Risk Management Process and

Enterprise Risk Management

(ERM)

Dr Arjaty Daud MARS

Disampaikan pada Kuliah Program Magister Administrasi RS

Univ Esa Unggul
Semsester 2 - 2016
 Pembahasan
Proses Manajemen risiko
Definisi Enterprise Risk Management
(ERM)
Frame work ERM
Elemen penting dalam ERM
Domain risiko
Area untuk di ases

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Risk Management Process

1. Risk Identification and Analysis

2. Risk Treatment
• Risk Control
• Risk Financing
3. Evaluation of Risk Treatment
Strategies

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 Structure Of The Risk Management Process
Identify/Analyze Exposure Treat the Exposure Through RM Techniques

Risk Risk Analysis Risk Control Risk Financing

Identification + Loss Frequency:
+ Identify the loss How likely is it that
a loss will happen? Risk Avoidance Transfer Retention
+ Loss Severity:
How serious will the Loss Prevention (frequency)
loss be? Non-Insurer Insurer Passive Active
Loss Reduction (severity) Hold A carrier Not Non-insurance
harmless recognize &
Loss Segregation agreements d Self-insurance

Contractual Transfer
Property Net Income Liability Personnel (noninsurance)

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 The Five Steps In The Risk
Management Process

1. Identify loss exposures

2. Examine potential risk management
technique(s)
3. Select risk management technique(s)
4. Implement technique(s)
5. Monitor results

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(ARM)
RISK MANAGEMNT PROCESS
(Standard Australia / New Zealand / AS/NZS)

6
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 Why
a centralized approach to risk management?
• globalization of financial and business
markets, / globalisasi keuangan & bisnis
• continued integration of the insurance
industry, /integrasi industri asuransi
• increased regulation, /meningkatnya regulasi
• greater focus on corporate governance. / lebih
fokus pada tata kelola korporasi
• context of clinical governance and patient
safety / clinical governance & keselamatan
pasien
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Definisi Enterprise Risk Management
(ERM) :
Suatu Proses yg dilakukan oleh BOD
dan manajemen di semua level unit
yang dirancang dalam suatu strategi
Institusi untuk mengidentifikasi
kejadian potensial yang dapat
mempengaruhi Institusi dan mengelola
risiko tersebut untuk pencapaian
tujuan institusi
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 ERM menggunakan pendekatan
fungsi silang untuk ases, evaluasi,
dan mengukur semua risiko
institusi, tidak hanya yang terkait
dengan risiko yang bisa ditransfer
seperti keuangan & risiko hazard

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The traditional six-step risk management process :
1. risk identification,
2. risk analysis,
3. development of alternative techniques to treat risks,
4. selection of best risk-treatment techniques,
5. implementation of selected techniques,
6. monitoring and evaluation of effectiveness of the chosen risk
management techniques and strategies.

ERM expands the process to more fully integrate

risk management into the organization’s structure. / lebih
mengintegrasikan manajemen risiko kedalam struktur
organisasi
This entails an interactive approach to risk identification,
analysis,and treatment through an entrenchment of risk
management principles into corporate operations and strategic
planning./ pendekatan interaktif untuk identifikasi risiko,
analisa & kelola melalui prinsip manajemen riisko kedalam
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operasional korporasi & Renstra
 The ERM Framework
KATEGORI

KOMPONENi

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 Achievement of Objectives
Within the context of an entity’s established mission or vision,
management establishes strategic objectives, selects strategy, and
sets aligned objectives cascading through the enterprise./ Dalam
konteks menetapkan misi atau visi korporasi, manajemen menetapkan
tujuan strategi, memilih strategi, dan menentukan tujuan yang sejalan
dengan korporasi

Framework ERM diarahkan untuk mencapai tujuan

korporasi :
EMPAT KATEGORI
1.Strategic – high-level goals, aligned with and supporting its
mission / tujuan kedepan sesuai dengan misi
•Operations – effective and efficient use of its resources
•Reporting – reliability of reporting
•Compliance – compliance with applicable laws & regulations
.

