At the same time, they need to protect the health and wellbeing of employees and the community. The discipline of risk management can help hospital and health care providers adapt and respond to COVID-19. The public and private health sectors are at the frontline of the COVID-19 pandemic, which is having widespread global economic, social and community impacts.

For many organisations, the ability to adapt and respond to the changing circumstances quickly and effectively will determine their long term viability, and will shape their ability to remain in operation as we wait for the curve to flatten and life to resume post COVID-19. This update considers some practical steps that health care providers can take to complete a risk assessment to support and guide their COVID-19 response.

New and long term risk exposure in health

The health sector is under particular pressure to make fast-paced decisions and manage risk as this evolving pandemic and health crisis unfolds. The public health authorities are required to make decisions about critical public health responses, for example quarantine, social distancing and actions needed to ensure patients have access to lifesaving ventilators. Private hospital operators are being nationalised to strengthen the health sector and Australia's ability to provide quality health care through this crisis. This has required the private sector to make fast paced decisions about taking on roles and responsibilities while considering the parameters and risks that may arise for them under their licences. The crisis shows no sign of resolving any time soon. While the public and private health sectors have already made many decisions and implemented strategies to manage risk, the situation is fluid and decisions and strategies will require constant review. There will also be new risks that arise as the pandemic unfolds, and many more difficult decisions will need to be made. While the focus of risk management and decision making needs to be on managing the health crisis, public and private healthcare providers should also be thinking of ways to protect against and manage their long term risk exposure. Already, there has been an announcement in NSW that there will be a special commission of inquiry into the Ruby Princess. There are also rumours of broader commissions of inquiry being convened on the other side of the COVID-19 curve.

Applying the risk management discipline

The need for a disciplined approach to risk right now is critical as management teams work through this unprecedented challenge. The risk management discipline has tools and techniques to assist health care providers to understand the constantly changing landscape, navigate the implications and determine an action plan to respond. Developing a phased approach to managing the controlled containment of risk will enable health care providers to focus on critical business and public health operations during this pandemic.

Risk assessment practical steps

Risk management is an iterative process that responds to a rapidly evolving situation. Completing a risk assessment can help to clarify priorities and confirm roles and responsibilities in a time when clear communication and accountability protocols will prove essential to driving focus and delivering outcomes.
The following practical steps can be followed to complete a risk assessment.

• Determine your objectives in the short, medium and long term.
• Identify areas of uncertainty. For example, considering what could go wrong, such as nurses and doctors not having adequate protective equipment to treat COVID-19 patients, or a failure to identify and address a COVID-19 cluster, resulting in broad community transmission. Also consider what could go right such as provisioning for adequate supplies and identifying the cluster early avoiding further cases.
• Determine mitigating strategies, treatment options and action plans that need to be put in place to manage the risk factors. For example, determine if your current technology can support your employees working from home, how you can enhance to hygiene practices, how to implement social and ethical distancing and source new suppliers.
• Prioritise your risks by rating them from low through to extreme based on the impact they have on meeting your objectives.
• Implement monitoring and reporting to ensure you are staying close to those key risks, ensuring the flow of critical information will be essential for you to make timely and informed decisions.
• Ensure you have a communication plan for your employees, customers, and other key stakeholders that reinforces your values, purpose and objectives during the pandemic. Ongoing, consistent and regular communication will be crucial during these uncertain times.

Review business continuity and pandemic plans

COVID-19 has highlighted the significant disruption to health care operations that a pandemic can have on supply chain and critical health care functions and operations. Completing a planning exercise to prepare your organisation for the short to medium term financial, risk and operational challenges you are likely to face as a result of COVID-19 can assist in ensuring continued, sound operation whilst maintaining a focus on regulatory compliance.

The following activities should be considered in the context of any existing crisis management and communication plans.

• Stay informed by closely monitoring developments and announcements by relevant authorities, and take a proactive approach to communication between governmental and regulatory authorities.
• Establish a system of communication to keep employees up to date in relation to COVID-19 developments.
  Review the effectiveness of your organisations Business Continuity Plan, reflect on what worked and what didn't work as planned and prioritise continuous improvement.
• Develop a pandemic plan or review your existing pandemic plan based on current guidance from WHO and the government. It will be important to reflect the latest thinking in your plan to ensure it is an effective plan to guide your organisations decisions and actions during this pandemic.  

Whilst a pandemic poses a high level of uncertainty on the ability for health care providers to meet objectives, the discipline of risk management can help to reduce those effects through the application of a consistent approach and framework. A clear strategy combined with strong sense of organisational purpose and values will reinforce to your patients, employees and stakeholders your service remains operational during the pandemic and well into the future.