Exploring factors that affect the implementation of ERM in Healthcare
Organization in the UAE
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1. Introduction
Over the recent past, the healthcare industry has increasingly adopted contemporary risk
management practices across the world (Gerard, 2020). In particular, the adoption of these
practices is informed by the need for increased security and quality in providing care to
patients (da Silva Etges et al., 2018). Besides, healthcare organizations have a general trend
to minimize inherent risks and respond to actual risk events (Gerard, 2020). In the United
Arab Emirates (UAE), healthcare organizations are exposed to numerous risks that threaten
their security systems and the quality of care and services offered to patients. The nature of
operations within healthcare organizations in the UAE necessitates effective enterprise risk
management to reduce the vulnerability of organizational systems. According to Carroll
(2016), effective enterprise risk management systems facilitate accurate consideration of all
risks and opportunities in organizational operations. Ultimately, healthcare organizations
within the UAE have numerous opportunities for the implementation of sound enterprise risk
management systems.
The emergence and subsequent declaration of the COVID-19 pandemic by the World
Health Organization (WHO) revealed underlying weakness in the global public health systems.
Healthcare organizations increasingly face challenges and risks that require appropriate
corporate governance strategies to identify and analyze risks and implement frameworks that
protect strategic organizational objectives. The UAE government remains committed to
developing a world-class health system that provides quality healthcare and improves health
outcomes to the population as the primary objective. The UAE is inherently a young nation,
and accomplishing the strategic objectives requires substantial investment into established
corporate governance to ensure alignment with the proposed objectives. Therefore, this
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current research will explore the possibility of an enterprise risk management (ERM)
framework that is based on strategic corporate governance, communicational efficacy, and
healthcare organization structures to ensure coherence across all seven Emirates (Wynia &
Osborn, 2010). The rapid advancement of the healthcare system stems from rapid economic
growth, resulting in increased healthcare facilities, professionals, and service levels in the
country. However, there is a need to ensure the extant resources are appropriately used by
mitigating potential risks and adversities through strategic management.
The improvement of the healthcare system in the UAE and enhanced healthcare
outcomes is a crucial objective. The enhanced health outcomes entail increased life
expectancy and reduced mortality. Still, there are infrastructural and organizational
structures that include appropriate regulations and policies requiring all healthcare facilities
to obtain external accreditation (Koornneff, Robben & Blair, 2017). Essentially, the healthcare
sector is vulnerable due to heavy involvement in patient confidential information, nature of
operations, and time constraints. The industry faces unprecedented risks such as cyber
threats, physical attacks, regulatory compliance lapse, healthcare illness, privacy, and
information security issues. The multifaceted nature of the risks requires stakeholders and
policymakers to incorporate an efficacious ERM framework that fosters collaboration and
communication to identify and mitigate risks based on the perceived threat to organizational
objectives. ERM frameworks help improve economic, financial, and non-financial
performance and assist in resource management, including the intellectual capital available
to healthcare organizations in the UAE. Besides, risk management in UAE using the proposed
ERM framework will help detect, monitor, assess, mitigate, and prevent risks to the clinical
and administrative systems and processes.
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The deployment of risk management strategies, more so an ERM process, is critical for
healthcare organizations in the UAE. The proposed ERM is based on corporate governance,
education, and qualitative/quantitative risk assessment frameworks. The strategy allows
strategic management of healthcare organizations while ensuring compliance and financial
control to ensure organizational resources are well-utilized. The ERM framework is based on
an economic healthcare process with fundamental components of risk management. The
framework advocates for identifying and delegating micro-processes to management teams
responsible for attaining defined strategic objectives. Subsequently, the management teams
will be responsible for identifying risk events for all critical processes that threaten the
organizational goals. Subsequently, the management teams should promote staff education
on the risk events. Still, the framework requires analysis and ranking of critical risk events
using a multi-criteria decision analysis based on the impact to develop the potential treatment
and monitoring strategy. The treatment and monitoring strategies based on the estimates of
the impact and urgency of the risks are backed by the promotion of risk education practices
and communication across all organization levels (Burtscher et al., 2020). Risk assessment
frameworks or techniques, as described in Figure 1, vary from qualitative to quantitative. The
amount of data required, and level of difficulty is much higher in quantitative than in
qualitative techniques (“Enterprise Risk Management: Tools and Techniques for Effective
Implementation | SSWM – Find tools for sustainable sanitation and water management!”,
2021).
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Level of difficulty and amount of data required.
Figure 1. Qualitative and Quantitative Techniques in Risk Assessment, adopted from Enterprise Risk Management: Tools and
Techniques for Effective Implementation | SSWM – Find tools for sustainable sanitation and water management!”, 2021).
2. Background and Context of ERM in UAE Healthcare services
Currently, the UAE government is significantly aspiring to develop a global competitive
healthcare system. According to Koornneef et al. (2017), the government has adopted the
application of ERM to enhance healthcare services qualities for improved health outcomes
for its people.
However, UAE does not have a specific framework followed when addressing
healthcare risks but uses ERM depending on the nature of the risk that needs to be addressed.
An example of the current situation of ERM in the UAE, can be explained by looking at how
the nations addressed the COVID-19 pandemic, which has threatened their healthcare
Qualitative
Risk identification
Risk rankings.
Risk maps.
Risk maps with impact
and likelihood.
Risks mapped to
objectives or divisions.
Identification of risk
correlations.
Qualitative/Quantitative
Validation of risk
impact.
Validation of risk
likelihood.
Validation of
correlations.
Risk-corrected
revenues.
Gain/loss curves.
Tornado charts.
Scenario analysis.
Benchmarking.
Net present value.
Traditional measures.
Quantitative
Problastic techniques:
Cash flow at risk.
Earnings at risk.
Earnings distributions.
EPS distributions.
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facilities. Hasan et al. (2021) argue that UAE deployed data-driven modeling and forecasting
as a comprehensive framework to make informed clinical decisions to curb the COVID-19
pandemic. The country has completed more than 4.9 million COVID-19 tests, which is the
primary source of data for the ERM process (Hasan et al., 2021). ERM in UAE healthcare
facilities extended to the development of protective decisions like the closure of learning
institutions, place of worship, night curfew, and restricted movement within the country.
Paying attention to this form of ERM in UAE healthcare was dependent on the situation
created by COVID-19. Hasan et al. (2021) stipulate that the adoption of movement
restrictions, isolation, and a more comprehensive National Screening Program in the COVID19 ERM dramatically reduced the daily reported cases. They conclude that the United Arab
Emirates lacks a specific ERM framework but addresses healthcare risks depending on their
nature.
