719 resultados para clinical risk management


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Enterprise Resource Planning (ERP) projects are strategic and capital intensive, so failure may be costly and even cause bankruptcy of companies. Previous studies have proposed ways for improving implementation, but they are mostly generic and follow standardized project management practices as specified in various standards (e.g. the “project management body of knowledge” of the Project Management Institute). Because ERP is interdisciplinary (involving change management, project management and information technology management), it warrants a customized approach to managing risks throughout the life cycle of implementation and operation. Through a practical case study, this paper demonstrates a qualitative, user friendly approach to ERP project risk management. Firstly, through a literature review it identifies various risk factors in ERP implementation. Secondly, the risk management practices of a UK-based multinational consulting company in one of its clients are evaluated. The risk factors from the case study organization and literature are then compared and discussed.

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The main purpose of the study is to develop an integrated framework for managing project risks by analyzing risk across project, work package and activity levels, and developing responses. Design/methodology/approach: The study first reviews the literature of various contemporary risk management frameworks in order to identify gaps in project risk management knowledge. Then it develops a conceptual risk management framework using combined analytic hierarchy process (AHP) and risk map for managing project risks. The proposed framework has then been applied to a 1500 km oil pipeline construction project in India in order to demonstrate its effectiveness. The concerned project stakeholders were involved through focus group discussions for applying the proposed risk management framework in the project under study. Findings: The combined AHP and risk map approach is very effective to manage project risks across project, work package and activity levels. The risk factors in project level are caused because of external forces such as business environment (e.g. customers, competitors, technological development, politics, socioeconomic environment). The risk factors in work package and activity levels are operational in nature and created due to internal causes such as lack of material and labor productivity, implementation issues, team ineffectiveness, etc. Practical implications: The suggested model can be applied to any complex project and helps manage risk throughout the project life cycle. Originality/value: Both business and operational risks constitute project risks. In one hand, the conventional project risk management frameworks emphasize on managing business risks and often ignore operational risks. On the other hand, the studies that deal with operational risk often do not link them with business risks. However, they need to be addressed in an integrated way as there are a few risks that affect only the specific level. Hence, this study bridges the gaps. © 2010 Elsevier B.V. All rights reserved.

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Purpose – The UK has experienced a number of flood events in recent years, and the intensity and frequency of such events are forecast to further increase in future due to changing climatic conditions. Accordingly, enhancing the resilience of small and medium-sized enterprises (SMEs) – which form an important segment in a society – to flood risk, has emerged as an important issue. However, SMEs often tend to underestimate the risk of flooding which tends to have a low priority in their business agenda. The purpose of this paper is to undertake an investigation of adaptation to the risk of flooding considering community-level measures, individual-level property protection, and business continuity and resilience measures. Design/methodology/approach – A total of four short case studies were conducted among SMEs to identify their response to flood risk, and what measures have been undertaken to manage the risk of flooding. Findings – It was observed that SMEs have implemented different property-level protection measures and generic business continuity/risk management measures, based on their requirements, to achieve a desired level of protection. Practical implications – SMEs are likely to positively respond to property-level adaptation following a post-flood situation. It is important that information such as costs/benefits of such measures and different options available are made accessible to SMEs affected by a flood event. Social implications – Implementation of property-level adaptation measures will contribute towards the long term adaptation of the existing building stock to changing climatic conditions. Originality/value – The paper contributes towards policy making on flood risk adaptation and SME decision making, and informs policy makers and practitioners.

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Purpose – This paper aims to explore the nature of the emerging discourse of private climate change reporting, which takes place in one-on-one meetings between institutional investors and their investee companies. Design/methodology/approach – Semi-structured interviews were conducted with representatives from 20 UK investment institutions to derive data which was then coded and analysed, in order to derive a picture of the emerging discourse of private climate change reporting, using an interpretive methodological approach, in addition to explorative analysis using NVivo software. Findings – The authors find that private climate change reporting is dominated by a discourse of risk and risk management. This emerging risk discourse derives from institutional investors' belief that climate change represents a material risk, that it is the most salient sustainability issue, and that their clients require them to manage climate change-related risk within their portfolio investment. It is found that institutional investors are using the private reporting process to compensate for the acknowledged inadequacies of public climate change reporting. Contrary to evidence indicating corporate capture of public sustainability reporting, these findings suggest that the emerging private climate change reporting discourse is being captured by the institutional investment community. There is also evidence of an emerging discourse of opportunity in private climate change reporting as the institutional investors are increasingly aware of a range of ways in which climate change presents material opportunities for their investee companies to exploit. Lastly, the authors find an absence of any ethical discourse, such that private climate change reporting reinforces rather than challenges the “business case” status quo. Originality/value – Although there is a wealth of sustainability reporting research, there is no academic research on private climate change reporting. This paper attempts to fill this gap by providing rich interview evidence regarding the nature of the emerging private climate change reporting discourse.

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These case studies from CIMA highlight the need to embed risk management within more easily understood behaviours, consistent with the overall organisational culture. In each case, some form of internal audit team provides either an oversight function or acts as an expert link in that feedback loop. Frontline staff, managers and specialists should be completely aligned on risk, in part just to ensure that there is a consistency of approach. They should understand instinctively that good performance includes good risk management. Tesco has continued to thrive during the recession and remains a robust and efficient group of businesses despite the emergence of potential threats around consumer spending and the supply chain. RBS, by contrast, has suffered catastrophic and very public failures of risk management despite a large in-house function and stiff regulation of risk controls. Birmingham City Council, like all local authorities, is adapting to more commercial modes of operation and is facing diverse threats and opportunities emerging as a result of social change. And DCMS, like many other public sector organisations, has to handle an incredibly complex network of delivery partners within the context of a relatively recent overhaul of central government risk management processes. Key Findings: •Risk management is no longer solely a financial discipline, nor is it simply a concern for the internal control function. •Where organisations retain a discrete risk management cadre – often specialists at monitoring and evaluating a range of risks – their success is dependent on embedding risk awareness in the wider culture of the enterprise. •Risk management is most successful when it is explicitly linked to operational performance. •Clear leadership, specific goals, excellent influencing skills and open-mindedness to potential threats and opportunities are essential for effective risk management. •Bureaucratic processes and systems can hamper good risk management – either as a result of a ‘box-ticking mentality’ or because managers and staff believe they do not need to consider risk themselves.

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Advances in our understanding of pathological mechanisms can inform the identification of various biomarkers for risk stratification, monitoring drug efficacy and toxicity; and enabling careful monitoring of polypharmacy. Biomarkers in the broadest sense refer to 'biological markers' and this can be blood-based (eg. fibrin D-dimer, von Willebrand factor, etc) urine-based (eg. thromboxane), or even related to cardiac or cerebral imaging(1). Most biomarkers offer improvements over clinical risk scores in predicting high risk patients - at least statistically - but usually at the loss of simplicity and practicality for easy application in everyday clinical practice. Given the various biomarkers can be informed by different aspects of pathophysiology (e.g. inflammation, clotting, collagen turnover) they can nevertheless contribute to a better understanding of underlying disease processes(2). Indeed, many age-related diseases share common modifiable underpinning mechanisms e.g. inflammation, oxidative stress and visceral adiposity.

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Failure to detect patients at risk of attempting suicide can result in tragic consequences. Identifying risks earlier and more accurately helps prevent serious incidents occurring and is the objective of the GRiST clinical decision support system (CDSS). One of the problems it faces is high variability in the type and quantity of data submitted for patients, who are assessed in multiple contexts along the care pathway. Although GRiST identifies up to 138 patient cues to collect, only about half of them are relevant for any one patient and their roles may not be for risk evaluation but more for risk management. This paper explores the data collection behaviour of clinicians using GRiST to see whether it can elucidate which variables are important for risk evaluations and when. The GRiST CDSS is based on a cognitive model of human expertise manifested by a sophisticated hierarchical knowledge structure or tree. This structure is used by the GRiST interface to provide top-down controlled access to the patient data. Our research explores relationships between the answers given to these higher-level 'branch' questions to see whether they can help direct assessors to the most important data, depending on the patient profile and assessment context. The outcome is a model for dynamic data collection driven by the knowledge hierarchy. It has potential for improving other clinical decision support systems operating in domains with high dimensional data that are only partially collected and in a variety of combinations.

