Risk Management Manager and Risk Management Methodology in Social Services of the Academy of Education and Research in Social Services

Risk management is part of the strategic management and planning of every successful organization, including organizations providing social services. Risk management is covered in the curricula for quality managers from the perspective of quality management. However, working life in social service facilities demonstrates the urgent need to prepare and educate not only top management in this area, but also middle-level and lower-level professional staff who are responsible for admitting clients or are in direct contact with clients.

I began working on this topic in 2010. When we introduced it at a professional conference in Skalica, I hoped it would open space for professional discussion. Emergency situations in social service facilities and the resulting risks are addressed continuously based on the financial capacity of providers and the founders themselves. Risks can cause not only property damage, but also loss of life. The value of a human life is defined as the monetary amount that society is willing to spend on saving a human life. (Procházková, 2010) We often cite the lack of funds as an excuse. But risk management does not rise or fall on finances. Risk management is also a matter of human resources. Where we cannot obtain funding, it is necessary to use the professional knowledge, skills, and competence of all staff involved. The Social Services Act 448/2008 Z.z. itself imposes the obligation to manage risks. Our long-standing clients asked us to prepare a training module on this topic.

We prepared the training product Quality Manager in Social Services at the Academy of Education and Research in Social Services for quality teams (in social service facilities with an implemented quality management system - QMS) and for interdisciplinary teams in social service facilities that do not have a QMS in place.

In this training product, we aim to teach course participants:

• To correctly gather information for risk management from both external and internal sources, to correctly interpret and record it.
• To correctly use methods and tools of diagnostics, tests, and measurement tools for analyzing the causes and impacts of risks in relation to the client (recipient of social services).
• To identify groups of measures in relation to the organization:
• infrastructure
• personnel
• professional and support processes,
• persons in contact with the client (family members, friends, other clients, etc.)
• To respond to identified risks by developing and implementing preventive and corrective measures to ensure the safety and health protection of the client and staff.
• To work with the correct risk management terminology.
• To integrate risk management into Individual Plans of the social service recipient.

The course Risk Management Manager in Social Services is prepared based on materials and findings from fifteen years of auditing practice both abroad and domestically, as well as from the latest professional literature on the subject. While it draws on theoretical foundations (training materials), the training sessions are conducted through practical exercises with model situations from practice and documentation recording.

After successfully delivering the first courses, we ourselves became convinced that it was time to teach professional staff to work with risk cards, nonconformity reports, incident reports, as well as diagnostic tools for detecting dehydration risk, nutritional deficit risk, decubitus risk, client escape risk, emotional lability risk, aggressive behavior risk, and other risks.

To this day, we do not have a developed risk management methodology for social service facilities in Slovakia. Similarly, professional literature on risk management in social services is not available. It may therefore easily give the impression that there is no need to engage with this subject matter. However, our seven years of experience from the activities of the Institute of Quality in Social Services tell us the opposite.

We consider risk management to be an important tool for ensuring and controlling quality in the social sector, just as it is in other service industries. Dozens of audits in social service facilities in Slovakia have demonstrated errors, misconduct, serious emergency situations, and threats that, in light of the new Social Services Act Z. z. 448, can no longer be tolerated. Nonconformities and errors in many cases were excused by a lack of financial resources and unqualified bedside staff. However, audit evidence points to an alarming state of unprofessional management that is not only related to financial resources but to the insufficient use of professional methods, procedures, and tools of quality management, change management, and risk management. Social services represent a special set of activities aimed at satisfying individual and collective needs, carried out in a manner different from the transfer of material goods.

Social services have their specific environment within the service industries. Their main activities include care, rehabilitation, therapeutic, and counseling processes, which cannot function without human relationships, professional expertise of staff, nursing and care techniques, the latest scientific findings in social counseling, and professional ethics. The gradual increase in demands for expertise, professionalism, and above all individualized approaches to social service recipients (PSS) brings with it the need to introduce tools for qualified and quality management. Top-level and middle-level professional management are expected to possess knowledge of quality management, in which risk management has an irreplaceable role.

Risk management is the resolution of risks that may arise in an organization or part of an organization, or in the environment, or it involves addressing technical risks. (Rovný, 2011).