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Components of Enterprise Risk Management
Enterprise risk management consists of eight interrelated
components. These are derived from the way management runs an
enterprise and are integrated with the management process. / ERM
terdiri dari DELAPAN KOMPONEN saling terkait yang diperoleh
dari cara manajemen mengelola korporasi dan integrasikan
dengan proses manajemen

DELAPAN KOMPONEN ERM :

1.Internal Environment – The internal environment encompasses
the tone of an organization, and sets the basis for how risk is
viewed and addressed by an entity’s people, including risk
management philosophy and risk appetite, integrity and ethical
values, and the environment in which they operate. / Lingkungan
internal meliputi “Tone” organisasi, dan menetapkan dasar
bagaimana risiko dipandang dan ditangani oleh orang2 dlm
Institusi, termasuk filosofi manajemen risiko dan risk appetite,
integritas dan nilai2 etika, dan lingkungan di mana mereka bekerja
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2. Objective Setting – Objectives must exist before management
can identify potential events affecting their achievement.
Enterprise risk management ensures that management has in
place a process to set objectives and that the chosen objectives
support and align with the entity’s mission and are consistent with
its risk appetite. / tujuan harus ada sebelum manajemen bisa
identifikasi event yang mempengaruhi pencapaian mereka. ERM
memastikan bahwa manajemen berjalan utnuk menentukan
tujuan sejalan dengan misi
3. Event Identification – Internal and external events affecting
achievement of an entity’s objectives must be identified,
distinguishing between risks and opportunities. Opportunities are
channeled back to management’s strategy or objective-setting
processes. / event internal & eksternal mempengaruhi pencapaian
tujuan korporasi harus diidentifikasi, bedakan antara risiko dan
peluang. Peluang merupakan alat untuk kembali ke strategi atau
proses untuk menentukan tujuan

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4. Risk Assessment – Risks are analyzed, considering
likelihood and impact, as a basis for determining how they
should be managed. Risks are assessed on an inherent
and a residual basis./ Risiko dianalisa, dihitung peluang
dan dampak, sebagai dasar menentukan mengelola risiko

5. Risk Response – Management selects risk responses –

avoiding, accepting, reducing, or sharing risk –
developing a set of actions to align risks with the entity’s
risk tolerances and risk appetite./ manajemen memilih
respon – tolak, terima, reduksi, atau transfer- buat aksi
untuk menangani riisko sesuai toleransi & risk appetite

6. Control Activities – Policies and procedures are

established and implemented to help ensure the risk
responses are effectively carried out./ kebijakan &
prosedur ditetapkan & diimplementasi utnuk memastikan
respon riisko dilaksanakan dengan efektif
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7. Information and Communication – Relevant information is
identified, captured, and communicated in a form and
timeframe that enable people to carry out their responsibilities.
Effective communication also occurs in a broader sense, flowing
down, across, and up the entity./ informasi yang relevan
diidentifikasi, dikomunikasikan dalam bentuk & jnagkawaktu
yang membuat individu melaksanakan tanggungjawabnya.
Komunikasi efektif juga terjadi sangat luas diseluruh korporasi

8. Monitoring – The entirety of enterprise risk management is

monitored and modifications made as necessary. Monitoring is
accomplished through ongoing management activities, separate
evaluations, or both./ ERM dimonitor & dimodifikasi jika
diperlukan. Monitoring dicapai melalui aktiiftas manajemen
yang berjalan, evaluasi yang terpsah, atau keduanya

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ERM considers activities at all
levels of the organization:

THREE LEVEL :
1. Enterprise-level
2. Division
3. Subsidiary
4. Business unit processes

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 KEY ELEMENTS OF ERM
Risk Strategy •What is your organization’s
ERM strategy?
•How is the ERM strategy
communicated and executed
throughout the company?

Risk Ownership •How does each division / unit

team contribute to meeting
the goals of the ERM strategy?
•How are teams/individuals
held accountable for success?

Risk Identification • What is your organization’s

definition of risk?
• What are your organization’s
top five risks? 19
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Risk Ranking •What are the estimated probability,
time to impact and severi
dimensions for the top five risks?
• What are the financial
consequences to you company?
• Which risks are material?
• How should the identified risks be
prioritized?