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Risk management in healthcare represents a group of various complex actions, implemented to improve the quality of healthcare services and guarantee the patients safety. Risks cannot be eliminated, but it can be controlled with different risk assessment methods derived from industrial applications and among these the Failure Mode Effect and Criticality Analysis (FMECA) is a largely used methodology. The main purpose of this work is the analysis of failure modes of the Home Care (HC) service provided by local healthcare unit of Naples (ASL NA1) to focus attention on human and non human factors according to the organization framework selected by WHO. © Springer International Publishing Switzerland 2014.

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Analysis of risk measures associated with price series data movements and its predictions are of strategic importance in the financial markets as well as to policy makers in particular for short- and longterm planning for setting up economic growth targets. For example, oilprice risk-management focuses primarily on when and how an organization can best prevent the costly exposure to price risk. Value-at-Risk (VaR) is the commonly practised instrument to measure risk and is evaluated by analysing the negative/positive tail of the probability distributions of the returns (profit or loss). In modelling applications, least-squares estimation (LSE)-based linear regression models are often employed for modeling and analyzing correlated data. These linear models are optimal and perform relatively well under conditions such as errors following normal or approximately normal distributions, being free of large size outliers and satisfying the Gauss-Markov assumptions. However, often in practical situations, the LSE-based linear regression models fail to provide optimal results, for instance, in non-Gaussian situations especially when the errors follow distributions with fat tails and error terms possess a finite variance. This is the situation in case of risk analysis which involves analyzing tail distributions. Thus, applications of the LSE-based regression models may be questioned for appropriateness and may have limited applicability. We have carried out the risk analysis of Iranian crude oil price data based on the Lp-norm regression models and have noted that the LSE-based models do not always perform the best. We discuss results from the L1, L2 and L∞-norm based linear regression models. ACM Computing Classification System (1998): B.1.2, F.1.3, F.2.3, G.3, J.2.

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The aim of this paper is to explore the management of information in an aerospace manufacturer's supply chain by analysing supply chain disruption risks. The social network perspective will be used to examine the flows of information in the supply chain. The examination of information flows will also be explored in terms of push and pull information management. The supply chain risk management (SCRM) strategy is to assess the management of information that allows companies to gather information which will allow them to mitigate that risk before any disruption to the supply chain occurs. There is a shortage of models in analysing the supply chain risk associated with information flows, possibly due to the omission of appropriate modelling techniques in this area (Tang and Nurmaya, 2011). This paper uses an exploratory case study consisting of a multi method qualitative approach using fifteen interviews and four focus groups.

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The current platform of conventional cardiovascular risk assessments tends to forsake the importance of endothelial function - a key biological mechanism by which cardiovascular risk factors exert their propensity for adverse vascular events. Moreover, the presence and severity of endothelial dysfunction in ‘low-risk’ individuals suggests considerable variability in pre-clinical risk that could potentially be detected well before the onset of disease. The aim of the present thesis was to investigate the presence and impact of retinal vascular dysfunction, as a barometer of endothelial function, in otherwise healthy individuals with one or more cardiovascular risk factors, but low to moderate cardiovascular risk. Systemic circulatory influences on retinal vascular function were also evaluated. The principle sections and findings of this work are: 1. Ageing effect on retinal vascular function • In low-risk individuals, there are age differences in retinal vascular function throughout the entire functional response curve for arteries and veins. Gender differences mainly affect the dilatory phase and are only present in young individuals. 2. Retinal vascular function in healthy individuals with a family history of cardiovascular disease • In low-risk individuals with a family history of cardiovascular disease, impairments in microvascular function at the retinal level correlate with established plasma markers for cardiovascular risk. 3. Ethnic differences in retinal vascular function • When compared to age-matched White Europeans, in low-risk middle-aged South Asians, there are impairments in retinal vascular function that correlate with established cardiovascular risk indicators. 4. Systemic circulatory influences on retinalµvascular function • Systemic antioxidant capacity (redox index) and plasma markers for cardiovascular risk (lipids) influence retinal microvascular function at both arterial and venous levels. 5. Retinal vascular function in individuals with obstructive sleep apnoea: a preliminarystudy • Patients with moderate to severe sleep apnoea exhibit attenuated retinal vascular function.

