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Опис істотних передбачуваних факторів ризику, що можуть вплинути на операції та результати діяльності комунального підприємства ,та заходи щодо управління такими ризиками

Опис істотних передбачуваних факторів ризику, що можуть вплинути на операції та результати діяльності комунального підприємства ,та заходи щодо управління такими  ризиками

Опис істотних передбачуваних факторів ризику, що можуть вплинути на операції та результати діяльності комунального підприємства ,та заходи щодо управління такими ризиками

Структура процесів та ризиків санаторію

 

 

Найменування процесу

Найменування посад відповідальних за процес Ризики Управління ризиками

(моніторинг ризиків не рідше,

ніж 1 раз на рік)

Зовнішні / внутрішні
Процеси з основної діяльності (санаторно-курортні та медичні послуги)
Група лікувально-діагностичних, профілактичних та реабілітаційних процесів
 

 

 

 

 

 

Прийом пацієнтів та діагностика

 

 

 

 

 

 

Керівники лікувальних підрозділів

Встановлення хибного діагнозу через:

– недостатню кваліфікацію медперсоналу

Оцінка (експертна) роботи медпрацівників з боку керівника.

Підвищення кваліфікації, атестація медичних працівників.

– використання неправильної методики діагностики, або неповне обстеження Дотримання вимог медико-технологічних документів.
– недостовірність інформації  від самого пацієнта (симуляція симптомів чи їх приховування) Збір анамнезу щодо перенесених захворювань, вивчення медичної документації.

Наявність електронної бази даних.

Можливість перевірки інформації через інформаційні медичні системи.

– недостовірність додаткової медичної інформації (лабораторних, інструментальних обстежень, тощо) В разі сумніву повторне обстеження, використання інших (альтернативних) засобів, методів, методик діагностики.

Дотримання стандартів при проведенні обстежень.

Перевірка технічного стану діагностичного обладнання.

Відмова пацієнта від окремих видів обстеження Ознайомлення пацієнта з медико-технологічним документом, що регламентує проведення даного обстеження;

роз′яснення змісту та порядку проведення необхідного обстеження, наслідків відмови від нього. Оформити відмову письмово за підписом пацієнта.

Виникнення у пацієнта ускладнень під час проведення  діагностичних  процедур Щоразу перед проведенням роз′яснити пацієнту правила поводження під час проведення обстеження, інформувати пацієнта про можливість  ризиків та ускладнень під час проведення обстеження та підписати інформовану згоду на медичне втручання.

Дотримуватися алгоритму дій (інструкції) при проведенні обстеження.

 

 

 

Санаторно-курортне лікування та реабілітація

  Не отримання очікуваного результату (досягнення ремісії або виздоровлення)

Негативний результат (відсутність покращення, погіршення, виникнення ускладнень)

Дотримання вимог медико-технологічних документів (використання методів доказової медицини).

Врахування супутньої патології при призначенні лікування.

Призначення медичних препаратів дозволених до застосування в Україні.

Збір анамнезу щодо алергічних реакцій.

Проведення обстежень на виникнення медикаментозної алергії.

Нагляд за побічними діями лікарських засобів.

Наявність порядку дій при виникненні невідкладних станів.

При можливості прийом препаратів в присутності медичних працівників (стосується стаціонарного лікування).

Визначення мікрофлори та її чутливості до антибіотиків.

Проведення спільних оглядів, консультування з спеціалістами.

Відмова пацієнта від окремих видів лікування Ознайомлення пацієнта з медико-технологічним документом, що регламентує відповідне лікування;

роз′яснення потреби в проведення саме такого лікування, наслідків відмови від нього. Оформити відмову письмово за підписом пацієнта.

 

Профілактика

  Невиконання пацієнтом визначених профілактичних заходів Проведення роз′яснювальної роботи про необхідність виконання визначених профілактичних заходів. Ознайомлення з наслідками відмови під особистий підпис пацієнта.
Процеси управлінської діяльності керівництва (стратегічне та оперативне управління)
  Планування.

