has two parts: 1. A table to collect each OIG allegation and compare to applicable legal, ethical, or regulatory principles 2. A series of questions that will target the issues in the PVAHCS case most relevant in the development of a new enterprise risk management (ERM) plan The information that is gathered in this worksheet will be used to inform two components of the final project: the interim ERM response and the new system challenge. Resources Use the following resources to complete this worksheet: ● Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System ● Enterprise Risk Management: Issues and Cases ● Impact Assessment Framework Part 1. Relevant Legislation or Regulation Allegation analysis table This table will be used to collect the allegations described in the OIG report of the PVAHCS case. For each allegation: ● determine the applicable ethical principles, and legal, or regulatory requirements that may have been violated, and ● consider the extent of these violations, what could have been done to prevent each, and remedial steps that may need to be taken. Compile this information in the notes column. Allegation from OIG Report Ethical, Legal, or Regulatory Violations Morally wrong on the grounds of violating principles of truthfulness, justice, and fairness. Gross mismanagement of VA resources Federal Statutes: Title 5 U.S.C. Section 1213, Provisions Relating to Disclosures of Violations of Law, Gross Mismanagement, and Certain Other Matters. Criminal misconduct by VA senior leadership Morally wrong on the grounds of violating principles of beneficence, nonmaleficence autonomy, Systemic patient safety issues Morally wrong on the grounds of violating principles of beneficence and nonmaleficence Possible wrongful deaths Morally wrong on the grounds of violating principles of beneficence and nonmaleficence Notes Part 2. Probing Questions for ERM Assessment Answer the following questions about the PVAHCS case intended to inform development of the ERM response. 1. Preventing risks through an ERM program. Consider the allegations included in the OIG report. How might an ERM program at the PVAHCS have potentially prevented or immediately mitigated some of these issues? An ERM program at the PVAHCS might have potentially prevented or immediately mitigated some of the issues through key structural elements such as governance (decision-making and authority on the exercise of risks), education, coordination, communication, infrastructure (evidence based processes, determining human capital, labor and technology capabilities), visibility, accountability, and sponsorship (administrative activities). A program as such aims to identify, assess, effectively respond, and continually predict and monitor for risks. 2. Patient safety issues at the Phoenix VA. What patient safety issues does the PVAHCS case illustrate from an ERM, ethical, and legal perspective? ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Patients waiting up to 8 mon ths for mental and physical health treatment Continuity of care Care transitions Delay in assignment to dedicated providers Impaired access to individual and specialized psychotherapies Health-care association infections Incomplete or postponed health evalutions Poor documentation in HER Scheduling delays for primary/follow-up care Cancelliing of necessary appointments without medically indicated reason Inappropriate treatment plans Misdiagnosis Undermanaged and untimely primary care Poor coordination of specialty care Delay in palliative care implementation Poor consult management Prolonged delays between lab test, diagnosis, and treatment Delayed referrals Misinformation regarding benefits Excessive wait times 3. Increasing visibility to patient concerns. How might an ERM program at the PVAHCS have helped give greater visibility to patient concerns about care? An ERM program at the PVAHCS might have helped give greater visibility to patient concerns about care through consciousness-raising, organization-wide communication, continuing education activities, orientation, and in-services. 4. Risk identification. How could the patient concerns and safety issues have been identified earlier? Which risk assessment processes or tools would have been most appropriate? Patient concerns and safety issues could have been identified earlier on had PVAHCS implemented a risk management information system with “real time” data necessary for decision-making and customized reports (near misses). Also, patient account representatives could have vetted some of those concerns as they may come up in conversation during the billing and collection process. Appropriate risk assessment processes or tools would include safety checklists, audits, flowcharts, failure mode evaluation and analysis (FMEA), strength/weakness/opportunity/threat (SWOT) analysis, and political/economic/social/techonological/legal/environmental (PESTLE) analysis. 