The UAE has made a substantial investment in healthcare over the last decade. The
government identified quality healthcare as a core value and objective for the nation. Ever
since the country gained independence in 1971, the government has focused on developing
healthcare infrastructure in line with international standards. However, the country’s health
issues are similar to those faced by the developed world, such as the prevalence of conditions
caused by sedentary lifestyles and fast food consumption. Healthcare in the country is divided
between public and private healthcare providers. However, the entire system experiences
challenges in keeping up with immigration-driven population growth and cost increase per
capita in healthcare spending from increased morbidity, affluence, and chronic diseases. Still,
healthcare goals in the country are under the direction of the Ministry of Health and
Prevention (MOHAP), and the evolution of healthcare services to offer quality care and
improve outcomes is still a top priority in all seven Emirates. For instance, Ras Al Khaimah and
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Fujairah act as distinctive and preeminent destinations for quality healthcare due to quality
infrastructure capitulated with foreign partnerships and investments (Moonesar, Elsholkamy
& Sayani, 2019). Additionally, healthcare development and spending in the UAE reveals the
country’s situation. Thus, the need for a quality healthcare system is a federal diversification
plan aimed at improving health system planning and ensure availability, accessibility, and
quality healthcare services.
The distinctive aspect of UAE’s healthcare sector is the commitment by Federal and
individual-emirate governments through significant and strategic investments intended to
boost the healthcare sector. Despite the numerous resources and investments by the
government, the UAE has a relatively small population which hinders substantial investment
in specialty care practices and gaps such as women’s care, oncology, pediatrics, and diabetes
care. Traditionally, such specialized care was obtained outside the UAE in countries such as
Singapore, India, Thailand, and North America, which is inherently expensive. The
government has focused on creating opportunities for US healthcare organizations hoping
that such partnerships will obliterate the need to travel to the country for quality care. For
instance, there is a high demand for medical supplies, equipment, and management
expertise, including cardiovascular medical devices. The demand reveals an inherent
vulnerability and lack of appropriate information technology infrastructure and supply chain
management challenges, which are opportunities for investors but challenges for the UAE’s
healthcare sector (Sittig et al., 2020). Therefore, the healthcare sector in the country has
untapped potential mainly propagated by barriers to international partnerships such as
inconsistencies in pharmaceutical pricing, outdated medical malpractice policies, inconsistent
licensing and insurance processes, unavailable medical information, and insufficient
healthcare education and training.
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The UAE is increasingly emerging as a popular tourist destination, and medical tourism
is an emergent niche that attracts health tourists and holidaymakers. However, medical
tourists are often motivated by various factors, including affordability, long waiting lists, local
regulations, privacy and opportunity to travel, religious restrictions, combining wellness with
vacation and insurance agencies. Despite the substantial health investments by the
government, the country is currently exploring ways to market the UAE as a medical tourist
destination. The weaknesses are barriers to advancements and risks for healthcare
organizations while risking government and private investments in the country’s healthcare
sector. Policymakers and corporate governance of healthcare organizations must collaborate
and cooperate through strategic decision-making to align the progress of UAE’s healthcare
sector to have an internationally accepted healthcare system (Turner & Wright, 2021).
Besides building national policies, a new threat looms across the global healthcare sector due
to incorporating health information technology as a mainstream and critical resource for
sustainable growth. The introduction of health information technology (IT) in the UAE is
aligned with improving care delivery but has introduced unintended risks and new challenges.
The safety of health IT in the clinical setting is a critical challenge that threatens the strategic
objectives and reputation of the UAE’s healthcare sector.
3. Existing Gap and Research Problem
The potential for the adoption of enterprise risk management systems in UAE healthcare
organizations is expansive. Indeed, effective ERM contributes to holistic frameworks through
which risk management decisions are achieved. There is an inherent need for systems of risk
management that reduce risk and uncertainty, thereby maximizing value creation and
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protection within healthcare organizations. While most healthcare organizations in UAE have
structured risk management systems, they do not meet the specific goals and objectives of
the management. In part, most of these approaches have a traditional focus on clinical events
through reactive strategies for risk management (Almansoori and Ali, 2020). Almansoori and
Ali (2020) further explained the dynamic nature of modern healthcare organizations
necessitates the integration of systems that underline the significance of shared
responsibilities in the identification, mitigation, and management of risks. While some
healthcare organizations have benefitted from the implementation of enterprise risk
management systems, they have been limited in their efficiency based on ineffective and
unresponsive models.
This dissertation proposes expanding the role of risk management across the
organization, hospitals and other healthcare facilities are adopting an ERM framework which
is a more holistic approach. ERM includes the traditional aspects of risk management,
currently followed by the healthcare organization, which includes patient safety and medical
liability however, it also expands involves the big picture approach to risk across the
organization (“What Is Risk Management in Healthcare?”, 2021).
According to the American Society for Healthcare Risk Management ( ASHRM),
Enterprise risk management in healthcare promotes a comprehensive framework for making
risk management decisions which maximize value protection and creation by managing risk
and uncertainty and their connections to total value. ASHRM also has identified eight main
domains that make up ERM in healthcare. The domains are mentioned in Figure (2).
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Figure 2. The Eight Risk Domains of Enterprise Risk Management
Operational
Clinical/patient
safety
Strategic
Financial
Human
Capital
Legal/Regulatory
Technology
Hazard
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The dissertation objectives are 1) to understand the current state of ERM in health care
organizations, 2) to explore the factors that lead to different implementations level.
This dissertation is adopting an ERM framework (Figure 3) from the literature (da Silva Etges,
Grenon, de Souza, Kliemann Neto & Felix, 2018).
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Figure 3. E 2 RM health care -Economic Enterprise Risk Management in Health Care.
Enterprise Risk Management for Healthcare
Critical risk evets analyzed and ranked using Multi-Criteria Decision
Analysis
Education of all staff on risk events
Identification and Anlysis
Step 1: Identification of macroprocesses and management
teams responsible for the attainment of the strategic
objectives.
Step 2: Identifiicationof risk events for each critical process that
threatens the achievement of the strategic objectives.
Corporate Governance
Institutional Strategic Management
Compliance and Finanicial Control
Risk education practices and
communication established at
all levels of the organization.
Treatment: Development of short and long term action plans.
Monitoring: Risk owner definition leading to service level
agreements between risk owner and ERM.