 

Моніторинг (процеси «зворотного зв′язку» в системі).

 

Аналіз функціонування системи управління якістю.

 

Прийняття управлінських рішень з поліпшення якості медичної допомоги, ресурсного забезпечення та функціонування системи.

Директор санаторію, заступники, керівники структурних підрозділів. Недосягнення очікуваних результатів (показників) діяльності установи через:

– зміни в законодавстві;

– зміни в системі фінансування;

– галузеві (зміни та реформи в галузі охорони здоров’я);

– недостатню компетентність керівників різних рівнів в питаннях менеджменту, економіки, правових відносин;

Моніторинг законодавчої бази – 1 раз на місяць. Приведення у відповідність чинному законодавству організаційно – правової документації та документів що регламентують діяльність установи.

Моніторинг тематичних періодичних та наукових видань – 1 раз на місяць.

Участь у конференціях, семінарах, навчаннях та заходах, що провадяться в галузі.

Підвищення кваліфікації, ТУ, участь у семінарах, вебінарах, навчаннях.

Проходження атестації.

Дотримання ліцензійних умов.

Дотримання акредитаційних вимог.

Проведення керівниками різних рівнів експертних оцінок роботи підлеглих працівників, структурних підрозділів, закладів, установи в цілому.

Проведення аналізу даних моніторингу, аудиту, самооцінки, анкетування пацієнтів.

Впровадження новітніх методик і технологій.

 

 

 

 Допоміжні процеси
 

Управління персоналом

  підбір кадрів

 

професійна підготовка, навчання, атестація, ліцензування, тощо.

  Неукомплектованість відповідними кадрами:

– звільнення кваліфікованого персоналу;

– тимчасова відсутність кваліфікованого працівника.

Створення сприятливого мікроклімату (спокій, емофійний комфорт) та умов праці.

Розробка програм мотивації персоналу.

Побудова кадрового забезпечення  таким чином, що працівники вільно можуть замінювати тимчасово відсутніх працівників (за принципом взаємозамінності).

Кадрові навчання.

Управління інфраструктурою
  Підтримка стану будівель, споруд, приміщень, пов′язаних з ними інженерних мереж, комунікацій, транспорту, зв’язку. Заступник директора з технічних питань Припинення/призупинення: – електропостачання;

– газопостачання;

– водопостачання;

( пошкодження систем водопостачання/водовідведення)

– опалювання приміщень в холодні пори року (пошкодження систем опалення, котельні тощо).

Пошкодження систем вентиляції.

Пошкодження інформацій ної мережі та зв’язку.

Проведення профілактичних оглядів технічного стану будівель, споруд, приміщень, пов′язаних з ними інженерних мереж, комунікацій, зв’язку.

Укладання договорів на технічне обслуговування комунікацій.

  Технічне обслуговування і ремонт медичного обладнання. Заступник директора з технічних питань вихід з ладу медичного обладнання, апаратури, комп’ютерного та іншого обладнання Наявність складу запасних частин, що можна замінити ( лампи, кабелі та ін)

Наявність договору про технічне обслуговування обладнання.

Здійснення перевірок технічного стану обладнання та апаратури;

Угода про взаємодію з іншим лікарняним закладом, де можливе проведення відповідного обстеження.

Забезпечення виробничого середовища для виконання процесів
  Забезпечення якості робочого середовища (охорона праці)

 

Інженер з охорони праці Звільнення працівників.

Ризики для здоров′я медичних працівників:

– робота в умовах підвищеної відповідальності та психоемоційної напруги;

– вірогідність зараження інфекційними хворобами;

– вірогідність виникнення професійних захворювань, тощо

 

Атестація робочих місць, визначення шкідливих факторів.

Приведення у відповідність до санітарних норм умов праці.

Проведення інструктажів, навчань з персоналом з питань охорони праці.

