Very rarely do human efforts to identify, assess, and control risks progress from their roots in moral law. However, the world seems to continue to move synchronously towards an amoral situation of "economy, efficiency and a sense of acting diligently." Caught in this sort of "crossfire" for our purposes, controlling health risks has to decide on an alternative. The systematic (enveloping) approach to risks provides a functional methodology for translating moral arguments into the traditional language of management that is well understood, such as cost, performance, and timelines.
Human life is so ephemeral. Its duration varies from culture to culture, from generation to generation and according to the occupation of the individual. Until a rational solution has been developed, to eliminate human mortality, a considerable effort has been deployed throughout history to extend the average life expectancy.
Given the inexorable fact that we must all die, we prefer to control both the time and the conditions in which death will occur. The primary forces are organized in such an order that such control can be called “health risks” while the lack of control of such health risks is represented by disease and, subsequently, death. We are assuming "disease" the antithesis of health, understanding by this last expression the health condition per se and bodily injury. Both preventive medicine and precautions taken against the occurrence of accidents can be considered as activities to control health risks.
The Worry of the Western World
The Judeo-Christian heritage of Western civilization provides us with a rigorous moral foundation of concern for the well-being of the individual. Denying the religious and moral roots of concern about the dangers and risks of health would not only be historically inaccurate, but also, certainly, a great ignorance of the subject. In fact, the health care industry, as an example in the United States, is still grounded in its deep-rooted Judeo-Christian concerns for the individual.
Caring for human health could indeed have been maintained as a moral responsibility had it not been for emerging and growing economic pressures. After all, one of the virtues of moral concern is that it knows no economic limits. Saving a child's life under difficulty or urgency can appeal to the mainstream media headlines and very often will result in sometimes futile and untimely spending of huge amounts of money. However, someone does not appear to file a claim for having incurred such exorbitant expense.
No one pretends to be insensitive to human life. Even to think of establishing an economic cost to human life is abominable and detestable for the people of the western world. Everything we can see, touch, hear, taste and smell can be subsequently charged. Beyond this, even the life of a person himself in some way and to some extent, within a weighted but unequivocally relative subjectivity, could also be priced. Thus, it seems that the historically moral concern, from which health care emerged, is in contrast to the reality of the economic world in which we now live.
This opposition between morality and economic precepts has presented a dilemma to those responsible for dispensing health. As medical technology progresses, the rate for its products and services also grows correlatively, exponentially and in real values. It is true that while medical advancement, particularly in electronic and especially cybernetic equipment, alleviates human suffering and extends life itself, there seems to be no moral way to measure the cost-effectiveness of these technological advances.
The Superstructure of Morality
To stop recognizing the subtle displacement, from morality to the economy in recent decades and especially in those spheres responsible for industrial security, is to insist on continuing on the path of a moralistic philosophy that has no practical applicability. Relying almost exclusively on slogans and posters in the media, simplistic and offensive to human intelligence, continues to build a moralistic superstructure on the true foundations and foundations of morality. Scourge the obvious in meetings held on safety (preventive medicine and occupational hygiene), just because it is, again, that "routine date of the month", and not, rather, because it refers to some new and useful information that it is important to reveal and assimilate,it is not an attitude that contributes to the reversal of the randomness of health risks.
There is no possible measure that allows us to take a reading of the effectiveness of Superstructure of Moralism, nor is there a tool to justify the assumptions attributed to it. Apart from the historical precedent, there is also no rationality to maintain the continuity of its existence. The Moralism Superstructure, long involved with occupational safety, stands on the brink of collapse.
Legal assault
In recent years, a factor has emerged that additionally interferes with the concepts of morality and economics. This refers to the laws. In the early 1960s, the concept of product liability emerged, as well as a corollary of legal responsibilities pertaining to services. Today, there is a litigation explosion that alienates American society. Fear of litigation arising from medical malpractice has led physicians and medical-hospital centers, as well as their support staff, to make financial decisions that would otherwise be unjustified.
Obviously, it is in the precinct of the courts of that country where the cost of human life is established, one by one. Skilled lawyers weave together arguments that stray from moral and economic views after searching for the loot that underlies the life of a human being.
We are, therefore, at the center of the health care organization. After looking at the dispute between these three forces, morality, economy and legality, it is not at all strange to see that health workers are found to be exhausted, bitter and cynical. There does not appear to be any expectation of success for these workers. If they showed great appreciation and concern for their patients, they would either go bankrupt or have the government harassing them to optimize health costs.
Then, if doctors make and execute economically efficient decisions, they are blamed for ruthless and cold attitudes. Finally, it doesn't matter what they do, morally or financially, since they can be sued for the most capricious motivations the vast majority of the time.
The Morality Results Template
The moral foundations for the control of health risks are kept safe and should be. This is demonstrated by the high ideals and values that we hold as strongly as if it were the mark of a great civilization. If morality serves well as a foundation, why shouldn't this be the only risk control tool? There are many reasons.