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Healthcare organizations in the UAE must acknowledge the responsibilities and
predispositions of operating in a dynamic health environment and the role of the external
environment in achieving national objectives. The external environment requires a critical
assessment of threat levels and opportunity factors to inform the decision-making process,
and corporate governance strategies hence align the organizational objectives with the
identified needs. Besides, the external environment, such as economic situations and
regulatory requirements, are paradigmatically beyond the control of most healthcare
environments. However, it is crucial to ensure appropriate resource management as the
external environment encapsulates numerous situational factors and considerations that
must inform healthcare organizational activities. For instance, the advancement of medical
tourism in the UAE is inextricably tied to compliance with international health practices and
tourism destinations. Essentially, medical malpractice and failure to comply with regulations
have numerous political, economic, and legal implications (Jacob et al., 2010). Moreover,
policymakers must develop strategies that mitigate increased drug abuse and overdoses of
over-the-counter medications throughout the country, but the factors are beyond the scope
of healthcare organizations. An ERM framework can help analyze the threat levels and
counter the latter by distributing drugs to responsible pharmacies and hospitals to avoid
lawsuits and improve logistical efficacy across the seven Emirates.
The advent of health information technology posits numerous threats to the
healthcare infrastructure in general. The rapid growth of the healthcare system in the UAE
has amassed international attention, prompting cybercriminals to target the extant
infrastructure. Despite advancements in cyber-security defense mechanisms, the UAE is a
potential target for malicious and highly skilled actors for various reasons, such as stealing
patient information and perpetuating system failures or incompetence for personal, financial,
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or political reasons. The extant incompetence in most organizations in cyber-security
decision-making emanates from a pronounced gap in information and knowledge among the
involved stakeholders. Subsequently, healthcare organizations in the UAE require a corporate
governance framework that fosters effective offensive, defensive, and education awareness
campaigns on cybersecurity threats in the healthcare infrastructure and technology. Notably,
government agencies and multinational corporations often struggle to defend against cyberattacks due to the lack of enough cyber-security talent. Contemporary cybersecurity attacks
are inherently diverse and sophisticated but still expose crucial data such as personally
identifiable information to attackers. Implementing an ERM framework in UAE’s healthcare
organizations to enforce legal and informed cybersecurity policies fosters data retention, data
encryption, security management, file system security, and improved vigilance of healthcare
information technology systems.
are pronounced across numerous government, nongovernmental and private healthcare organizations. Similarly, the UAE’s focus on developing
the healthcare sector has increased attention by experts, international healthcare
organizations, and healthcare tourism. The latter reduces the communicational efficacy,
which is a substantial threat to the sustainability and viability of the healthcare system in the
country (Blair & Sharif, 2013). Moreover, the flow of information across all seven emirates
and healthcare organizations is inherently challenging. Therefore, there is a pronounced need
to integrate healthcare objectives across the country by establishing a standard and viable
communication strategies and frameworks. Communication posits threats and discrepancies
in clinical and administrative tasks in the UAE’s healthcare sector, making it difficult to align
the entire healthcare sector with national objectives and ensure compliance by all
stakeholders. For instance, healthcare institutions must focus on delivering patient-centered
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care that adheres to best practices instead of performing regular procedures and diagnoses.
The importance of communication in all healthcare processes, including clinical accuracy in
sharing patient information with professionals and organizations and collaboration on the
treatment of current and new patients, reiterates the need for concise and effective
communication. The proposed ERM strategy promotes communicational efficacy by fostering
collaboration and cooperation to mitigate risks and threats to patients and key UAE’s
healthcare infrastructure.
4. Motivation and Justification
The current dissertation is based on the realization that risk management is not a one-sizefits-all approach or proposition. Despite the universality of risks associated with healthcare
organizations, the organizational culture, and structure in the UAE is uniquely different from
that of other countries. According to The Prospect Group (2017), healthcare administration
in UAE is, to some extent, complicated with multiple authorities managing the sector from
the various free zone within the country. According to Ghebreyesus (2017), multiple nations
are dramatically adopting universal healthcare to promote accessible and affordable
healthcare coverage for all citizens. Notably, universal healthcare coverage is a primary
government project since it aims to make healthcare services accessible even to poor
communities. However, UAE Embassy in Washington, DC (2021) claims that UAE is
dramatically shifting healthcare services from public to private sectors. This is because private
providers will promote safety and efficient healthcare services to UAE residents. Furthermore,
the country has multiple types of Union Health insurances, with SANAD providing a unique
health plan for dependents with Dubai visas. Now Health International. (2021) noted that the
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expat population contributes 75% of individuals healthcare facilities. This means the biggest
population in need of healthcare services in the UAE is not citizens.
One of the key strategic goals of the UAE government since its formation in 1971, is
to improve the quality of healthcare as well as the actual health outcomes for its citizens and
residents (Koornneef et al., 2017). The Federal Ministry of Health and Prevention (MOHAP)
is responsible for licensing, regulating and quality assurance of five emirates, whilst Dubai and
Abu Dhabi have its own independent health authorities to fulfil these functions in their
respective authority (Brownie, Hunter, Aqtash & Day, 2015). The different entities
responsible of the healthcare sector in the UAE are summarized in Figure 4. Consequently,
healthcare organizations warrant a unique and different approach to risk management.
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Figure 4. Summary of Healthcare Authorities within UAE
Since the country has multiple healthcare sector administrators; hence the risk
management approach must consider how to integrate the whole administration into the
plan.
The government of Abu Dhabi, in 2006, embarked on a significant health system
reform program with a clear focus on the redesign of the healthcare financing and regulatory
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system (Koornneef, Robben, Al Seiari & Al Siksek, 2012). The regulatory function and
service provision were split into two separate entities. The Health Authority Abu Dhabi took
responsibility of regulations, and Abu Dhabi Health Service authority handled service
provision and operations of the healthcare facilities. Furthermore, the new system required
all individuals to have private health insurance and provides a centralized platform for
automated claims processing and an improved level of accountability and transparency due
to market regulation (Vetter & Boecker, 2012).
Dubai began to introduce mandatory health insurance in 2014, with about one third
of its residents currently estimated to be insured (“Investing in Quality: Healthcare in the
UAE”, 2021). MOHAP is also considering introducing health insurance but has not yet done
so.
The fragmentation of the UAE health regulatory system is considered to be a serious
challenge to the future of healthcare in the UAE, hence highlighting the importance of n ERM
system. A study by Koorneef et al. (2012), reported the lack of regulatory control and a lack
of competition between insurance companies as the two main obstacles to achieving greater
cost efficiency in the healthcare market.