It has four phases:

• Risk identification,
• Risk analysis and its consequences,
• Risk response management,
• Risk monitoring.

Risk management in social services is the process of identifying, evaluating, and addressing potential or current risks that may be a source of:

• deterioration of living conditions for people who cannot manage their life situation on their own;
• worsening health status of a physical person dependent on the help of another physical person;
• failure to create appropriate conditions that would prevent the emergence or increase of negative social phenomena;
• failure to create support activities that would prevent adverse social development of an individual, family, or society;
• financial loss for an individual or facility;
• ineffective and inefficient management of financial, human, and material resources;
• loss of good reputation for a social worker or social facility.

Similarly to quality management, risk management also requires defined standards, a process approach, and measurement and control tools, which include both external and internal audits. If a social service facility has a process approach in place, then managing such an organization will lead to:

• systematic definition of necessary activities to achieve desired results;
• clear assignment of responsibilities and duties for managing key activities;
• measurement and analysis of the capability of key activities;
• identification of links of key activities with and/or between the functions of the facility;
• focus on factors such as resources, methods, and materials that will improve the organization's key activities;
• evaluation of risks, consequences, and impacts of activities on social service recipients, suppliers, and other interested parties (founder, family members, municipality, other community, etc.).

Applying the principle of evidence-based decision-making will lead to:

• ensuring that data and information are sufficiently accurate and reliable;
• appropriate processing of data for those who need it;
• analysis of data and information using valid methods;
• making decisions and carrying out activities based on analysis of facts, balanced with experience and intuition.

If we want professional staff to make decisions based on facts, we must teach them to correctly gather information for risk management from both external and internal sources, to correctly interpret and record it. This point concerns work with controlled documentation and administration.

Management has the predisposition to be successful when it is based on professional knowledge and experience. Acquiring this knowledge and experience is very demanding, as it requires constantly gathering, evaluating, and verifying data, and reviewing qualified assessments, which only qualified and experienced professionals can do.

Procházková (2010) notes that despite deliberate efforts to manage data, in the case of data on human systems, it must be stated that it is not possible to expect that complete data will ever be obtained for decision-making. This means that the relevant decisions will always be burdened with uncertainty and indeterminacy. Examples in social services: a schizophrenic or a client with dementia (manifestations of aggression, escape, suicide)? Therefore, methodological tools used in converting data into information must account for this. Every client has their specific needs, which we may or may not recognize and define. However, it is important to learn from case studies or through work with case management. Indicators or indexes as quantified data simplify complex phenomena and are therefore important in communication. But even quality data management does not guarantee that data will be correctly interpreted and used. Reasons:

1. There is insufficient integration between data collection procedures and the conversion of data into information.
2. The monitoring system is sometimes purposeless and has no clear and distinct objective set for it.
3. Data are often non-homogeneous, insufficient, incomplete (missing values), insufficiently covering spatial structure, and from a procedural perspective, the main problems are with sampling (temporal exposure scales, including sampling errors).

This implies the need to create an integrated information system (monitoring system, data validation, databases, analysis, and data-to-information conversion) based on databases, models, and an expert system, a decision support system. We acquire knowledge through the process of interpreting information in the system for which the information is valid. This means that when information applies only to a certain section, the validity of the knowledge is also limited to that section. (Grasseová, 2008).

We might say that the above facts, as described by experts from other industries, cannot be managed in social services. Why? Are we truly so incapable, or do we lack the confidence of a professional who can learn this?

Why do we not know and do not have the position of a risk manager in social service facilities? Perhaps because we do not have enough risks for them to deal with? During the three-day training course, we identified with interdisciplinary teams dozens of unaddressed and therefore unmanaged risks. Currently, we are preparing a Methodological Manual for Risk Management, in which the risks of main professional processes (care, nursing, housing process, and meal process), as well as personnel policy, occupational health and safety, and fire protection, will be identified and documented. The Methodological Manual also includes a terminological glossary focused on social services. Similarly to quality management systems, where a quality manager is designated, it is necessary to have a qualified risk manager trained.

