ASSESSING IMPLICATIONS OF RISK MANAGEMENT ON PERFORMANCE OF SELECTED FEDERAL HEALTH INSTITUTIONS IN SOUTH EAST, NIGERIA

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ABSTRACT


The study sought to determine the extent to which risk identification affects organizational productivity in selected federal health institutions, ascertain the extent of the relationship between risk assessment and creativity in selected federal health institutions, determine the effect of risk response strategy on innovation in selected federal health institutions, determine the nature of the relationship between risk management and organizational effectiveness in selected federal health institutions and ascertain the extent at which internal environment affects organizational growth in selected federal health institutions. The study had a population size of 4535, out of which a sample size of 553 was realised using Freund and Williams’s formula at 5% error tolerance and 95% level of confidence. Instrument used for data collection was primarily questionnaire and interview. Out of 553 copies of the questionnaire that were distributed, 506 copies were returned while 47 were not returned. The descriptive survey research design was adopted for the study. The hypotheses were tested using Pearson product moment correlation coefficient and simple linear regression statistical tools. The findings indicate that risk identification significantly affects organizational productivity in selected federal health institutions (r = 0.764; F = 418.677; t= 13.516; p= 0.05 ) . There is a significant relationship between risk assessment and creativity in selected federal health institutions (r =. 955, p < .05). Risk response strategy has a significant effect on innovation in selected federal health institutions ( r = 0.782 ; F= 4.4103; tc = 9.149 > tt = 1.96; p < 0.05). There is a positive relationship between risk management and organizational effectiveness in selected federal health institutions (r =.583, p <. 05). Internal environment significantly affects organizational growth in selected federal health institutions ( r = 0.619 ; F= 313.489; tc = 9. 744 > tt = 1.96; p < 0.05). The study concluded that risk management is a corner stone of good corporate governance which must result in to better service delivery, efficient and effective use of scarce resources .The study recommended that risk management should be a common thread throughout the entire organization. The study recommends that all health institutions should critically carryout risk management programmes, so as to enjoy inherent benefits of the programme and there should be continuous training and development programmes for those who work under risk/safety and emergence units on how to assess risk, handle risk and manage risk for organizational effectiveness and Firms should integrate risk management into their organization’s philosophy, practices and business plans rather than being viewed or practiced as a separate programme and that would allow them to see risk management as a proactive activities rather than reactive.

TABLE OF CONTENTS

List of Tables
Abstract

CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives of the Study
1.4 Research Questions
1.5  Research Hypotheses
1.6  Significance of the Study
1.7  Scope of the Study
1.8 Operational Definitions of Terms
1.9Profile of the Selected Federal Health Institutions
            References

CHAPTER TWO
REVIEW OF RELATED LITERATURE
2.1       Conceptual Framework
2.2       Uncertainty and Risk
2.3       Risk Management
2.4       Risk Management Process
2.5       Reasons for Developing Risk Management
2.6       The Risk Management Procedures
2.7       Categories of Risk Management
2.8       Benefits of an Effective Risk Management System
2.         9 Problems for Risk Management
2.         10 Critical Success Factors for Effective Risk Management
2.         11 Risk Management in a Socio-Technical System Perspective
2.         12  The Rationale for Risk Management
2.         13  Risk Regulation Regimes
2.         14  Theoretical Framework
2.         15  Empirical Review
2.         16Summary of Review of Related Literature
2.         17Gaps in the Literature on Assessing Implications of Risk Management On performance of selected Federal Health Institutions
References

CHAPTER THREE
METHODOLOGY
3.1 Research Design
3.2 Sources of Data
3.3 Area of the Study
3.4 Population of the Study
3.5 Determination of Sample Size
3.6 Description of Research Instruments
3.7 Data Analysis Techniques
3.8 Decision Rule
3.9       Validity of the Research Instrument
3.10     Reliability of the Research Instrument
References

CHAPTER FOUR
PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA Test of Hypotheses 137

CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSION AND RECOMMEDATIONS
5.1 Summary of Findings
5.2 Conclusion
5.3 Recommendations
5.4 Limitations of the Study
5.5 Contribution to Knowledge
5.6 Suggested Area For Future Research
Bibliography
Appendix
Questionnaire

CHAPTER ONE

INTRODUCTION

1.1 Background of the Study

Risk management began to be studied after World War II. Several sources (Crockford, 1982; Harrinton and Neihaus, 2003; Williams and Heins, 1995) date the origin of modern risk management to 1955-1964. Snider (1956) observes that there were no books on risk management at the time, and no university offer courses in the subject. The first two academic books were published by Mehr and Hedges (1963) and Williams and Hems (1964). Their content cover pure risk management, which excluded corporate financial risk. Risk management, has long been associated with the use of market insurance to protect individuals and companies from various losses associated with accidents (Harrington and Neihaus, 2003).