Also, the fact the healthcare is being moved from public to private, the risk
management approach needs to establish how to integrate auditing to ensure private sectors
have remained ethical when handling the healthcare sector. The private sector in the
northern Emirates is less well developed when compared to Dubai and Abu Dhabi,
consequently the cost of services and the quality varies between these two Emirates and the
remainder of the country (Koornneef et al., 2017).
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The present dissertation is based on the inherent benefits of enterprise risk
management approaches in the healthcare industry. According to Gates (2016), enterprise
risk management systems are holistic in assessing risks and the associated management
practices. Still, the justification for the dissertation is informed by the need for more efficient
programs that facilitate accountability and risk oversight responsibilities within healthcare
organizations. Indeed, enterprise risk management systems have the potential of helping
healthcare organizations to accurately identify, manage, and communicate critical risks within
the scope of their operations.
Tourism, education, and healthcare are the primary diversification strategies to
reduce the UAE’s over-reliance on oil while ensuring improved quality of life for the citizens.
The health sector is intricate and requires established corporate governance practices and
coordination across all seven emirates to ensure the country achieves the desired outcomes.
Extant literature and research highlight that the UAE’s health sector has various competitive
strengths and weaknesses that require input from pivotal stakeholders to ensure strategic
management of the country’s health infrastructure (Da Silva Etges et al., 2018). The resourcebased theory asserts that proper utilization of resources is crucial for gaining a competitive
advantage and relies on corporate governance and policymakers to implement a framework
aligned with the country’s health objectives and vision. Healthcare resources are
sophisticated, and the UAE’s infrastructure might be difficult to imitate, distinguishing the
country’s health sector in the developed world. However, as the vision is not yet
accomplished, there is a need to implement various strategic initiatives to leverage a global
medical tourism hub’s acquired advantage for the future. The expanding and expanding role
of healthcare organizations jeopardizes the country’s efforts due to existing and emergent
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threats such as cybersecurity concerns, fast-paced medical science, rapidly changing
healthcare regulatory, legal, political, and financial concerns.
In the contemporary era of globalization, healthcare organizations increasingly rely on
ERM to obtain more accurate information and data to base risk management strategies. As
a relatively younger country, there is a need for transformative leadership and visional
corporate governance that capitalizes on existing opportunities while reducing the exposure
to risks in the sector through enforcing frameworks that protect critical resources and
infrastructure of the country’s healthcare system. For instance, healthcare organizations in
the UAE require specialized and advanced skills in clinical and administrative tasks as the
government intends to have world-class healthcare quality (Blair & Sharif, 2013). However,
the underlying weakness in the country’s healthcare sector is the lack of a framework and
capabilities to utilize extant resources and develop a competitive advantage. For instance,
poor management and inefficacious organizational culture of risk management will inevitably
reduce the UAE’s healthcare competitive advantage regardless of the available resources. The
proposed ERM framework promotes communicational and strategic practices crucial for
identifying and analyzing threats, weaknesses, and vulnerabilities. The approach ensures that
the involved stakeholders and management teams have a predefined system in securing and
improving critical infrastructure, policies, and practices in line with the national healthcare
objectives.
is a critical component of sustainable growth and achievement of
organizational and national healthcare objectives. Constructively, the utilization of resources
requires understanding the existing population health problems and developing frameworks
and infrastructure that gradually meet the public health demands while improving the
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country’s healthcare quality. However, the main challenge of strategic planning in the UAE is
the nationwide focus on improving healthcare. Still, there is a need for corporate governance
and leadership responsible for promoting the strategic objectives and implementing
programmable, systematic, rational, and holistic principles that incorporate the short,
medium, and long-term objectives of the healthcare organization. Subsequently, an
organization can focus on long-lasting future transformations such as improving technological
interoperability and security in the future. The proposed ERM framework focuses on the
administrative and economic risks prevalent in UAE’s healthcare organizations, such as
corporate governance, communication, cyber-security, and compliance with international
standards. For instance, the UAE should collaborate with health information technology
providers with a proven track record of empowering vulnerability exploitation and cybersecurity programs that legally and responsibly exploit and disclose vulnerabilities. However,
corporate governance might not handle all the requirements. The ERM framework advocates
the need to delegate to management teams responsible for such infrastructure to identify
risks and develop mitigation and treatment strategies.
5. Research Questions and Hypothesis
The proposed research will answer the following research questions;
RQ1. What are the main components of ERM applied in healthcare institutions in UAE?
It is expected to find statistical differences in implementing ERM across healthcare
institutions in UAE.
RQ2: What are the factors that influence the implementations across UAE healthcare
institutions?
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It is expected to find statistical associations/influences of certain factors (differential) across
UAE healthcare institutions that explain variations on the levels of ERM implementation.
Based on these research questions, the following hypothesis are derived:
H0: the level of implementation for ERM (as per a proposed model, should be driven based
on holistic approach) does not vary across healthcare institutions in UAE.
H1: the level of implementation for ERM (as per a proposed model, should be driven based
on holistic approach) varies across healthcare institutions in UAE.
H0: The observed levels of ERM implementation are not statistically associated with different
factors across UAE healthcare organizations.
H2: The observed levels of ERM implementation are statistically associated with different
factors across UAE healthcare organizations.
6. Concenptual Framework, Relevant Literature and Opertionalization
The concept of enterprise risk management is increasingly gaining prominence within
healthcare organizations across the world. In part, the absorption of enterprise risk
management systems within healthcare industries is based on the transformation of
healthcare service delivery. According to da Silva Etges (2018), the operation of healthcare
facilities has dramatically changed from a volume-based approach to a delivery model that is
more focused on value creation and sustenance. In their study on the value of risk
management systems in hospital transformation, the author found that ERMs are significant
in enhancing efficiency and quality improvement. Inherently, the need for alignment of
healthcare organizations with physicians, healthcare professionals, and other providers is
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justified through this approach. Similarly, effective enterprise risk management systems focus
on financial management and productivity that facilitate efficiency in operations. Besides
improving efficiency, effective enterprise risk management systems focus on improving
patient safety and quality of care.