Risk Treatment •How are these risk currently

managed?
•Is the approach effective?

Risk Solutions •What risk management processes

are appropriate based upon the
findings of the above elements?
•What action plans should be in
place?
• How are risks monitored?
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 Areas to Assess
Risiko tidak terjadi secara terisolasi (silos)
namun diidentiifkasi secara kelompok dan
dikategorikan dlm Domain Risiko :
1. Operational
2. Financial
3. Human Capital
4. Strategic
5. Legal/Regulatory
6. Technology

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DOMAIN RISIKO :

1.Risiko operasional. timbul dari praktik bisnis

utama organisasi. Dalam organisasi kesehatan,
risiko operasional terkait dengan pelayanan
kesehatan.

2.Risiko keuangan. berhubungan dengan

kemampuan organisasi untuk meningkatkan dan
mempertahankan akses ke modal, masalah
kontrak, biaya risiko, dan evaluasi dukungan
pemasok. Domain ini termasuk risiko memenuhi
syarat untuk risiko pembiayaan, seperti
asuransi.
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3. Risiko modal manusia. kemampuan
organisasi untuk memperoleh, mengelola, dan
mempertahankan pekerja. Kompensasi
pekerja, pekerjaan dan lingkungan bahaya,
omset, absensi, kekerasan di tempat kerja,
pelecehan, dan diskriminasi masuk dalam
domain ini

4. Risiko strategis. Risiko yang berdampak

pada pertumbuhan organisasi. Risiko strategis
termasuk merger, akuisisi, usaha patungan,
dan kewajiban iklan. Selain itu, domain risiko
strategis meliputi risiko reputasi yang terkait
dengan hubungan masyarakat dan ekspektasi
kinerja bagi Arjaty
organisasi oleh pasien dan
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5. Hukum dan peraturan risiko. termasuk risiko
yang terkait dengan aturan yang diamanatkan,
peraturan, UU dan standar. Dalam pelayanan
kesehatan, peraturan dan standar2 ini banyak
dan rumit. Contoh akreditasi dan privasi dan
peraturan keamanan.

6. Risiko teknologi. berhubungan dengan

teknologi baru. Ini adalah domain resiko yang
tumbuh dalam pelayanan kesehatan dan
termasuk perangkat biomedis, telemedicine, obat
elektronik, sistem informasi manajemen risiko
dan teknologi informasi lainnya, dan peralatan
usang
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Areas to Assess
1. Operational risks
2. Financial
3. Human capital
4. Strategic
5. Legal/regulatory
6. Technology

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 Enterprise Risk Management

Operational
Operational

Strategic
Strategic Financial
Financial Human
HumanCapital
Capital

Legal/
Legal/ Technology
Technology
Regulatory
Regulatory
ASHRM
ASHRMHandbook
Handbook 26
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 Enterprise Risk Management
Assessment

Assessment Operational
Model

Technology
Financial

PATIENT /
Legal/Regulatory ORGANIZATION

Human Capital
Strategic 27
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 Areas To Assess:
Operational

 Qualityinitiatives
 Risk management
 Adverse event management
 Board governance

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 Areas To Assess:
A Board’s Legal Risks
Duty to Provide satisfactory
supervise/manage patient care
Select competent Select competent
physicians administrator
Conflict of interests Require competitive
Provide adequate bidding
facilities and Provide safe
equipment environment
Provide adequate Regulatory and
insurance JCAHO compliance
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 Areas To Assess:
Operational

Credentialing and staffing

– Initial appointment
– Reappointment
– Affiliated staff

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 Areas To Assess:
Operational
● Clinical
– Patient communication
– Patient care records
– Confidentiality
– Informed decision making
– Telephone protocols
– Tracking diagnostic information
– Primary care screening and monitoring
– Supervision
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 Areas To Assess:
Operational
● Clinical
– Patient satisfaction/complaints
– Referrals and consultations
– Coverage issues
– Infection control
– Medication safety
– Emergency response
– Patient and staff education