New forms of pure risk management emerged during the mid-1950s as alternative to market insurance when different types of insurance coverage became very costly and incomplete. Several business risks were costly or impossible to insure. During the 1960s, contingent planning activities were developed, and various risk prevention or self-protection activities and self-insurance instruments against some losses were put in place. Protection activities and coverage for work-related illness and accidents also arose at companies during this period (Harrington and Neihaus, 2003).

The use of derivatives as instruments to manage insurable and uninsurable risk began in the 1970s, and developed very quickly during the 1980s. It was also in the 1980s that companies began to consider financial management or risk portfolios. Financial risk management has become complementary to pure risk management for many companies. Financial institutions, including banks and insurance companies, intensified their market and credit risk management activities during the 1980s. Operational risk and liquidity risk management emerged in the 1990s (Harrington and Neihaus, 2003).

International regulation of risk also began in the 1900s. Financial institutions developed internal risk management models and capital calculation formulas to protect themselves from unanticipated risks and reduce regulatory capital. At the same time, governance of risk management became essential, integrated risk management was introduced, and the first risk manager positions were created (Harrington and Neihaus, 2003).
The concept of risk management has been used in banking and insurance services since the early 1970’s. Risk management has been an accepted practice in industries in the West since the 1900s and in hospitals in the U.S. since the mid-1970s. However, the activities related to risk management have been in place for decades without the specific name of “Risk Management.” The term risk management in the curriculum of postgraduate studies in hospital administration in Asian countries is almost absent. Yet, the graduates of these postgraduate programs will be at the helm of the hospital industry. They will have little or no appreciation of the critical importance of the continuing process of risk management in the delivery of quality care and sustainability of the hospital in the long run. Risk management activities were inducted into the health care industry in response to the growing national malpractice insurance costs (Woodfin, 2012).

Silvers (2005:2) states that “risk management is the art and science of planning, assessing, and handling future events to ensure favourable outcomes and the act or practice of dealing with risk”. Silvers (2005) cited in O’Toole, (2002) stresses that there is an increase in risk management planning by event stakeholders such as government agencies, insurance companies and sponsors. Generally speaking, risk management is the process to protect the assets and minimize financial loss to the organization. Managing risk is a proactive function. It is taking action to reduce the frequency and severity of unexpected incidents, reduce the impact of legal claims, and promote high reliability performance, system design, and the uniqueness of each patient exposes the organization to the potential for liability.


Risk management (RM) is a concept which is used in all industries, from IT related business, automobile or pharmaceutical industry, to the construction sector. Each industry has developed their own RM standards, but the general idea of the concept usually remain the same regardless of the sector. Risk is an essential part of business because firms cannot operate without taking risks. Risk is commonly associated with uncertainty, as the event may or may not occur. Risk implies exposure to uncertainty or threat (Kannan and Thangavel, 2008). Organizations operate in a web of risks which span from the cluster of natural catastrophes, failures related to human acts, breach of security, financial turmoil, unsteady business environments and project failures. An organization needs to understand its mission and articulate it clearly. This makes it easier to recognize the risks associated with the mission. Once an organization identifies its mission, it can begin its risk assessment by listing the possible risks that threaten the business with the aim of identifying high priority risks and focusing on those first (Mehr and Hedges, 1963).

Risk management is generally a part of other management systems such as quality, environmental or work environmental management systems. Some core values are common in many quality and environmental management systems viz. the commitment of all employees, customer focus, management commitment, focus on process, continuous improvement and fact-based decisions. Risk management is a crucial part of the total project management system regardless of the focus on quality, environment or work environment (Kannan and Thangavel, 2008).

Risk management is viewed as a corner stone of good corporate governance and therefore results in better service delivery, more efficient and effective use of scarce resources and better project management (Collier et al., 2007). It has to do with identification, analysis and control of such risks that threaten resources, assets, personnel and the earning capacity of a company (Dorfman, 2007).

According to Dorfman (2007), risk management is the logical development and implementation of a plan to deal with potential losses. It is important for an organization to put in place risk management programmes so as to manage its exposure to risks as well as protect its assets. The essence is to prepare ahead of time on how to control and finance losses before they occur. Dorfman continues to say that risk management is a strategy of pre-loss planning for pre-loss resources.

Risk management is: “a process of understanding and managing the risks that the entity is inevitably subject to in attempting to achieve its corporate objectives. For management purposes, risks are usually divided into categories such as operational, financial, legal compliance, information and personnel. One example of an integrated solution to risk management is enterprise risk management” (CIMA, 2005).

Enterprise Risk Management deals with risks and opportunities affecting value creation or preservation, defined as “a process, effected by an entity’s board of directors, management and other personnel, applied in strategy setting and across the enterprise, designed to identify potential events that may affect the entity and manage risks to be within its risk appetite, to provide reasonable assurance regarding the achievement of entity objectives” (COSO, 2004)......

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