5. Preventing inaccurate data reporting. Given the allegation that managers were directing staff to report inaccurate data, what oversight and accountability practices measures could be put in place to guard against similar occurrences in the future? Who should be responsible for implementing these practices? Given the allegation that managers were directing staff to report inaccurate data, implementation of both an error disclosure and error reporting policy is a good oversight and accountability practice. The reporting error policy would mandate written and verbal account of unanticipated outcomes to medical staff, senior management, quality control, risk management, board of trurtees, federal and local regulatory compliance agencies, the community, and or professional organizations; while the disclosure policy would suggest voluntary disclosure of medical negligence to patients and families only. Reporting/disclosing errors in this fashion provides opportunity to reduce the errors effects and mitigate the likelihood of future occurences. 6. Assessing the impact of inaccurate data reporting. Using the Impact Assessment Framework, perform an analysis scan of the impact dimensions specifically focused on the Leadership and Culture outcome under the Organization and Workforce dimension. In particular, what impact does the allegation of management directing staff to report inaccurate data have on operations at the PVAHCS? 7. Determining responsibility. Who is ultimately responsible for the allegations in the PVAHCS case? Summarize what leadership principles and practices should have been followed. 8. Identifying impact on VHA patients. According to the OIG Report, up to 40 deaths may have been caused by alleged improper practices at the PVAHCS. What other impacts to patients are anticipated if the current practices continue? 9. Potential risk effects on VHA staff. Describe potential impacts on VHA staff, both those employed in the PVAHCS and throughout the rest of the VHA system. What risks do those effects pose to the VHA system? 10. Impact of allegations on reputational risk. How have these allegations harmed the reputation of the PVAHCS? Is reputational risk a legitimate concern of an ERM program? If so, what should be addressed in the development of an ERM program to proactively anticipate and mitigate this risk? Instructions Use this worksheet to complete Assignment 2. It will be used to analyze effective strategies for risk management and ethical leadership in the VHA Medical Home case and will be used for the first half of the final project, the ERM plan. Resources Use the following resources to complete this worksheet: ● The Veterans Health Administration: Implementing Patient-Centered Medical Homes in the Nation’s Largest Integrated Delivery System ● Enterprise Risk Management: Issues and Cases VHA Medical Home Case Questions 1. Addressing risks. Consider the risks from the case study concerning the implementation of the patient-aligned care team (PACT) model. How could these risks be addressed as part of an ERM plan? Risks from the case study concerning the implementation of the patient-aligned care team (PACT) model could be addressed as part of an ERM plan with a proper framework that easily examines risks, considers interrelation between individual risks, and 2. Identifying strategies. What risk management strategies were used? At what level and how was leadership engaged in implementing those strategies? 3. Risks for implementation. What risks were involved in implementing those strategies (legal, regulatory, ethical, leadership, operational, etc.)? 4. Leadership measures in the VHA Medical Home case. In contrast to the PVAHCS case, what leadership oversight and accountability measures are present in the team-based models in the VHA Medical Home case? How appropriate would the identical measures be for monitoring performance in the PVAHCS case? Leadership measures in the VHA Medical Home case are not benchmarked, instead, they are used only as an evaluation tool, with no accountability. These measures are then focused on patient experience moreso than on cost savings. 5. Increasing visibility to patient concerns. In what ways has the enterprise-wide teambased approach to care management in the VHA Medical Home case helped give greater visibility to patient concerns about care? An ERM program at the PVAHCS might have helped give greater visibility to patient concerns about care through consciousness-raising, organization-wide communication, continuing education activities, orientation, and in-services. 6. Patient safety issues in the VHA Medical Home. What patient safety issues are inherent or explicitly identified in the VHA Medical Home case? Describe what might be the implications of these safety concerns from an ERM, ethical, or legal perspective? ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ ▪ Patients waiting up to 8 mon ths for mental and physical health treatment Continuity of care Care transitions Delay in assignment to dedicated providers Impaired access to individual and specialized psychotherapies Health-care association infections Incomplete or postponed health evalutions Poor documentation in HER Scheduling delays for primary/follow-up care Cancelliing of necessary appointments without medically indicated reason Inappropriate treatment plans Misdiagnosis Undermanaged and untimely primary care Poor coordination of specialty care Delay in palliative care implementation Poor consult management Prolonged delays between lab test, diagnosis, and treatment Delayed referrals Misinformation regarding benefits Excessive wait times 7. Assessing the impact of the transition to team-based operations. Using the Impact Assessment Framework, perform an assessment of all impact dimensions and the transition towards a team-based operational model (e.g., PACT) within the VHA Medical Home cases. 8. Applying risk management principles to the PVAHCS. According to the OIG report, up to 40 deaths may be linked to ongoing practices at the PVAHCS. What practices, implemented in the VHA Medical Home case, would be appropriate to address leadership accountability, ethical, operational, and other risks specific to the PVAHCS case? 9. Risk impacts throughout the VHA. Describe and contrast potential effects on the VHA clinical staff based on the events in the VHA Medical Home case, the PVAHCS system case, and throughout the rest of the VHA system. 10. PACT model impact on reputational risk. Based on the VHA Medical Home case study, describe the following topics: ● Impact the PACT model had on the reputation of the VHA clinics ● Significance of reputation risk within an ERM program ● A recommended measure of effectiveness of the PACT model in relation to reputation. ▪ The PACT model had a positive impact on the reputation of the VHA clinics, bringing competitive advantage in attracting new members, new employees, and retaining of old employees. ▪ The significance of reputation risk within an ERM program ▪ Recommended measures of effectiveness of the PACT model in relation to reputation include o Turnover rate o Dividends and market price per share o Corporate Social Responsibility o Quality awards o Return on Investment Note for Student The worksheet for Assignment 2 is designed to help prepare you for the final project. As such, it helps you achieve the following learning objectives defined for this project (numbers are WGU codes for each objective): ● 3042.1.1-06 Interpret the effectiveness of leadership strategies used by a given organization ● 3042.1.1-08 Analyze ethical leadership principles in a given healthcare system ● 3044.1.2-05 Analyze state and federal risk management legislation and corporate laws in a healthcare setting ● 3044.1.2-10 Identify the role of medical ethics in risk VA Office of Inspector General Veterans Health Administration Review of Alleged Patient Deaths, Patient Wait Times, and Scheduling Practices at the Phoenix VA Health Care System August 26, 2014 14-02603-267 ACRONYMS CBOC CBT COPD CPRS CSTAT CT DBT ED EHR EWL FY GAO HAS HRC HVAC ICD LPN NEAR OEF/OIF/OND OIG PCP PDF PET PSA PTSD PVAHCS RSA SPC VA VAMC VHA VISN VistA VSSC WIG Community Based Outpatient Clinic Cognitive Behavioral Therapy Chronic Obstructive Pulmonary Disease Computerized Patient Record System Consultation Stabilization Triage Assessment Team Computerized Tomography Dialectical Behavioral Therapy Emergency Department Electronic Health Record Electronic Wait List Fiscal Year Government Accountability Office Health Administration Service Health Resource Center House Committee on Veterans’ Affairs Implantable Cardioverter Defibrillator Licensed Practical Nurse New Enrollee Appointment Request Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Office of Inspector General Primary Care Provider Portable Document Format Positron Emission Tomography Prostate-Specific Antigen Post-Traumatic Stress Disorder Phoenix VA Health Care System Replacement Scheduling Application Suicide Prevention Coordinator Department of Veterans Affairs Veterans Affairs Medical Center Veterans Health Administration Veterans Integrated Service Network Veterans Health Information Systems and Technology Architecture Veterans Health Administration Support Service Center Wildly Important Goal The VA OIG Hotline is the responsible office for complaints of fraud, waste, abuse, and mismanagement within the Department of Veterans Affairs. Using the VA OIG Web page, at www.va.gov/oig, will facilitate the processing of your input. Federal regulations require that VA employees must report criminal matters involving felonies to the OIG. Complainants are protected under the Inspector General (IG) Act of 1978, which requires IGs to protect the identity of agency employees