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### Introduction to Risk Analysis in Healthcare

Lecture OutlineLecture OutlineLecture Outline### Take Home Lesson

Farrokh Alemi Ph.D.Professor of Health Administration and PolicyCollege of Health and Human Services, George Mason University4400 University Drive, Fairfax, Virginia 22030703 993 1929 [email protected]

Scope of Topic

- From introduction to probability to probabilistic risk analysis
- Subjective probability assessment
- Conditional likelihood ratios
- Causal modeling
- Bayesian networks
- Time to the event assessment
- Tools you can use at work
- Logical reasoning

Not More of the Usual

- Teach by application
- Continuous distributions not covered
- Focus on contingency tables

Focus on Modeling

- Rules of probability
- Causes and effects
- Model complex tasks
- Estimated probabilities
- Check assumptions
- Ask “what if” questions

Other Books

- Feldman RM, Valdez-Flores C. Applied Probability and Stochastic Processes
- Hallenbeck W. Quantitative Risk Analysis for Environmental and Occupational Health
- Bedford T, Cooke R. Probabilistic Risk Analysis: Foundations and Methods
- Cox LA. Risk Analysis: Foundations, Models and Methods

Why Do Risk Analysis?

- Allocate resources
- Reduce
- Manage
- Insure
- Provides an organization with insight

Why Probabilistic Analysis?

- To compare one risk against another
- Consistent method of aggregating risk of a sequence of events

Why Probabilistic Analysis?

- To compare one risk against another
- Consistent method of aggregating risk of a sequence of events

Criticism of PRA

- It cannot be done because catastrophic events are rare
- It is not practical as it takes too much time
- It should not be done because it misses creative new threats

Criticism of PRA

- It cannot be done because catastrophic events are rare
- It is not practical as it takes too much time
- It should not be done because it misses creative new threats

Criticism of PRA

- It cannot be done because catastrophic events are rare
- It is not practical as it takes too much time
- It should not be done because it misses creative new threats

History in Aerospace Industry

- 1967 Apollo flight loss
- 1969 Probability of loss 1%
- 1983 probabilistic risk analysis of shuttle flights
- NASA administrators abandon PRA
- Later events proved accuracy of analysis
- Common practice

History in Nuclear Safety

- Reactor Safety study
- Three Mile Island accident
- Probability of reactor melt down
- NRC manual for risk analysis
- Assessment of other catastrophic events

History in Natural Disasters

- Earthquake predictions
- Floods and coastal designs
- Environmental pollution
- Waste disposal and environmental health

History in Healthcare

- Root causes of sentinel adverse events
- Typically not quantified risk
- Failure mode analysis of near catastrophic events
- Typically based on rank order of risks
- New drug development

Relatively

New

History in Terrorism

- Cyber terrorism risks
- Department of Homeland Security Critical Infrastructure Protection

Relatively

New

Requirements Prior to Start

- Algebra, not calculus
- Facile with numbers and counting
- Access to a software for Bayesian analysis
- Software to make contingency tables
- No prior course in probability
- No course in statistics
- No computer programming
- Some knowledge of health care systems
- Access to an organization to try out the ideas

Expectations

- Probabilistic analysis
- Apply to a realistic problem
- No exams
- No other assignments

Pedagogical Features

- Learn one, do one, teach one assignments in class
- Question and answer
- Take home message
- Peer to peer comments

Primary Audience

- Graduate course on risk analysis
- Professionals in the field

Secondary Audience

- These lectures may also be of use to students of probability and causal modeling.

Lecture Outline

- What is probability?
- Probability distributions
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

Lecture Outline

- What is probability?
- Probability distributions
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

Lecture Outline

- What is probability?
- Probability distributions
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

Lecture Outline

- What is probability?
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

Lecture Outline

- What is probability?
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

Lecture Outline

- What is probability?
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

- What is probability?
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

- What is probability?
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

- What is probability?
- Assessment of rare probabilities
- Calculus of probability
- Conditional independence
- Causal modeling
- Case based learning
- Validation of risk models
- Examples

Tools that are better than comprehensive list of risks

What Do You Know?

- Why is probabilistic risk analysis preferred to comprehensive lists of vulnerabilities?

What Do You Know?

- How is our approach to risk analysis different from other books on probability or on risk analysis?

What Do You Know?

- What is assumed and required prior to start of these lectures?

What Do You Know?

- What is expected from you prior to end of this course?

Minute Evaluations

- Please use the course web site to ask a question and rate this lecture

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