The role of risk management professionals in enhancing the effective implementation
of strategies is also widely covered in the literature. As noted in Rao (2007), professionals
engaged in risk management are uniquely positioned to respond to any potential challenges
in the implementation of risk identification and management of risks. Inherently, the role of
risk managers in assessing the potential risks associated with services or practices following
their introduction within healthcare organizations. While the study focuses on the specific
role of risk managers in averting potential risks in the offer of services and the practice of
professionals, Elamir (2019) considers the value of collaborations. In their study on effective
risk management, the authors consider the necessity for collaborative efforts in managing
and identifying risks within healthcare facilities. Particularly, the study identifies the need for
aligning risk management with robust organizational programs on patient safety.
The significance of enterprise risk management systems in healthcare organizations is
based on their potential to achieve safe service delivery. According to Martin (2020),
enterprise risk management facilitates the attainment of reliable and secure healthcare
services for patients. Similarly, effective risk management can be integrated into patient
safety programs in a structured framework based on the implementation of sound ERM
systems. In addition, the approach provides an interactive platform through holistic risk
identification, treatment, and analysis. In articulating the role of enterprise risk management
in healthcare organizations, the authors are accurate in defining the superiority of proactive
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and interactive approaches over-reactive and traditional approaches. In turn, the value of
sound risk management systems is evidenced by the entrenchment of risk managements
identified principles in organizational operations. Moreover, the study also identifies the need
for realignment of risk management approaches to comply with organizational strategic
planning processes.
Still, the use of enterprise risk management systems imparts value in healthcare
organizations through holistic management. In particular, the approach provides an
opportunity for managers to apply cross-functional approaches in the assessment, evaluation,
and measurement of risks. According to Roberta (2017), the benefit of cross-functional
approaches in risk management is that it informs decision making processes. In identifying
the centrality of enterprise risk management systems, the author explores the role of recent
trends and a broader focus on corporate governance as integral in the adoption of the new
system. Accordingly, the shift from traditional and reactive approaches towards the
interactive enterprise risk management system is based on various factors, including the
developments in corporate governance. The inherent value of ERM approaches in healthcare
facilities is also responsible for the widespread adoption of the systems. Besides, the system
has the potential of improving the value of healthcare organizations through the prevention
of financial losses and enhancement of gains in reputation.
The implementation of enterprise risk management systems is also beneficial through
investments in expanded healthcare services. In turn, the concept of enterprise risk
management benefits the community and the healthcare organization. The ERM approach
goes beyond the traditional models, whose focus on avoidance, control, and risk transfer was
largely ineffective. As noted in Kaya, Ward, and Clarkson (2019), traditional risk management
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approaches emphasized the transfer of risk through insurance, among other means. Through
the insurance of services and assets, conventional methods of risk management were based
on risk control activities in safeguarding the security of organizations.
In contrast, however, enterprise risk management considers the prospects of risks as
assets by focusing on the potential for both gains and losses in activities that produce risk.
Still, the ability of enterprise risk management systems to predict and avert risks in the pursuit
of organizational profitability makes them more efficient. In this regard, therefore, enterprise
risk management has significant advantages over traditional risk management approaches.
The concept of ERM further extends beyond the identification and management of
clinical risks within healthcare organizations. According to (Zakaria et al., 2019), enterprise
risk management systems provide a platform through which potential risks are identified,
measured, and acted upon. In turn, ERM is significant to the operations of healthcare
organizations as it goes beyond mere financial losses. Instead, enterprise risk management
facilitates the solution of potential risks by increasing value for all critical players, including
suppliers, healthcare professionals, and patients. Similarly, the concept of enterprise risk
management imparts enhanced effectiveness in management, thereby providing greater
stability within the organization. In this regard, ERM systems are not limited to the alleviation
of traditional risks of loss of property or financial resources. Instead, contemporary enterprise
risk management systems are critical in sustaining positive reputations for organizations while
increasing the levels of confidence in the boards of management. In essence, ERM systems
achieve greater success in uplifting the overall image of healthcare organizations.
The potential for ERM systems to address the challenges of organizational
management in a holistic approach is also the subject of scientific studies. In Martin (2020),
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the benefits of ERM are considered in light of their potential to consider risks collectively. In
contrast, traditional approaches focused on managing risks in functional departments, with
each set of risks being explored separately. However, in enterprise risk management systems,
risks are considered interrelated, thereby necessitating collective management to maximize
operational efficiency. In their study on operational risks in the healthcare sector, the author
found that healthcare organizations are exposed to risks in the form of the conduct of their
core business. In particular, the provision of care to patients exposes healthcare organizations
to various operational risks. Moreover, the ERM system can accurately identify operational
and financial risks associated with the pursuit of an organizations core business.
Still, enterprise risk management systems are associated with increased effectiveness
in the identification of strategic risks in healthcare organizations. According to Almansoori
and Ali (2020), ERM systems have the potential of reducing the exposure of healthcare
organizations to the demerits of strategic choice such as mergers and acquisitions. Moreover,
the program provides a structured framework through which reputational risks can be
minimized by sustaining performance expectations from patients and community relations.
Carroll (2016) is accurate in asserting that effective ERM systems contribute to better
management of human capital and legal risks by limiting an organizations exposure. In part,
the minimization of occupational hazards and effective management of harassment and
discrimination through ERM systems is a significant factor in managing healthcare
organizations. Similarly, the systems have the capabilities of identifying and managing risks
associated with regulatory risks, including accreditation and compliance.
The proposed ERM Framework is designed for healthcare organizations in the United
Arab Emirates. The components allow for evaluating existing ERM practices and subsequent
Page 26
development of healthcare organizational culture and practices. Healthcare service delivery
in the 21st century is more patient-centered and requires healthcare organizations to improve
practices and systems to optimize the patient experience. The proposed ERM framework can
be combined with existing clinical risk management frameworks in the country at various
levels, including National, Emirate, and corporate levels, to improve the specificities in the
overall healthcare industry (Bodolica & Spraggon, 2014). The framework is based on
recognizing the input of numerous stakeholders such as employees in risk identification
through teamwork and corporate governance to protect the organization and align with
intended objectives. Besides, the framework obliterates existing gaps in traditional ERM
frameworks designed for specific risk events and included identified risk scenarios and
descriptions of impacts. The proposed ERM allows management teams to contribute to the
efficacy of the UAE healthcare system as it enables threat and risk analysis in numerous facets
of healthcare organizations. The risk identification and risk analysis methodologies in the ERM
are indispensable for healthcare organizations in UAE. They allow flexibility, education,
delegation, and strategic decision-making in risk treatment and mitigation.
The application of the conceptual ERM proposed in the study is subject to the strategic
positioning and objectives of the UAE Federal government. The framework supports
structural autonomy in risk management processes and fosters education and informational
support in decision making. Empirical research asserts the need for collaboration among
stakeholders with different expertise and different organizational hierarchies or roles to
develop and incorporate specific characteristics and challenges of the program to be
implemented (Bodolica & Spraggon, 2014). The ERM structure clearly defines the procedures
and prevents communicational discrepancies in risk management. It also facilitates
stakeholders and policymakers with different expertise and professional experience to share
Page 27
knowledge and develop coherent understanding and specificities of defined risk events.
Transparency is a crucial component of risk management for healthcare organizations in the
UAE, and the proposed framework allows two-way communication among healthcare staff
and policymakers in the government. Subsequently, predefined risks and potential mitigation
strategies can be easily identified and communicated to involved parties to ensure patient
care, patient experience, and healthcare organizations adopt practices aligned with the
national healthcare objectives. The approach fosters consensus and makes it easier to
develop strategies and identify potential areas of improvement in healthcare organizations in
the seven emirates hence removing inconsistencies and promoting international healthcare
standards across the United Arab Emirates.
The proposed ERM framework is built on present empirical research and is designed
to be applicable and practical in ensuring conformity among healthcare organizations in UAE.
The ERM is divided into four focus levels, including baseline, education, quantitative, and
governance, and is oriented to perform economic risk analysis (Etges et al., 2019). The levels
also allow healthcare organizations in the UAE to utilize consistent ERM practices based on
organizational needs and practices. For instance, the baseline level enables healthcare
organizations to focus on risk identification, analysis, and ranking using an analytical hierarchy
process based on multifaceted criteria decision making by the involved teams to provide more
accurate and consistent results. Healthcare organizations in the country face similar
challenges to the developed world, but the practices are relatively inconsistent across the 7
Emirates. Subsequently, an analytical hierarchy process can help prioritize risks in healthcare
and improve the decision-making process for policymakers at the corporate, Emirate, and
national levels, more so preventing risks from interfering with strategic objectives and
actions. Implementing the ERM in UAE will enable the Ministry of Health and involved
Page 28
stakeholders to capitalize on opportunities and achieve the strategic objectives by creating
healthcare value through competitive and sustainable practices.
The proposed ERM framework has the education, quantitative, and governance levels
that enable fundamental analysis and innovative risk management strategies for healthcare
organizations in the United Arab Emirates. The education level ensures health care
organizations develop educational materials and tools to foster knowledge among employees
and the organizational leadership on the identified risks. The strategy will contribute to a
widespread understanding of risks and contributes to improved communication. The
quantitative level fosters healthcare organizations to determine the economic impacts of
established risk events using existing financial data. For instance, the UAE has made
substantial investments in healthcare infrastructure, and cost-management frameworks can
be used to assess the direct and indirect impact of identified risk events on healthcare
organizations. The magnitude of the risks and potential financial implications is crucial in
prioritizing risks and developing mitigation strategies in line with the national goals by
considering variables such as costs, revenue, and allocating budget for risk treatment. The
governance level is inarguably a crucial component of ERM and focuses on communication
with stakeholders to foster corporate governance practices (Da Silva Etges et al., 2018). In the
UAE, the Ministry of Health and the board of directors of various health organizations form
corporate governance. They are at the top of the health hierarchy hence can address
weaknesses and threats in different levels and capacities through strategic decision making
in line with national health objectives.
Page 29
7. Research Design
7.1 Sampling
The selection of participants for the proposed study will be achieved through purposive
sampling. According to Sharma (2017), purposive sampling entails selecting participants
through reliance on the researchers judgment. This sampling method is relevant as it allows
the researcher only to limit the choice of participants to managers and executives from
healthcare organizations in the UAE. The managers will be drawn from seven emirates, with
two managers and executives selected from each of the seven emirates. Each of the fourteen
participants will provide responses to the questions in the survey. The initial contact with the
participants will be made through email requests before signing their informed consent form.
The participants will be notified of their voluntary participation in the research study and
allowed to opt-out at any time if they want. The research study will also comply with ethical
standards on privacy and confidentiality of participants.
7.2 Research Method
The current dissertation is based on a quantitative research design targeting healthcare
organizations in the UAE. In particular, the study will use surveys addressed to executives and
managers drawn from contemporary healthcare organizations in the UAE. According to
Callegaro and Yang (2018), the use of surveys in quantitative research designs is based on the
collection of data from a sample population. Inherently, these surveys will be utilized in
recording and describing the opinions, behaviors, and attitudes of the managers and
executives towards enterprise risk management systems in their respective healthcare
organizations. The research design will be used to provide answers regarding the proposed
research questions. The study will be based on a survey of healthcare organizations through
Page 30
their managers and top executives. In turn, the survey results will be used to analyze data on
the types of risks that are critical for healthcare organizations in the UAE. Besides, the use of
surveys effectively assesses the current status of implementation for ERM systems in
healthcare organizations.
The present study will use an explorative research design to evaluate the efficacy of
the proposed ERM in improving risk management among healthcare organizations in the UAE.
The research design will undertake three steps designed to answer the three research
questions and test the validity of the hypothesis. The first step will consist of semi-structured
interviews with open and close-ended questions with healthcare organization leaders in all
seven Emirates. The second step is a qualitative data analysis using thematic analysis on
information from the interviews to assess the inputs of healthcare organization leaders on
the feasibility of the proposed ERM framework in improving healthcare delivery in the United
Arab Emirates. The third step will be case studies on healthcare organizations’ challenges in
the UAE and how the proposed ERM frameworks can improve risk management and foster
strategic decision-making in line with national health objectives and goals.
Questionnaires will be developed based on the proposed ERM frameworks and
guidelines. Subsequently, health organization risk managers will be asked to rate the
feasibility of the proposed ERM frameworks in risk analysis, assessment, and treatment of
identified risks such as communication, cybersecurity, corporate governance, and clinical
practice in the UAE consideration to ethical principles of research. The results will be analyzed
qualitatively through thematic analysis to identify the attitudes and perceptions of risk
managers on the proposed ERM framework.
Page 31
7.3 Data Collection
The first step will consist of semi-structured interviews with open and close-ended questions
with healthcare organization leaders in all seven Emirates. The second step is a qualitative
data analysis using thematic analysis on information from the interviews to assess the inputs
of healthcare organization leaders on the feasibility of the proposed ERM framework in
improving healthcare delivery in the United Arab Emirates. The third step will be case studies
on healthcare organizations’ challenges in the UAE and how the proposed ERM frameworks
can improve risk management and foster strategic decision-making in line with national
health objectives and goals.