who complain or provide other information to the IG. In addition, the IG Act makes reprisal against an employee contacting the IG a prohibited personnel practice. -------------To Report Suspected Wrongdoing in VA Programs and Operations: Email: vaoighotline@va.gov Telephone: 1-800-488-8244 (Hotline Information: www.va.gov/oig/hotline) (This Page Left Intentionally Blank) EXECUTIVE SUMMARY The VA Office of Inspector General (OIG) reviewed allegations at the Phoenix VA Health Care System (PVAHCS) that included gross mismanagement of VA resources, criminal misconduct by VA senior hospital leadership, systemic patient safety issues, and possible wrongful deaths. We initiated this review in response to allegations first reported to the VA OIG Hotline. We expanded our work at the request of the former VA Secretary and the Chairman of the House Committee on Veterans’ Affairs (HVAC) following an HVAC hearing on April 9, 2014, on delays in VA medical care and preventable veteran deaths. Since receiving those requests, we have received other Congressional requests including those submitted by the Chair and Ranking Members of the following Committees and Subcommittees. A complete list of requestors is located in Appendix J.  House Committee on Veterans’ Affairs  HVAC Subcommittee on Oversight and Investigations  House Appropriations Committee  House Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies  Senate Committee on Veterans’ Affairs  Senate Appropriations Committee  Senate Appropriations Subcommittee on Military Construction, Veterans Affairs, and Related Agencies On May 28, 2014, we published a preliminary report, Review of Patient Wait Times, Scheduling Practices, and Alleged Patient Deaths at the Phoenix Health Care System – Interim Report, to ensure all veterans received appropriate care and to provide VA leadership with recommendations for immediate implementation. This report updates the information previously provided in the Interim Report to reflect the final results of our review. We focused this report on the following five questions and identified serious conditions at the PVAHCS and throughout the Veterans Health Administration (VHA).  Were there clinically significant delays in care?  Did PVAHCS omit the names of veterans waiting for care from its Electronic Wait List (EWL)?  Were PVAHCS personnel following established scheduling procedures?  Did the PVAHCS culture emphasize goals at the expense of patient care?  Are scheduling deficiencies systemic throughout VHA? i Due to the multitude and broad range of issues, we assembled a multidisciplinary team comprising board-certified physicians, special agents, auditors, and health care inspectors to evaluate the many allegations, determine their validity, and assign individual accountability if appropriate. The team interviewed numerous individuals to include the principal complainants, Dr. Samuel Foote, a retired PVAHCS physician, and Dr. Katherine Mitchell, the Medical Director of the PVAHCS Operation Enduring Freedom/Operation Iraqi Freedom/and Operation New Dawn (OEF/OIF/OND) clinic. In addition:  We obtained and reviewed VA and non-VA medical records of patients who died while on a wait list or whose deaths were alleged to be related to delays in care.  We reviewed two statistical samples of completed primary care appointments to determine the accuracy of patient wait times based on our assessment of the earliest indication a patient desired care.  We reviewed over 1 million email messages, approximately 190,000 files from 11 encrypted computers and/or devices, and over 80,000 converted messages from Veterans Health Information Systems and Technology Architecture emails. The patient experiences described in this report revealed that access barriers adversely affected the quality of primary and specialty care at the PVAHCS. In February 2014, a whistleblower alleged that 40 veterans died waiting for an appointment. We pursued this allegation, but the whistleblower did not provide us with a list of 40 patient names. From our review of PVAHCS electronic records, we were able to identify 40 patients who died while on the EWL during the period April 2013 through April 2014. However, we conducted a broader review of 3,409 patients identified from multiple sources, including the EWL, various paper wait lists, the OIG Hotline, the HVAC and other Congressional sources, and media reports. OIG examined the electronic health records (EHRs) and other information for the 3,409 veteran patients, including the 40 patients reflected above in PVAHCS’s records, and identified 28 instances of clinically significant delays in care associated with access to care or patient scheduling. Of these 28 patients, 6 were deceased. In addition, we identified 17 care deficiencies that were unrelated to access or scheduling. Of these 17 patients, 14 were ...
Purchase answer to see full attachment

Tutor Answer

ChloeL134
School: Rice University

here we goLemme know in case of anythingAll the best and Goodbye

Enterprise Risk Management

New Systems Challenge

Name

Date

Part A: Healthcare Delivery Model Comparison
1. Complete this section of the template by comparing your hypothetical integrated PVAHCS model with the current nonintegrated Phoenix VHA
model (as described in the OIG report) by addressing each of the following points:

What guidelines are in place for
leadership accountability and
transparency?

Nonintegrated Phoenix VHA
Current Model

Proposed Integrated Phoenix VHA
Future Model

The Office of Management (OM) at PVAHCS offers
operational and strategic leadership in areas such
as cost analysis, budgeting and enterprise
management. It promotes public confidence
through stewardship and providing oversight of all
operations at the facility. The leadership also
examines the compliance of the organization with
the national policy and the different regulations
that govern its operations. The Office of Human
Resource
and
Administration
promotes
accountability and transparency by hiring a
diverse and proficient workforce to lead the
development and implementation of human
capital management strategies. The office strives
to uphold integrity by addressing discrimination
issues and labor-management relations. Another
office is leadership position is the office of the
general counsel which provides legal guidance and
service to PVAHCS and all components of the
organizations to advise them on issues related to
accountability and transparency.
The leaders create a culture of no- blame, which is
the most effective form of promoting
accountability and transparency since the two
aspects start with the leaders. They lead as
examples through integrating a culture of justice

The proposed integrated Phoenix VHA future
model requires the healthcare directors to
implement strategies that would ensure
sufficient information is provided to the
workforce of outpatient medical support
assistance. The Human Resource Management
Service personnel should record accurate hiring,
recruitment and staffing information. The data is
required to be captured, recorded, and
documented how leadership strategies align with
the strategy of the workforce as well as the
clinical operations of the outpatient. The leaders
should promote accountability and transparency
by recruiting and retaining qualified applicants
especially in the positions of the human resource
specialists.

What is the leadership hierarchy
structure?

What resources exist for addressing long
patient waiting lists?

How is care coordinated across
departments (emergency, mental
health, etc.)?

Which key departments and services
need to collaborate to provide optimal
care to veterans?

and fairness which improves the safety of the
patients by empowering the staff to examine their
workplace proactively and take part in safety
efforts in a healthcare setting.
The leadership hierarchy structure did not have
the positions of chief supervisors and service
chiefs. It was characterized by duplication of
services through unnecessary fragmentation. The
organizational structure did not specify the
number of the location of almost 60% of the
outpatient workforce (VA Office of Inspector
General, 2014). This reduced the effectiveness of
monitoring the documentation of information and
the evaluation of the effectiveness of aligning
clinical operations for outpatients.
The existing resources are characterized by
obstacles in the attempts of providing care. This
has adverse impacts on the quality of primary
care.

There was a delay in the coordination between
departments. An example is the delays in the
department of lung cancer and Urology, between
diagnosis and treatment. Poor coordination was
noted in the identification of the symptoms, and
lack of patients’ education and the involvement of
the primary care provider in subsequent
appointments.
The PVAHCS Urology Service did not cooperate
with the Department of Non- VA Coordination.
The staff failed to offer care and overseeing the
timely delivery of urological services to the

The proposed structure includes the positions of
the service chiefs and chiefs’ supervisors to
review the delivery of services. The leadership
structure will be required to maintain functional
statements while ensuring the achievement of
the appropriate ratio in supervisory and
managerial staff positions. The structure will also
specify the locations of all the members of the
workforce to ease monitoring the allocation of
resources at specific clinics and evaluate their
clinical operations.
Necessary resources and facilities for performing
routine and quality assurance review are
recommended. The resources are meant for
scheduling appropriate and randomly selected
appointment schedulers. The funds will also start
the process of monitoring selective calls form
veterans.
The proposed model will strengthen the
coordination between different departments to
improve the delivery of care, patient education,
documentation, patients' screening and
consultant of management.