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The purpose of this study was to determine which factors predicted maladaptive outcomes in sexually abused children. Key factors were aggregated into four categories: abuse characteristics risk factors, individual-level risk factors, family disruption risk factors, and social disruption risk factors. It was hypothesized that (a) individual-level risk factors (e.g., school performance, child alcohol/substance abuse) and (b) abuse characteristics risk factors (e.g., longer duration/frequency of abuse, use of force/threats of force, intrafamilial abuse) would predict higher levels of trauma symptoms. Furthermore, it was hypothesized that (a) family disruption risk factors (e.g., family alcohol/substance use, family psychopathology) and (b) social disruption risk factors (e.g., parental divorce, homelessness, witnessing homicide or violence) would moderate the impact of prior sexual abuse and predict higher levels of trauma symptoms. ^ The participants were 110 female children (5 to 18 years old) presenting for treatment for sexual abuse at a community agency (The Journey Institute) in Miami, Florida. This study conducted a retrospective analysis of an archival data set collected over a three-year period (1998–2001). The measures completed upon intake included The Journey Psychosocial Assessment and The Trauma Symptom Checklist for Children (TSCC; Briere, 1996). Using Pearson correlations and hierarchical multiple regression analysis, this study found that abuse characteristics risk factors and individual-level risk factors were predictive of maladaptive outcomes in this sample of sexually abused girls. However, no moderating effects were found for family disruption risk factors or social disruption risk factors. Therefore, the results of these analyses provided support for the contention that abuse characteristics and individual-level risk factors were appropriate targets for treatment for sexually abused girls. Moreover, limitations of this study, implications for treatment, and directions for future research were discussed. ^

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A major consequence of contamination at the local level’s population as it relates to environmental health and environmental engineering is childhood lead poisoning. Environmental contamination is one of the pressing environmental concerns facing the world today. Current approaches often focus on large contaminated industrial size sites that are designated by regulatory agencies for site remediation. Prior to this study, there were no known published studies conducted at the local and smaller scale, such as neighborhoods, where often much of the contamination is present to remediate. An environmental health study of local lead-poisoning data in Liberty City, Little Haiti and eastern Little Havana in Miami-Dade County, Florida accounted for a disproportionately high number of the county’s reported childhood lead poisoning cases. An engineering system was developed and designed for a comprehensive risk management methodology that is distinctively applicable to the geographical and environmental conditions of Miami-Dade County, Florida. Furthermore, a scientific approach for interpreting environmental health concerns, while involving detailed environmental engineering control measures and methods for site remediation in contained media was developed for implementation. Test samples were obtained from residents and sites in those specific communities in Miami-Dade County, Florida (Gasana and Chamorro 2002). Currently lead does not have an Oral Assessment, Inhalation Assessment, and Oral Slope Factor; variables that are required to run a quantitative risk assessment. However, various institutional controls from federal agencies’ standards and regulation for contaminated lead in media yield adequate maximum concentration limits (MCLs). For this study an MCL of .0015 (mg/L) was used. A risk management approach concerning contaminated media involving lead demonstrates that the linkage of environmental health and environmental engineering can yield a feasible solution.

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Financial survival in the hotel and restaurant business can depend upon a mastery of the basic principles of risk management. This article explains the series of steps leading to the successful implementation of the risk management techniques most appropriate for a given hotel or restaurant.

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Purpose – The purpose of this paper is to provide an analysis of sistematización’s use as a research tool in the operationalization of a “neighborhood approach” to the implementation of disaster risk reduction (DRR) in informal urban settlements. Design/methodology/approach – The first section highlights sistematización’s historical origins in Latin America in the fields of popular adult education, social work, and rural development. The second explains why sistematización was made a required component of project implementation. The third section addresses the approach to sistematización used. The final discusses how this experience both contributes to sistematización’s theoretical development and practical application as a methodology. Findings – The introduction of “sistematización” as a research tool facilitated real-time assessment of project implementation, providing timely information that positively influenced decision-making processes. This on-going feedback, collective learning, and open-exchange of know-how between NGOs and partner institutions allowed for the evaluation of existing practices and development of new ways of collaborating to address disaster risk in complex and dynamic urban environments. Practical implications – Sistematización transcends the narrow focus of traditional monitoring and evaluation on final results, emphasizing a comprehensive understanding of processes and contexts. Originality/value – Its use in the implementation of DRR initiatives in informal urban environments is particularly novel, highlighting the capacity of the methodology to be tailored to a variety of needs, in this case, bridging the gap between NGOs, local governments, and vulnerable communities, as well as between urban, development, and disaster risk management planning.