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 Areas To Assess:
Operational
General Liability Assessment Topics
– Safety program
– Security program
– Facility management
Parking (lighting, location, security)
– Visitor control procedures
– Valuables

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 Enterprise Risk Management
Assessment
Assessment
Operational
Model

Technology
Financial

PATIENT /
Legal/Regulatory ORGANIZATION

Human Capital
Strategic
34
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 Areas To Assess:
Financial
Risk Financing Treatments
– Insurance
– Self-insurance
Ability to raise capital
Reimbursement
Billing and collection

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 Areas To Assess:
Financial
 Contract Administration
– Scope of service and method of payment /
ruanglingkup layanan dan metode pembayaran
– Professional services provided / layanan profesional
– Quality expectations / ekspektasi mutu
– Contractual terms
– Termination provisions
– Risk-sharing agreements
– Apparent agency liability
– Hold harmless and indemnity agreements
– Remedies for breach

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 Enterprise Risk Management
Assessment

Assessment
Model Operational

Technology
Financial

PATIENT /
Legal/Regulatory ORGANIZATION

Human Capital
Strategic 37
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 Areas To Assess:
Human Capital
Employment Practices/ Human
Resources Topics
– Workers’ compensation
– Harassment
– Negligent firing
– Discrimination
– Testing
– Background checks
– Grievance procedures
– Confidentiality
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 Areas To Assess:
Human Capital
Employment Practices/Human Resources Topics
– Education
 orientation
 continuing education
 CPR
– Employee health
 exposures
– Employee assistance programs (EAPs)
– Benefits
– Staff rights and staff competency
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 Areas To Assess:
Human Capital

Environmental issues related to

employees
– Safety
– Security
– Occupational hazards
– Environmental hazards

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 Enterprise Risk Management
Assessment
Assessment
Model Operational

Technology
Financial

PATIENT /
Legal/Regulatory ORGANIZATION

Human Capital
Strategic 41
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 Areas To Assess:
Strategic
Strategic plan and mission
– Immediate goals vs. long range goals
Business ventures
– Mergers
– Acquisitions and divestitures
– Joint ventures
Competition’s status
Advertising liability
Reputational risks
– Patient and community relations
– Media relations
– Marketing and sales 42
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 Areas To Assess:
Strategic

New Projects and Services Topics

– “Fit” with existing organization structure
– Identification of insurance needs
– Staff requirements
– Contract needs
– Competitive impacts
– Process development
 Policies/procedures
– Implementation schedules

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 Areas To Assess:
Strategic
Construction/Renovation
– Licenses/permits
– Contracts
– Disruption of services
– Hazards
 Air quality
 Interim and design safety
– Communication issues
– Approvals
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 Enterprise Risk Management
Assessment

Assessment
Model Operational

Technology
Financial

PATIENT /
Legal/Regulatory ORGANIZATION

Human Capital
Strategic 45
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 Areas To Assess:
Legal and Regulatory

Statutes, standards and regulations

– Federal, state and local impacts
Licensure
Accreditation

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 Areas To Assess:
Legal and Regulatory
Corporate Compliance Program/Interface
– Identification of related compliance factors
/ identifikasi faktor terkait kepatuhan
– Compliance assessment results / hasil
asesmen kepatuhan
– Program components - education,
reporting, data maintenance, review,
monitoring
– Relationships

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 Enterprise Risk Management
Assessment

Assessment
Model Operational

Technology
Financial

PATIENT /
Legal/Regulatory ORGANIZATION

Human Capital
Strategic 48
Arjaty Daud/Esa Unggul 2016
 Areas To Assess:
Technology
Information systems
Telemedicine
Equipment
New technologies
Inventory control

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 Areas To Assess
Setting priorities for program development /
buat prioritas untuk pengembangan program
– Utilize information from external and
internal assessment sources / gunakan
informasi dari sumber ekstrenal & internal
– Goals should be:
 Flexible
 Short and long term
– Priorities should be:
 Politically correct
 Financially correct
 Ethically correct
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