The proposed model recommended that the
interim director of the PVAHCS to oversee the
timely delivery of urological care to patients and
proper documentation of the clinical information

Which areas or domains (clinical,
operational, leadership, financial,
ethical, other) are most vulnerable?

Who is responsible for bearing the risks
described above?

veterans that were in need (VA Office of Inspector
General, 2014). The leadership lacked a plan to
deliver the urology services at the time when
there was a significant shortage of providers of
these services. They also failed to respond to the
crisis in staffing which led to losing many patients
for follow up. The staffs were frustrated because
they lacked directions.
The domains that were most affected are
leadership and operations. The leadership failed
to account for clinical operations of more than
60% of its outpatient workforce (VA Office of
Inspector General, 2014). The process of hiring
and recruiting the medical support assistants was
not ascertained. This problem was contributed by
the failure of the human resource management
service to record accurate and concise medical
data. The leadership of PVAHCS violated the hiring
metrics.
These challenges impacted the clinical operations,
and eligible applicants could not be ascertained.
The performance of the medical service assistance
was halt and lacked effectiveness in process and
procedure. Besides, there were no efforts to
ensure that services were effectively coordinated.
The human resource service management should
bear the risks by completing accurate recruitment
and hiring records. The service should also utilize
available recruitment and retention strategies.

through Electronic Health Record. The model
also included the collaboration of the interim
director with the Regional Counsel concerning
the necessity of disclosing patients' data to
families especially to patients that had severe
outcomes due to the poor quality of care.

The recommendation for the new model involves
the directors to ensure there is a full
implementation of resources of the facility. The
aim is to allow the leaders to align the workforce
with clinical outpatient operations strategically.
Proper documentation of medical records is
proposed including the hiring information of
medical support assistants, the recruitment and
retention information.

The Veteran Integrated Service Network should
take the risk by allowing the leadership of the
facility to develop strategic plans for merging
the workforce with the clinical operations of the
outpatients.

Part B: Current Phoenix VHA System Analysis
1. Complete this section of the template by discussing which structural characteristics or system failures in the current Phoenix VHAC system
may have contributed to each of the following OIG violations:

OIG Violation
Clinically significant delays in care

The omission of the names of veterans waiting for
care from its Electronic Wait List (EWL)

Noncompliance in following established scheduling
procedures

An organizational culture that emphasized goals at the
expense of patient care

Structural characteristic(s) or System failures
Lack of credibility and sustainable accountability in leadership contributed to
delays in care. The facility launched the office of Accountability Review only after
the global media report that it was providing inaccurate information concerning
the waiting of patients in medical appointments. The lack of flexibility in the
budgeting of the institution also contributed to this chall...

flag Report DMCA
Review

Anonymous
Excellent job

Brown University





1271 Tutors

California Institute of Technology




2131 Tutors

Carnegie Mellon University




982 Tutors

Columbia University





1256 Tutors

Dartmouth University





2113 Tutors

Emory University





2279 Tutors

Harvard University





599 Tutors

Massachusetts Institute of Technology



2319 Tutors

New York University





1645 Tutors

Notre Dam University





1911 Tutors

Oklahoma University





2122 Tutors

Pennsylvania State University





932 Tutors

Princeton University





1211 Tutors

Stanford University





983 Tutors

University of California





1282 Tutors

Oxford University





123 Tutors

Yale University





2325 Tutors