Replay: Care governance and risk management

As part of a Q&A Series on “A Case Study of Risks from an Outbreak of COVID-19 in a Care Facility” which Marsh is running for Health, Aged and Disability Care organisations as part of our Pandemic Risks Support Hub, below is a summary of the our latest Q&A forum, ‘Care governance and risk management’ which was hosted on 5 May 2020.

Lyle Steffensen, National Practices Leader for Care Solutions at Marsh, interviewed Anthony Black, the Senior Risk Consultant at AnsvarRisk with a background in nursing as a health service executive and risk adviser for the Victorian Government.

Each question and answer below ties to the Marsh Pandemic Response LifeCycle, which can be accessed here.

Anthony Black (AB) also refers to a Pandemic Response strategy for care providers throughout which can be accessed here .

Pandemic lifecycle response phase – Exponential pandemic growth & business interruption

LS: What have been your reflections on governance and risk management throughout the pandemic so far in care sectors?

AB: The care sector has been under the spotlight more recently and there have been negative comments at times when many organisations working through this pandemic are demonstrating solid governance and that needs to be recognised. Prior to the pandemic, it was already not a particularly easy environment in the care sector. There was a lot of regulatory change, royal commissions, difficult workforce challenges, and increases in care complexity. This time has also been a tipping point for many organisations in terms of their financial viability and one element of the recovery will be to quantify the financial impact of the pandemic. This makes for a challenging period. Governance and the adequacy of risk management are constantly being questioned and after this period, it will continue to be scrutinised.

LS: We have received very positive feedback from individual family of residents on how well providers have handled the pandemic so far and the high level of clear communication being provided within their facility, which is counter to many of the negative stories we are seeing in the media. What do you think about how the care industry has responded?

AB: The ability of the sector to respond to guidelines and compliance, manage expectations and deliver care has been extraordinary. The death rates in our country and other advanced economies are incomparable. This also demonstrates how fragile these environments are and it is evident how challenging an outbreak can be once it takes place. The fact that the sector generally has been able to minimise outbreaks and manage these circumstances so well is a credit to it. All care sectors, which likewise have been able to manage difficult circumstances, should be recognised for their efforts.

LS: From your perspective, what has been the focus of pandemic plans for the care sector?

AB: The primary purpose of risk management is about achieving your objectives, not to manage risk in isolation. This is fundamental but it is often lost and in many circumstances, one risk objective dominates the thinking of an organization. The four critical objectives that are the most consistent between organizations are:

• Prevent an outbreak and manage infection prevention controls
• Communicate effectively to stakeholders
• Manage safe and appropriate access, environments and socialisation
• Ensure good governance and compliance

Being clear about your objectives is crucial and in Australia as well as across the world, leaders who talk with clarity, purpose and consistency about their objectives are well regarded.  Organisations need to ensure they are clear about their 3-5 critical objectives that supports their strategy through the pandemic. 

LS: What have you seen are some of the risks and issues that have emerged through the pandemic?

AB: The challenge with the pandemic is that it has occurred at an already difficult risk environment with more risks emerging specific to the pandemic. This means that being compliant during this time is extremely difficult. Governance and compliance is impacted by a number of schemes and directions have been introduced because of COVID-19, such as the national health and emergency plan, the access plan, the disability plan and the code of conduct for care workers which will be introduced shortly. These are additional measures which organisations still need to meet in terms of general compliance requirements as well. It is unknown how the Commissioners (Aged Care Royal Commission and Disability Royal Commission) will assess performance and compliance and whether a retrospective view will be taken on how providers have managed through the pandemic. Care governance has always been a challenge and having an overlay of infectious disease and outbreak management means that those other care elements become increasingly complex. Whilst the focus has been on infection prevention, other care aspects need to have the same line of sight to ensure there has not been a trade off in the standard of care.

LS: It seems like the Government has placed a strong focus on infection prevention so far and that could make organisations de-prioritise other risks. If an organization has infection prevention under control, there are other areas to focus on such as employee wellbeing, and business continuity. What are your thoughts on this?

AB: The whole health pandemic emergency response has been through the lens of a very acute care focus and that has not translated into practice for continuing care very well. The focus on infection prevention and outbreak management is important but the trade-off is chronic illness, and we do not yet know the impact on chronic illness that the pandemic focus has brought. The clinical governance framework is a stress test for an organisation currently and its relevance and applicability will be highly scrutinized. This and other pandemic specific risks and issues are explained further in this PDF.

LS: You have a thought provoking question to ask yourself to care providers. Would you like to expand on this?

AB: An important topic now is the official line versus the official experience, especially concerning the current access-to-facility challenge. Whilst the sector has done well to minimize an outbreak through the strategies implemented, they have also been criticized for taking too strong of an approach. For many organisations, the communication from the government differs from their experiences within the organisation. In organisations that have surveyed residents or families, the majority suggest that the current restrictions should continue to apply. This creates contezt for providers to make decisions on how to proceed. Anita Courtney from Russell Kennedy, who will be interviewed next week on Liability risks arising out of pandemic response, raised an important point around the need to respect the rights and decisions of residents in their home and therefore, if the residents want to continue restrictions, organizations will need to demonstrate how they respect the majority decision.

LS: This comes back to the key standard in the new quality standards about dignity. This is about giving people a choice about dignity in the way they manage their risk and that should not be forgotten.

LS: What are some of the key actions to take from here?

AB: The three key actions an organisation should take are:

1.      Reassess Pandemic Plans

The context has changed too much to assume that what organisations put in place in March will continue to provide success over the coming months. Organisations need to reassess whether their strategies are on track, and make sure their objectives are still correctly aligned with regulatory commitments. They also need to test plans for possible future outcomes such as prolonged pandemic exposure and access plan changes. There are other risks worth considering, so now is a good time for organisations to stop and rethink their plans’ adequacy.

2.      Rethink Risk Communication

Organisations need to communicate their critical objectives to staff and the community about the risks to those objectives. Good communication and an ongoing plan is imperative and will guide an organisation’s recovery.

3.      Seek Guidance on Insurance Cover

Boards and Executive should work closely with their broker and seek a brief to understand the insurance implications of COVID-19.

LS: We had a question about how insurance will respond for COVID-19 related claims particularly D&O insurance. We have just completed a Webinar on how Management Liability insurance (Management Liability is a form of D&O insurance for smaller organisations) works and what it covers, and this question is addressed there .   We have provided to our care provider clients a specific response on where insurance cover is/is not available for each class of cover for COVID-19. If anyone has questions on their cover, they should speak to their broker.

AB: This is the time for organisations to consider post-pandemic recovery plans. There needs to be line of sight to the end and develop a recovery plan that includes the strategic risks that existed before the pandemic. Organisations should also review their current operations, strategies and the effectiveness of their risk management framework to assess what should be done differently and how to develop it further. A “lessons learned” so to speak.

AB: Ansvar have been developing a series of risk alerts, which are available from the website, and they touch on all those actions to give guidance and support. This includes checklists, key things to look for in the pandemic plan and the critical risks to assess against that pandemic plan. These can be accessed here. 

If you have any further questions or feedback, please do not hesitate to contact Lyle Steffensen who will be happy to assist.

Thank you for continuing to provide the level of care to vulnerable persons in our community, we are grateful. 

LCPA number: 20/170