Questionnaires will be developed based on the proposed ERM frameworks and
guidelines. Subsequently, health organization risk managers will be asked to rate the
feasibility of the proposed ERM frameworks in risk analysis, assessment, and treatment of
identified risks such as communication, cybersecurity, corporate governance, and clinical
practice in the UAE consideration to ethical principles of research.
7.4 Data Analysis
The results will be analyzed qualitatively through thematic analysis to identify the attitudes
and perceptions of risk managers on the proposed ERM framework. Thus, to determine the
link between ERM and strategic corporate governance, communicational efficacy, and
healthcare organization structures in UAE, a regression analysis may be used.
7.5 Variables & Models
Empirical model for H1: UAE healthcare organizations have different levels of implementation
of overall ERM and/or to each component, as per revised graph on page 11 (Figure 3).
Page 32
Empirical model for H2: UAE healthcare organizations have different factors that can explain
variations on the levels of implementation of overall ERM and/or to each component, as per
revised graph on page 11 (Figure 3).
Y = + 1X1+ 2X2+ 3X3 + ,
where Y refer to levels of ERM,
X1 refer to the strategic corporate governance,
X2 communicational efficacy,
X3 healthcare organization structures, and
, ,and are constants.
Corporate governance
Compliance
Financial Control
Quality Improvement
Education
Educational
Programs &
Training
Quantitative risk assessment
Risk Register
Risk Management
Plan
ERM
Strategic corporate governance
Strategic Alignment
Resource Allocation
Stakeholders
Communicational efficacy
Interdepartmental
Intradepartmental
Healthcare organization
structures
Clinical
Managerial/Administrative
Other factors/ other elements (i.e., demographic institutional and personal factors)
The distinctive aspect
of UAE’s healthcare
sector
Page 33
8. Potential Contributions and Implication
The proposed study seeks to showcase the inefficiencies of the current status of enterprise
risk management systems in UAE healthcare organizations. In turn, the present study
proposes the adoption of a new ERM model for use in healthcare organizations. The proposed
ERM framework is based on the use of indicators to avert potential financial risks by
identifying and managing cash flow at risk (Etges et al., 2019). Indeed, healthcare
organizations are highly vulnerable to variations in cash flow because of the immediacy of
services and supplies. The implementation of this framework is likely to impart changes in the
management of risks in the healthcare sector through proactive approaches. In particular,
alleviation of risks in the healthcare sector has the implication of reducing the vulnerability of
these organizations and eventually resulting in performance improvement.
The proposed model of enterprise risk management puts the ERM department lower
than the strategic decision-making level. In turn, the position of the ERM department is
evidence of the centrality of risk management in the organizational structure. The proposal
further advances the idea of staffing the department with professionals from diverse and
multiple competencies (Etges et al., 2019). The diversity of professionals in the ERM
department is based on their mastery of routine operations in the healthcare organization. In
the positioning of the risk management department, staff has easier access to risk
management information, thereby providing sufficient information to facilitate decision
making. As part of the changes in the hierarchy proposed by the model, the top leadership
achieves unlimited access to the ERM department. In turn, this has positive implications for
the healthcare organization in terms of sustained performance and quality of care services.
Page 34
Besides, the integration of the proposed ERM model in UAE healthcare organizations
is likely to enhance the quality of services. In particular, the centrality of medical care
processes within the organizational structure helps in prioritizing patient satisfaction. In
particular, this approach is consistent with the primary goals of healthcare organizations in
providing relevant assistance to patients. By adopting a process-based approach in risk
management, healthcare organizations in the UAE can achieve greater efficiency in
identifying risks. According to Rao (2007), ERM approaches enhance the identification of risks
across all processes and their specific activities. Besides, the approach also facilitates accurate
identification of risks at the interconnections between different processes. In this regard, the
vulnerability of the organization to risks is minimized. Moreover, the ERM model considers
risks as a whole and not by limiting them to specific sectors of the organization. Through this
shift in management, organizations have the opportunity of exploiting synergies to improve
their performance across different sectors.
Still, the proposed model of the ERM program espouses the significance of value
creation in the organization. Indeed, the model facilitates interaction between creation and
protection of value through astute management of identified and perceived risks. As noted in
Etges et al. (2019), the use of sound ERM systems positively influences the determination of
costs of services offered within the healthcare organization. Through the use of the model,
healthcare organizations achieve the most accurate prices, thereby making them more
competitive and profitable in the long term. By accurately identifying economic risks in the
management of healthcare reorganizations, ERM approaches facilitate streamlining of
resource utilization to the benefit of the organization. The gains achieved from ERM systems
have the prospects of ensuring financial transparency and procedural management. Similarly,
Page 35
the proposed model is expected to contribute to the proactive identification of flaws and
opportunities for considering healthcare organizations in the UAE.
Healthcare organizations in the UAE face numerous risks in maintaining sustainability
in line with healthcare objectives developed by the Federal and Emirate governments under
the ministry of health. The challenges include promoting public health education,
communicational efficacy, cybersecurity threats due to health information technology, and
corporate governance in aligning healthcare organization practices and culture with
predefined national objectives. The UAE lacks a practical framework including leadership
committed to risk mitigation in the International healthcare sphere. For instance, a healthcare
organization problems in the seven emirates include inconsistent pharmaceutical prices,
outdated medical malpractice policies, inconsistency in license and insurance acquisition,
unavailability of an integrated nationwide medical database, and insufficient public
healthcare education and training to reduce morbidity and mortality due to sedentary
lifestyles in the country. The challenges reiterate the failure to identify threats and risks to
achieving national health objectives and the need for collaboration among policymakers in
the country in strategic decision making to align practices with national goals of having a
world-class healthcare system.
The proposed ERM framework is highly structured and promotes delegation of risk
management duties to involved parties, reducing the burden on fewer stakeholders by
distributing risk management responsibilities to management teams concerned with specific
macro-processes in the country’s healthcare system. The framework also proposes a risk
treatment and management strategy through detailed analysis on the extent and possible
adversities of identified threats and education of involved team members on the risk factors
Page 36
such as compliance issues with minimal resource utilization and wastage. The proposed ERM
can be implemented at the National and Emirate healthcare management level and in
healthcare organizations to ensure compliance and alignment of the country’s healthcare
sector with the national objectives to become a leading medical tourism destination and
improve health outcomes of the population.