Дотримання персоналом інструкцій з охорони праці, алгоритмів роботи з інструментами та апаратурою та правил внутрішнього трудового розпорядку.

Використання персоналом засобів індивідуального захисту.

Проведення медичних профілактичних оглядів працівникам.

Проведення оперативного контролю з охорони праці.

Перевірка знань з охорони праці та запровадження системи депреміювання за порушення цих вимог.

  Управління пожежною безпекою Відповідальний за протипожежну безпеку в установі Виникнення пожежі, що може спричинити загрозу життю та здоров′ю пацієнтів, персоналу, знищення майна. Проведення інструктажів, навчань з питань протипожежної безпеки.

Дотримання інструкцій з протипожежної безпеки.

Наявність засобів пожежогасіння та плану евакуації на випадок виникнення пожежі.

Дотримання алгоритмів роботи з інструментами та апаратурою.

Перевірка знань та запровадження системи депреміювання за порушення  вимог протипожежної безпеки.

Метрологічне забезпечення
      Хибні результати досліджень та обстежень;

неякісне проведення лікування;

 

Забезпечення закладу нормативними документами з питань метрології.

Наявність повного переліку засобів вимірювальної техніки що перебувають в експлуатації та підлягають повірці.

Забезпечення вчасної метрологічної атестації, повірки та ремонту засобів вимірювальної техніки.

 

Фінансово-економічне та матеріально-технічне забезпечення
  формування бюджету (кошторису санаторію) Відповідальний – розпорядник бюджетних коштів  (директор)

Виконавці: заступник з економічних питань, гол. бухгалтер, бухгалтерія

Зовнішні:

неприйняття Верховною радою України Закону «Про Державний бюджет України на відповідний рік» в терміни, визначені Бюджетним кодексом України. Невиконання доходної частини державного бюджету України, прийняття рішення про секвестр бюджету та скорочення обсягів фінансування установи. Внутрішні: неправильне обґрунтування потреби в бюджетних коштах, внаслідок чого відбудеться недостатнє або зайве фінансування установи.

Неврахування головним розпорядником в повному обсязі обґрунтованої потреби установи в коштах при  складанні кошторису установи.

Дотримуватись вимог нормативних актів з питань складання кошторису при формуванні бюджетного запиту.

 

 

 

 

Приведення у відповідність до кошторисних призначень фонду оплати праці,  обсягів укладених договорів, збільшення обсягів наданих платних послуг.

  складання та своєчасне оприлюднення плану закупівель на рік та укладання відповідних договорів Відповідальні: керівники закладів та структурних підрозділів установи,  тендерний комітет установи (голова – заст. з економічних питань), бухгалтерія Неподання об’єктивної потреби в товарах та послугах для забезпечення виконання функцій структурними підрозділами та закладами установи, та як наслідок, формування плану закупівель, проведення  процедур закупівель, укладання  договорів, що не дозволяють забезпечити повноцінну діяльність установи Вивчення та планування закупівель на основі аналізу роботи попередніх періодів та з урахуванням заходів передбачених планами роботи,  планових обсягів надання медичних послуг установою.
  виконання договорів (з постачальниками, отримувачами послуг, тощо) Відповідальні: керівники закладів та структурних підрозділів установи,  тендерний комітет установи (голова – заст. з економічних питань), бухгалтерія Дострокове припинення договорів з постачальниками про продаж/ постачання комунальних послуг та інших послуг, товарів Наявність договорів постачання з декількома постачальниками, у разі, якщо це не заборонено ЗУ «Про публічні закупівлі», постійний моніторинг ринку постачання.
      Порушення контрагентами умов господарських договорів: порушення термінів поставки, передача товару, який не відповідає якості та кількості, підвищення ціни тощо Наявність альтернативних договорів. Співпраця з юридичними компаніями з метою перевірки умов договорів, виставлення претензій при порушенні умов постачання та інше.

 

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