Risk manager = manages the process of risk identification, risk assessment, creation of preventive strategies, and control of the effectiveness of corrective actions. Risk management cannot function without data-based, information-based, and fact-based decision-making. This important quality management principle can bring the following key results for a social service facility:

• it will increase the ability to demonstrate the effectiveness of previous decisions by the director or professional staff by referencing records of facts.
• it will increase the ability to examine, provoke, and change opinions and decisions.

The basic tasks of a risk manager include:

• developing an effective change management process;
• creating an effective incident reporting and prevention process;
• introducing controlled documentation and monitoring documentation systems;
• developing a database of current risks based on the legislative environment and societal demands, demographic development, marketing research, and the labor market.
• introducing complaint management.
• introducing quality and risk measurement tools into all processes.
• training staff in risk management.

What are the most common risks in social services: A. Risk of leakage of confidential and personal data; Training block on documentation and controlled administration and Act No. 122/2013 Z.z. on personal data protection and on amending certain acts. - Corporate culture and ethical code B. Risk of ineffective communication; C. Risk of improperly maintained documentation; - See documentation and controlled administration block D. Risk of nosocomial infections from the external environment or internal environment (residential bacterial flora, colonizing bacteria; infected wounds - decubiti, respiratory infections, sepsis, hepatitis B); E. Risk of working with hazardous waste (disposal of waste with biological material = blood, other body fluids, objects contaminated with fluids, etc.); F. Risk of weakened psyche (emotional unrest) and mentally ill clients (PSS); G. Risk of misconduct in care, nursing, rehabilitation, or counseling processes; H. Risk of emotional and work-related stress for staff (burnout syndrome); I. Risk of client disappearance. - See Risk Management in Professional Processes block J. Risk of untrained staff when using technology; - See block: Risk Manager and Staff Training K. Risk of emergency situations from ecological or natural disasters.

Quality management systems are managed and controlled based on numbers, data, and facts. It is precisely measurement, analysis, and improvement that can ensure systematic and continuous improvement of the quality of social services. The task of top management and experts is to develop appropriate procedures for review, measurement, and analysis at relevant points in process management. There is no need to fear modern statistical findings and other systematic methods that help monitor service quality. Measurement needs to be established where we can determine positive effects influencing service quality and client satisfaction.

The goal of the social service provided is to recognize and fulfill the requirements of social service recipients to the highest quality possible, and in case of changed needs, to respond quickly and professionally and competently provide services required by their condition. In order to achieve a high level of client satisfaction with our services, we need to implement several important measures:

• determine information sources for conveying client satisfaction.
• develop a concept for collecting this information and develop a concept for evaluating the conveyed information, which is updated according to the latest scientific findings.
• collaborate on developing client satisfaction questionnaires with experts in social work.
• introduce a quality tool "Complaint Management," whether as a process or as a regulation.
• develop a concept for capturing errors, marking errors, and handling errors within defined measures for their elimination.

Given the complexity of the topic, the course requires maximum concentration from participants, so courses can only be conducted in an undisturbed environment. At the same time, the complexity of the topic requires the participation of the entire interdisciplinary team or quality team. It is not enough to send one or two staff members from the facility, because the course content is designed for the organizational system of the entire facility, from infrastructure to the management of human, material, and financial resources, as well as the processes themselves. The recommended number is 5 participants (process owners or team leaders).

Risk Identification and Management in Social Service Facilities

According to Grasseová (2010), risk arises from the interaction of a threat and an asset and is expressed as a combination of the probability of an undesirable event occurring and its impact on the given asset. Risk can therefore be understood as a quantification of the impact of a threat on an asset.

