Editorial

Risk management in Cuban hospitals: a pending and necessary element

0000-0001-7758-2561Leudis Orlando Vega de la Cruz^{1  *}  , 0000-0002-5470-2572Fernando Marrero Delgado² 

¹Universidad de Holguín, Holguín, Cuba.

²Universidad Central de Las Villa Marta Abreu, Villa Clara, Cuba.

The term risk has been known since ancient times, having a similar context at present. Since the very beginning it focused on issues related to nature, nowadays it is closely related to human actions and decisions which can cause negative effects, not only because of negligence, but also due to the possibility of incorrect decision-making, being today a high impact element, also remarkable in health entities, especially in Cuba where they are budgeted units, so they must be taken into account to avoid high costs to the country. Today, as a result of the complex epidemiological situation caused by the COVID-19 pandemic, this topic has been relevant in the hospital environment.

In Cuba, risk administration is managed by the Office of the Comptroller General of the Republic of Cuba where the Risk Management and Prevention component establishes the bases for the identification and analysis of the risks faced by the organs, agencies, organizations and other entities to achieve their goals ¹ according to article 11 of resolution 60 of 2011, second section, it is important to highlight the relevance that other processes have given to this topic, such as Quality Management, Human Resources and Supply Chain Management. Once the risks have been classified into internal and external, by processes, activities and operations, and the main vulnerabilities have been evaluated, the control objectives are determined, then the risk prevention plan is created to define the way they will be managed. The component is structured by the following rules: risk and change detection, control objective decision and risk prevention. However, at a hospital institution this management is quite complicated and there is not enough knowledge to perform it correctly. To guarantee an effective risk management with the participation of all care and non-care workers, efficient collaboration is necessary among all the actors involved, thus it is essential to reach a consensus on the component definition. ²

In the term risk management and prevention according to resolution 60 of 2011, it is considered in this letter that the term prevention is totally unnecessary since it is done in advance to reduce a risk. The objective of prevention is to assure that an eventual damage does not perform. On the other hand, managing means carrying out procedures that make it possible the performance of any desire, it encompasses the ideas of planning, arranging, directing, ordering or organizing and controlling a certain situation. Prevention is considered to be implicit in management, so the term risk management should be adopted.

In this sector, hospital risk management must be adopted to the continuous process that starts from the strategy and efficiently develops a set of activities such as: identification, analysis and risk evaluation, decision-making to prevent, eliminate, reduce and control the adverse effects that can be performed in a hospital processes that can affect the health of any citizen. Cuban regulation starts from the classification of internal and external risks, however, it´s valuable the narrow classification of these risks according to:

• Strategic: related to strategies, relationships, planning in hospitals.

• Commercial: everything related to management from the logistical assurance viewpoint.

• Operational: it frames most of the inherent risks on the hospital activity, also including those related to human risks, technical failures, information management and occupational risks, related to the risks present due to non-favorable working conditions, among others.

• From the environment: includes all external risks that affect the main goals of the hospital on regulations, laws, social, up to those more limited to the sectors where the entity operates.

• Economic-financial: related to all financial activity, both internal and external.

• Environmental: hospital - environment interaction.

• Technological: both internal and external technological risks, due to lack, failures and advances on information and communication technologies.

From the internal risk viewpoint also taking great relevance in healthcare services, operational and technological risks will play a determining role in the Committee for the Prevention and Control of Infections Associated with Healthcare, the Therapeutic Drug Committee, the Tissue Committee, the Committee of deceased, the Committee on the quality of medical records, among others. For risk management, it must be taken into account that the scope and size of these hospitals have become so complex and extensive that the administration must rely on innumerable reports and analysis to effectively control operations. The verification and review inherent to good management provide protection against medical weaknesses (taking into account human resources) and reduce the possibility of errors and irregularities, at the same time they establish quantitative tools for their management, ³ in addition, the Cuban regulation on risk prevention plan is recommended by area where the process approach prevails in efficiency and effectiveness in health sector.

The objective and process risk identification, the control elements to manage the risks (risk prevention plan), the management body proceedings and the risk prevention committee, are the methodological and management basis for obtaining reasonable results in the hospital internal control management.

From this reference, it urges to health researchers attending to the Cuban Economic and Social Model with a focus on public Health, not only to limit their studies to measure the frequency on which health problems occur in the population, but also to transcend the world of management assumed by professionals who work in the health sector, managing the hospital change and promoting an effective risk management that gradually affects citizen satisfaction related to health services, so that in a cultural and contextualized way its solution can be determined.

REFERENCIAS BIBLIOGRÁFICAS

1.  Cuba. Ministerio de Justicia. Gaceta Oficial No. 013. Contraloría General de la República de Cuba. Resolución 60/11 [Internet]. La Habana: Ministerio de Justicia; 2011. [citado 16 Oct 2017]. Disponible en: Disponible en: https://www.gacetaoficial.gob.cu/sites/default/files/go_x_013_2011.pdf 1.

2.  Vega de la Cruz L, Herrera González YI, González Reyes LL, Cantero Cora H. Construcción de futuros en una institución hospitalaria cubana. AMC [Internet]. 2017 [citado 16 Oct 2017];21(3):348-60. Disponible en: Disponible en: http://scielo.sld.cu/pdf/amc/v21n3/amc060317.pdf 2.

3.  Vega de la Cruz LO, de la Luz González Reyes L. Diagnóstico estadístico del control interno en una institución hospitalaria. Rev haban cienc méd [Internet]. 2017 Abr [citado 2 Dic 2017];16(2):295-309. Disponible en: Disponible en: http://scielo.sld.cu/pdf/rhcm/v16n2/rhcm15217.pdf 3.

Received: November 28, 2020; Accepted: December 22, 2020

^*Autor para la correspondencia. Correo electrónico: [e-mail]

Los autores declaran no tener conflicto de interés en esta investigación.