COVID-19 (Special Edition)

This risk relates to the multifactorial influence the current COVID-19 pandemic has had on healthcare organizations and healthcare providers. The pandemic has significantly impacted care and operations within healthcare and has been a crucial patient safety and resource concern. Many healthcare organizations are seeking ways to identify the risks and potential risk mitigation strategies associated with pandemic activities across the various risk categories within the taxonomy. This document contains information entered by HIROC Subscriber healthcare organizations (acute and non-acute) in the Risk Register application to help you in your assessment of this risk.

Care: Infection Control

Key Controls / Mitigation Strategies

  • Committee oversight (e.g. infection prevention and control, senior management, incident management, etc.)
  • Ministry, public health and local supports, resources and guidelines
  • Organization communication process to ensure frontline healthcare providers are aware of measures taken to manage pandemic activities
  • Communication strategies to enhance infection prevention and control practices for staff, patients and others
    • Operationalize electronic platforms currently in place to push out notifications, alerts and communications
  • Provincial Infectious Diseases Advisory Committee (PIDAC) daily updates
  • Increased surveillance protocols:
    • Active screening protocols
    • Frequent infection surveillance reporting
    • Outbreak management processes
  • Closure of non-essential services and clinics
  • Emergency Operations Centre (EOC) operational 
  • Management oversight of Personal Protective Equipment (PPE) usage
  • PPE policies and procedures to enhance supplies and stewardship:
    • Monitor PPE usage and supplies
    • Accurate tracking of equipment orders and donations of PPE
    • Increased access to N95 mask fit testing
    • PPE staff support to encourage appropriate use and monitor needs of staff
    • PPE procurement strategy
    • Participation in regional pandemic supply management working group
    • Exploration of methods for safely and effectively reprocessing/disinfecting PPE
    • Conservation strategies and plan in effect for PPE and other supplies
  • Visitor restrictions 
  • Virtual care delivery options
  • Physical environment design:
    • Physical distance in public spaces and measures in place to ensure adherence
    • Protective barriers in screening areas and other spaces where physical distancing is not possible
    • Engineering controls (e.g. air handling systems, barriers, sharps management, hand hygiene supplies at point of care, etc.)
    • Increase number of negative pressure rooms
    • Use of unconventional spaces 
    • Support staff who are able to work from home
  • Administrative planning and policy:
    • Implementation of Incident Management System (IMS) processes and structure
    • Leadership participation both within organization and at regional tables
    • Administrative controls (e.g. training/education, policies and procedures)
    • Plans for staff training to enable redeployment to areas with higher demands for care (e.g. cross-training)
  • Staff wellness and psychological safety processes and support mechanisms (e.g. peer-to-peer hotlines, increased corporate communication, responsiveness to staff concerns, access to Employee Assistance Program (EAP), etc.)

Monitoring / Indicators

  • Creation of a PPE-specific dashboard to track inventory, usage, volumes of available stock
    • Monitored by specific and designated team or committee 
  • Monitor ongoing availability of ventilators
  • Monitor staff wellness (physical) and COVID-19 testing status through Occupational Health and Safety and Infection Prevention and Control processes
    • Contact tracing process (ensure confidentiality maintained) to track potential exposures
  • Staff screening daily reports 
    • Daily reporting of staff screening data to IMS committee / team
  • Reports generated from Electronic Medical Record platform to monitor: 
    • Hospital clinical status
    • Infection rates
    • Hand hygiene compliance
    • Patient transfers from different levels of care and / or isolation precautions
  • Hand hygiene audit reports
  • Track number of times room cleaned and usage of isolation rooms
  • Track availability of negative pressure rooms when required

Care: Medication or Supply Shortage

Key Controls / Mitigation Strategies

  • Proactive monitoring of shortages and current stock of supplies
  • Network with manufacturers and peer facilities
  • Ongoing communication with Shared Service / procurement providers
  • Maintain awareness of back up supply availability and access 
  • Communication strategies that involve key stakeholders to ensure capacity to make timely decisions
  • Operational readiness that enables agile procurement strategies
  • Frontline staff engagement and awareness of the impact of shortages to care and the need for rapid practice changes
  • Ongoing and timely communication to staff on changes to medication or supply items (e.g. packaging, strength of contents, recommended usages, etc.)

Monitoring / Indicators

  • Maintaining accurate shortage list
  • Utilization statistics
  • Incident report data to monitor potential adverse events with changes to medication or supply items
  • Daily reporting to the appropriate committees

Financial: Revenue Funding

Key Controls / Mitigation Strategies

  •  Routinely scheduled budget planning operational review
    •  Senior management oversight and monthly reviews
    • Board oversight and approval process
  • Budget projection activities conducted
    • Creation of specific budgets according to various scenarios and outcomes
  • Cost control policies
  • Monthly and quarterly financial statement analysis 
    • Cost analysis
  • Regular comparisons to budget and prior year actuals
  • Government funding for cost recovery for community support activities
  • Major contract expenditures put to public tender
  • Use of shared service / group purchasing advantage for volume discounts
  • Ongoing review of staffing and operational efficiencies
  • Government-approved reimbursements for COVID expenses and capital
  • Foundation fundraising activities and discussions for innovative ways to conduct them
  • Deferral of programs for international patients where possible and optimizing virtual care 
  • Proactive external relations
  • Diversification of revenue generation

Monitoring / Indicators

  • Monthly reviews of department budgets
  • Monitor large variances and rational for differences
  • Number of new sources of revenue
  • Number of fundraising activities and donations
  • Tracking of COVID-19 related expenses and reimbursements received from government

Human Resources: Development / Psychological Injuries

Key Controls / Mitigation Strategies

  • Interview process based on performance standards and organizational fit
  • Ensure screening process for new hires is maintained during COVID-19
  • Ensure applicants are fully informed of the nature of the position, time period required and placement expectations / possibilities while employed, including redeployment to other community agencies as required
  • Ensure all onboarding and orientation requirements are delivered within one month of hire, if not immediately, in relation to the new hire placement
  • Ensure all mandatory education components are completed prior to new hire allocation to patient care areas (e.g. Hand Hygiene, Infection Prevention and Control practices, Emergency Codes, Privacy, etc.)
  • Ensure new staff are provided with supervision and supports for time period specified by Human Resources policy and processes
    • New staff are provided with information for EAP and other mental health staff support programs 
  • Unit specific orientation and training for specialty care areas or areas encountering staff shortages

Monitoring / Indicators

  • Number of staff hired during COVID-19
  • Monitor number of staff who attended orientation
    • Who completed mandatory education
  • Number of staff who participated in mock codes
  • Aggregated and de-identified report for number of staff who accessed supports 
  • Monitor sick time and attendance management reports
  • Occupational Health and Safety Reports for workplace injuries / adverse events
  • Number of WSIB claims

Additional Subscriber-Identified Risk Register Categories: