Introduction to Risk Introduction to Risk Analysis in HealthcareAnalysis in Healthcare

Farrokh Alemi Ph.D.Farrokh Alemi Ph.D.Professor of Health Administration and PolicyProfessor of Health Administration and Policy

College of Health and Human Services, George Mason UniversityCollege of Health and Human Services, George Mason University4400 University Drive, Fairfax, Virginia 220304400 University Drive, Fairfax, Virginia 22030

703 993 1929 703 993 1929 falemi@gmu.edufalemi@gmu.edu

Scope of TopicScope of Topic

From introduction to probability From introduction to probability to probabilistic risk analysis to probabilistic risk analysis Subjective probability assessmentSubjective probability assessment Conditional likelihood ratiosConditional likelihood ratios Causal modelingCausal modeling Bayesian networksBayesian networks Time to the event assessmentTime to the event assessment

Tools you can use at work Tools you can use at work Logical reasoningLogical reasoning

Not More of the UsualNot More of the Usual

Teach by application Teach by application Continuous distributions not Continuous distributions not

coveredcovered Focus on contingency tablesFocus on contingency tables

Focus on ModelingFocus on Modeling

Rules of probability Rules of probability Causes and effectsCauses and effects

Model complex tasksModel complex tasks Estimated probabilitiesEstimated probabilities Check assumptionsCheck assumptions Ask “what if” questionsAsk “what if” questions

Other BooksOther Books

Feldman RM, Valdez-Flores C. Feldman RM, Valdez-Flores C. Applied Probability and Applied Probability and Stochastic ProcessesStochastic Processes

Hallenbeck W. Quantitative Risk Hallenbeck W. Quantitative Risk Analysis for Environmental and Analysis for Environmental and Occupational HealthOccupational Health

Bedford T, Cooke R. Bedford T, Cooke R. Probabilistic Risk Analysis: Probabilistic Risk Analysis: Foundations and MethodsFoundations and Methods

Cox LA. Risk Analysis: Cox LA. Risk Analysis: Foundations, Models and Foundations, Models and MethodsMethods

Why Do Risk Analysis?Why Do Risk Analysis?

Allocate resourcesAllocate resources ReduceReduce ManageManage InsureInsure

Provides an organization with Provides an organization with insightinsight

Why Probabilistic Analysis?Why Probabilistic Analysis?

To compare one risk against To compare one risk against anotheranother

Consistent method of Consistent method of aggregating risk of a sequence aggregating risk of a sequence of eventsof events

Why Probabilistic Analysis?Why Probabilistic Analysis?

To compare one risk against To compare one risk against anotheranother

Consistent method of Consistent method of aggregating risk of a sequence aggregating risk of a sequence of eventsof events

Criticism of PRACriticism of PRA

1.1. It It cannot be donecannot be done because because catastrophic events are rarecatastrophic events are rare

2.2. It is It is not practicalnot practical as it takes as it takes too much timetoo much time

3.3. It It should not be doneshould not be done because it misses creative because it misses creative new threats new threats

Criticism of PRACriticism of PRA

1.1. It It cannot be donecannot be done because because catastrophic events are rarecatastrophic events are rare

2.2. It is It is not practicalnot practical as it takes as it takes too much timetoo much time

3.3. It It should not be doneshould not be done because it misses creative because it misses creative new threats new threats

Criticism of PRACriticism of PRA

1.1. It It cannot be donecannot be done because because catastrophic events are rarecatastrophic events are rare

2.2. It is It is not practicalnot practical as it takes as it takes too much timetoo much time

3.3. It It should not be doneshould not be done because it misses creative because it misses creative new threats new threats

History in Aerospace IndustryHistory in Aerospace Industry

1967 Apollo flight loss1967 Apollo flight loss 1969 Probability of loss 1%1969 Probability of loss 1% 1983 probabilistic risk analysis 1983 probabilistic risk analysis

of shuttle flightsof shuttle flights NASA administrators abandon NASA administrators abandon

PRAPRA Later events proved accuracy of Later events proved accuracy of

analysisanalysis Common practiceCommon practice

History in Nuclear SafetyHistory in Nuclear Safety

Reactor Safety studyReactor Safety study Three Mile Island accidentThree Mile Island accident Probability of reactor melt downProbability of reactor melt down NRC manual for risk analysisNRC manual for risk analysis Assessment of other Assessment of other

catastrophic eventscatastrophic events

History in Natural DisastersHistory in Natural Disasters

Earthquake predictionsEarthquake predictions Floods and coastal designsFloods and coastal designs Environmental pollutionEnvironmental pollution Waste disposal and Waste disposal and

environmental healthenvironmental health

History in HealthcareHistory in Healthcare

Root causes of sentinel adverse Root causes of sentinel adverse eventsevents Typically not quantified riskTypically not quantified risk