We present the principles of risk management:

• Integration principle (risk management must be an integral part of processes and projects carried out in the organization).
• Uncertainty consideration principle (risk management directly addresses uncertainty, the nature of this uncertainty, and how this uncertainty can be resolved).
• Systematicity and timeliness principle (a systematic and timely approach to risk management contributes to effectiveness and to consistent, comparable, and reliable results).
• Information availability principle (inputs to the risk management process must be based on high-quality information sources, such as experience, monitoring and measurement, observation, forecasts, or professional opinion).
• Adaptability principle (risk management must be adapted to external and internal contexts and the organization's environment and types of risks.
• Personnel and cultural factors consideration principle (risk management must take into account human and cultural factors by examining the requirements, expectations, and impact of external and internal stakeholders).
• Transparency and comprehensiveness principle (adequate and timely involvement of stakeholders and managers at all levels of the organization ensures that risk management remains factual, current, transparent, and comprehensive).
• Dynamism and responsiveness principle (risk management must be dynamic so that through monitoring and review, continuous perception of changes and timely response to changes is possible).
• Improvement and development principle (new applied strategies for improving the development of the risk management system must be developed within the organization).

Managers fear risks primarily when making strategic decisions. Therefore, the risks of implementing strategic intentions can also be perceived as an undesirable result of the effects of internal and external processes.

Risk identification and analysis means examining all potential problem areas of a project, verifying the list of identified risks and their categories using historical information or the experience of other experts, and then determining the risk acceptability threshold. (Preuss, 2012)

This is joined by the distribution of risk management among all involved parties. Distribution in legal management is carried out on the basis that all involved parties are responsible for risk management and that the management of a specific risk is best assigned to the entity best prepared for it. However, this is only possible in an organization with qualified project and process management, meaning that activities and measures are applied based on knowledge, both subject-matter and management knowledge (i.e., activities are interconnected (processed interfaces), there are no communication errors, and every involved person knows what to do and how to do it). (Procházková, 2010) The most common question is, who bears the risk of client escape or the occurrence of decubiti? It is not about the responsibility of one person, but about transferring risk management to managerial, professional, and service staff. However, this should not again become collective blame. On the contrary, by identifying and analyzing the causes of risk, as well as implementing preventive and corrective measures, we arrive at specific risk management, which will lead to the reduction or complete elimination of risk.

Outputs of the risk management process:

1. Evaluated Risk List (Risk Assessment Document), which contains all information about each relevant risk.
2. Top Risks List, which contains a list of selected risks whose resolution has the highest demands, resources, and time requirements.
3. Retired Risk List, which serves as a historical reference for future decision-making.

Conclusion

What is better: pretending we have no risks, or managing them by describing them from Google and translating them from Czech materials, or learning the risk management methodology itself? If you are interested in engaging professionally with this subject, I would be very glad to meet with you, either at our course or in methodological work. Current information about the course can be found on the website of the Academy of Education and Research in Social Services www.avvss.sk

Author: PhDr. Mária Kovaľová, PhD. MHA Academy of Education and Research in Social Services www.avvss.sk

List of References:

GRASSEOVÁ, M. et al 2008. Procesní řízení ve veřejném sektoru. Brno: Computer Press, 2008, 266s.. ISBN 978-80-251-1987-7. GRASSEOVÁ, M. et al 2010. Analýza v rukou manažéra. Brno: Computer Press, 2010. 325 s. ISBN 978-80-251-2621-9. PREUSS, K. GORDEEVA, A.V. Strategické řízení v organizacích zdravotních a sociálních služeb. Brno : Econ publishing, s.r.o. 2012. 246s. ISBN 978-80-86433-56-1. PROCHÁZKOVÁ, D.2010. Bezpečnost a krízové řízení a udržitelný rozvoj. Praha : Univerzita JAK. 2010. 248s. ISBN 978-80-86723-97-6. ROVNÝ, I. - BIELIK, I. et al. 2011. Vybrané kapitoly verejného zdravotníctva I. Bratislava: Interpharm, 2011. 591s. ISBN 978-80-89057-33-7. ŠKRLA, P. ŠKRLOVÁ, M. 2008. Riadenie rizík v zdravotníckych zařízeních. Praha : Grada, 2008. 199s. ISBN 978-80-247-2616-8 VYMĚTAL, Š. 2009. Krizová komunikace a komunikace rizika. Praha : Grada,2009. 176s. ISBN 978-80-247-2510-9 Zákon č. 448/2008 Z.z. o sociálnych službách a o zmene a doplnení zákona č. 455/1991 Zb. o živnostenskom podnikaní (živnostenský zákon) v znení neskorších predpisov.