Implementing the proposed ERM framework requires further research and
contextualization in line with organizational practices and national health objectives.
Although the framework allows healthcare organizations to work at the baseline and
governance levels, the latter is only viable for basic activities. However, for advanced actions
and decisions, there is a need to consult the corporate governance and Ministry of Health
guidelines to prevent further discrepancies. For instance, there is a need for coordinated
effort in maintaining consistencies across all Emirates on service delivery, medical
malpractice, pharmaceutical costs, and other regulations beyond individual healthcare
organizations. The main contribution of the proposed ERM framework is that organizations
can use multidimensional decision-making tools to rank risks and identify the best
opportunities for improvement. Moreover, the acceptance of the framework by the Ministry
of Health and respective authorities in the Emirates and other healthcare decisions can inform
numerous policy and resource management reforms in the country and ultimately ensure
transparency, accountability, and sustainability of the United Arab Emirates healthcare
objectives.
Page 37
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Wynia, M. K., & Osborn, C. Y. (2010). Health literacy and communication quality in health
care organizations. Journal of health communication, 15(S2), 102-115.
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Page 40
Appendix A. E 2 RM health care -Economic Enterprise Risk Management in Health Care.
(da Silva Etges, Grenon, de Souza, Kliemann Neto & Felix, 2018).
Page 41
Appendix B: Literature Review Summary Table
Summary Table
Discipline Resources and Studies
Healthcare in the
United Arab
Emirates
Almansoori, A. S., & Ali, M. (2020). Risk Management Measurement Models of UAE Public
Hospitals using Confirmatory Factor Analysis (CFA). Psychology and Education Journal, 57(9),
5472-5481.
Brownie, S., Hunter, L., Aqtash, S., & Day, G. (2015). Establishing Policy Foundations and
Regulatory Systems to Enhance Nursing Practice in the United Arab Emirates. Policy, Politics, &
Nursing Practice, 16(1-2), 38-50.
Moonesar, I. A., Elsholkamy, M. M., & Sayani, H. (2019). The State of UAE Healthcare Service
Delivery: Public Perceptions-Preliminary Insights.
Koornneef, E., Robben, P., Al Seiari, M., & Al Siksek, Z. (2012). Health system reform in the
Emirate of Abu Dhabi, United Arab Emirates. Health Policy, 108(2-3), 115-121.
Koornneef, E., Robben, P., & Blair, I. (2017). Progress and outcomes of health systems reform
in the United Arab Emirates: a systematic review. BMC health services research, 17(1), 1-13.
Jacob, A., Newson-Smith, M., Murphy, E., Steiner, M., & Dick, F. (2010). Sharps injuries among
health care workers in the United Arab Emirates. Occupational Medicine, 60(5), 395-397.
Blair, I., & Sharif, A. (2013). Health and health systems performance in the United Arab
Emirates. In Papers from the 38th IHF World Hospital Congress in Oslo (Vol. 49, No. 4, p. 412).
Corporate
Governance
Turner, S., & Wright, J. S. (2021). The corporatization of healthcare organizations
internationally: A scoping review of processes, impacts, and mediators. Public Administration.
Bodolica, V., & Spraggon, M. (2014). Clinical governance infrastructures and relational
mechanisms of control in healthcare organizations. Journal of Health Management, 16(2), 183-
198.
Risks
Management
Da Silva Etges, A. P. B., Grenon, V., Lu, M., Cardoso, R. B., de Souza, J. S., Neto, F. J. K., & Felix,
E. A. (2018). Development of an enterprise risk inventory for healthcare. BMC health services
research, 18(1), 1-16.
Gates, S. (2016). Incorporating strategic risk into enterprise risk management: A survey of
current corporate practice. Journal of Applied Corporate Finance, 18(4), 81-90.
Page 42
Kaya, G. K., Ward, J. R., & Clarkson, P. J. (2019). A framework to support risk assessment in
hospitals. International Journal for Quality in Health Care, 31(5), 393.
Healthcare
Information
Technology
Sittig, D. F., Wright, A., Coiera, E., Magrabi, F., Ratwani, R., Bates, D. W., & Singh, H. (2020).
Current challenges in health information technology-related patient safety. Health informatics
journal, 26(1), 181-189.
Zakaria, H., Bakar, N. A. A., Hassan, N. H., & Yaacob, S. (2019). IoT security risk management
model for secured practice in healthcare environment. Procedia Computer Science, 161, 1241-
1248.
Communication in
Healthcare
Wynia, M. K., & Osborn, C. Y. (2010). Health literacy and communication quality in health care
organizations. Journal of health communication, 15(S2), 102-115.
Burtscher, M. J., Nussbeck, F. W., Sevdalis, N., Gisin, S., & Manser, T. (2020). Coordination and
Communication in Healthcare Action Teams. Swiss Journal of Psychology.
Enterprise Risk
Management in
Healthcare
Carroll, R. (2016). Identifying risks in the realm of enterprise risk management. Journal of
healthcare risk management, 35(3), 24-30.
da Silva Etges, A. P. B., Grenon, V., de Souza, J. S., Neto, F. J. K., & Felix, E. A. (2018). ERM for
Health Care Organizations: An Economic Enterprise Risk Management Innovation Program
(E2RMhealth care). Value in health regional issues, 17, 102-108.
da Silva Etges, A. P. B., Grenon, V., Lu, M., Cardoso, R. B., de Souza, J. S., Neto, F. J. K., & Felix, E.
A. (2018). Development of an enterprise risk inventory for healthcare. BMC health services
research, 18(1), 1-16.
Etges, A. P. B. D. S., de Souza, J. S., Kliemann Neto, F. J., & Felix, E. A. (2019). A proposed
enterprise risk management model for health organizations. Journal of Risk Research, 22(4),
513-531.
Elamir, H. (2019). Enterprise risk management and bow ties: going beyond patient safety.
Business Process Management Journal.
Martin, N. (2020, July). Enabling effective oversight: Enterprise risk management and board
governance in healthcare. In Healthcare management forum (Vol. 33, No. 4, pp. 182-185). Sage
CA: Los Angeles, CA: SAGE Publications.
Roberta, C. (2017). Enterprise risk management: The impact on healthcare organizations.
Principles of risk management and patient safety, 115.
Page 43
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Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.
There is a very low likelihood that you won’t like the paper.
Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.
We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.
You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.
We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.
You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.
Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.
You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.
The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.
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You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.
Read moreEach paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.
Read moreThanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.
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