Failure mode analysis of near Failure mode analysis of near catastrophic eventscatastrophic events Typically based on rank order of Typically based on rank order of

risksrisks New drug developmentNew drug development

History in TerrorismHistory in Terrorism

Cyber terrorism risksCyber terrorism risks Department of Homeland Department of Homeland

Security Critical Infrastructure Security Critical Infrastructure ProtectionProtection

Requirements Prior to StartRequirements Prior to Start

Algebra, not calculusAlgebra, not calculus Facile with numbers and countingFacile with numbers and counting Access to a software for Bayesian analysisAccess to a software for Bayesian analysis Software to make contingency tablesSoftware to make contingency tables No prior course in probabilityNo prior course in probability No course in statisticsNo course in statistics No computer programmingNo computer programming Some knowledge of health care systemsSome knowledge of health care systems Access to an organization to try out the Access to an organization to try out the

ideasideas

ExpectationsExpectations

Probabilistic analysisProbabilistic analysis Apply to a realistic problem Apply to a realistic problem No examsNo exams No other assignmentsNo other assignments

Pedagogical FeaturesPedagogical Features

Learn one, do one, teach one Learn one, do one, teach one assignments in class assignments in class

Question and answerQuestion and answer Take home messageTake home message Peer to peer commentsPeer to peer comments

Primary AudiencePrimary Audience

Graduate course on risk Graduate course on risk analysisanalysis

Professionals in the fieldProfessionals in the field

Secondary AudienceSecondary Audience

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

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?2.2. Probability distributionsProbability distributions3.3. Assessment of rare probabilitiesAssessment of rare probabilities4.4. Calculus of probabilityCalculus of probability5.5. Conditional independence Conditional independence 6.6. Causal modelingCausal modeling7.7. Case based learningCase based learning8.8. Validation of risk modelsValidation of risk models9.9. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?2.2. Probability distributionsProbability distributions3.3. Assessment of rare probabilitiesAssessment of rare probabilities4.4. Calculus of probabilityCalculus of probability5.5. Conditional independence Conditional independence 6.6. Causal modelingCausal modeling7.7. Case based learningCase based learning8.8. Validation of risk modelsValidation of risk models9.9. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?2.2. Probability distributionsProbability distributions3.3. Assessment of rare probabilitiesAssessment of rare probabilities4.4. Calculus of probabilityCalculus of probability5.5. Conditional independence Conditional independence 6.6. Causal modelingCausal modeling7.7. Case based learningCase based learning8.8. Validation of risk modelsValidation of risk models9.9. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?

2.2. Assessment of rare probabilitiesAssessment of rare probabilities

3.3. Calculus of probabilityCalculus of probability

4.4. Conditional independence Conditional independence

5.5. Causal modelingCausal modeling

6.6. Case based learningCase based learning

7.7. Validation of risk modelsValidation of risk models

8.8. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?

2.2. Assessment of rare probabilitiesAssessment of rare probabilities

3.3. Calculus of probabilityCalculus of probability

4.4. Conditional independence Conditional independence

5.5. Causal modelingCausal modeling

6.6. Case based learningCase based learning

7.7. Validation of risk modelsValidation of risk models

8.8. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?

2.2. Assessment of rare probabilitiesAssessment of rare probabilities

3.3. Calculus of probabilityCalculus of probability

4.4. Conditional independenceConditional independence

5.5. Causal modelingCausal modeling

6.6. Case based learningCase based learning

7.7. Validation of risk modelsValidation of risk models

8.8. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?

2.2. Assessment of rare probabilitiesAssessment of rare probabilities

3.3. Calculus of probabilityCalculus of probability

4.4. Conditional independence Conditional independence

5.5. Causal modelingCausal modeling

6.6. Case based learningCase based learning

7.7. Validation of risk modelsValidation of risk models

8.8. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?

2.2. Assessment of rare probabilitiesAssessment of rare probabilities

3.3. Calculus of probabilityCalculus of probability

4.4. Conditional independence Conditional independence

5.5. Causal modelingCausal modeling

6.6. Case based learningCase based learning

7.7. Validation of risk modelsValidation of risk models

8.8. Examples Examples

Lecture OutlineLecture Outline

1.1. What is probability?What is probability?

2.2. Assessment of rare probabilitiesAssessment of rare probabilities

3.3. Calculus of probabilityCalculus of probability

4.4. Conditional independence Conditional independence

5.5. Causal modelingCausal modeling

6.6. Case based learningCase based learning

7.7. Validation of risk modelsValidation of risk models

8.8. Examples Examples

Take Home LessonTake Home Lesson

Tools that are better than Tools that are better than comprehensive list of riskscomprehensive list of risks

What Do You Know?What Do You Know?

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

What Do You Know?What Do You Know?

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

What Do You Know?What Do You Know?

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

What Do You Know?What Do You Know?

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

Minute EvaluationsMinute Evaluations

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