First, we all agree with the moral argument that "… no one should be a victim of a health risk…". With such an unobjectionable consensus, why are there still victims of health risks then? Because this consensus does not guide us to conclusions that should inevitably refer to the health risks themselves. There remains, in this way, a wide gap between the general consensus and the specific action to be implemented. Meanwhile, the moralists mistakenly feel that they have succeeded as soon as they receive 100% support for the aforementioned argument.
Health risks, unfortunately, continue to exist and threaten us progressively as they always have.
Second, that worn out and moralistic saying that "… security is or should be everyone's concern…" has virtually guaranteed that security does not concern anyone. After all, if something can be done by everyone, this, in principle, should be very simple. Something so simple does not seem to be important. Therefore, nobody pays attention to it.
Third, within a range of considerations related to the previous point, it is very difficult to hire highly qualified personnel in security organizations, because management frequently perceives risk control as something that anyone can do, since “… everything the world is concerned… ”, referring to“ safety ”and, in particular, that applied to health risks. Meanwhile, the complexity of this world is changing rapidly, introducing risks that are subtly increasing in our lives, in their frequency, severity and complexity, and, therefore, requiring of us a very specialized and capable personnel to control them.
Fourth, this is perhaps the most important aspect, which refers to decision-makers who cannot assign resources consistent with the moral argument. These people are frustrated by an axiom that is always present and irrefutable, one that they personally endorse, along with everyone else, without having in their minds a practical resource on how to objectively resolve it.
Managers, whether from circuses, churches, or corporations, only work in three dimensions, such as cost, performance, and timelines. Morality must be translated into these three dimensions before risk control becomes an integral part of the management process.
Systemic Strategy Against Risk
The failure of morality as a resource to control health risks has been established. However, the recognition of this situation of failure has structured a scenario or environment for the successful introduction and adaptation of the Systems Methodology ("systemic"), to address this serious challenge, as an optimization tool to resolve the relative conflictive forces to morality, economy and legality.
The central idea of Systems Methodology ("systemic") is the concept of observing all aspects of a situation simultaneously, rather than separately or sequentially. This is sometimes called "Holistic Thought". Through the implementation of this tool, efforts are made to overcome the weakness in specialization, through the recognition that the "whole" is more than the sum of its parts and that the parts acquire certain particular characteristics due to their existence in that "whole". "
Partial alteration in a patient's healthcare will induce change, to varying degrees, where that specific patient care is involved, as all facets are inexorably and intricately linked together.
Previously, it was established that the control of health risks had two aspects: Preventive Medicine and Accident Prevention. The first criterion focuses on the disease and the second refers to bodily injury by accident. Obviously, under the criteria of a Systems Methodology and, to control a disease or illness, both aspects must be covered and done before the occurrence of the illness or injury inferred by the occupational accident.
The implementation of the Systems Methodology in this type of environment is widely documented by the American schools (guilds or professional associations) of hospital administrators. In this particular application, preventive medicine is not addressed because it is beyond the reach of the hospital or clinic administrator. However, in an industrial application, by way of illustration, the same methodology could and should be extended to cover preventive medicine as if it were the prevention of occupational accidents.
A Word of Caution
A word of caution regarding preventive medicine must be formulated at this time. There are some reasons why the applications of Systems Methodology, for preventive medicine, would lag behind those precautions in relation to accident prevention per se, namely:
- The causes of illness are generally more subtle. For example, they cannot be identified as easily as the causes of accidents. Our society is better conditioned. As an illustration, through a process of opposition that seeks the causes of accidents, rather than delineating the causes of the disease, especially within an industrial setting, accidents that occur in the workplace are seen as intrinsically related to work while a worker's illness is less likely to be viewed the same way. Most managers would be very reluctant to accept responsibility for employee illnesses,fundamentally because almost all of them cannot impose preventive medicine measures as quickly as they could control the factors that cause accidents in the work environment. Before attempting to apply the Systems Methodology to the health risk control strategy, it is crucial to define the concepts of risk and danger. In a typically industrial environment, a hazard is "… a condition, actual or potential, that can result in injury or death to personnel or damage to or loss of material property or reputation…". Because health risks are a subgroup of all risks, then the definition will apply only to the portion concerning "bodily injury" and "death".Before attempting to apply the Systems Methodology to the health risk control strategy, it is crucial to define the concepts of risk and danger. In a typically industrial environment, a hazard is "… a condition, actual or potential, that can result in injury or death to personnel or damage to or loss of material property or reputation…". Since health risks are a subgroup of all risks, then the definition will apply only for the portion concerning "bodily injury" and "death".Before attempting to apply the Systems Methodology to the health risk control strategy, it is crucial to define the concepts of risk and danger. In a typically industrial environment, a hazard is "… a condition, actual or potential, that can result in injury or death to personnel or damage to or loss of material property or reputation…". Since health risks are a subgroup of all risks, then the definition will apply only for the portion concerning "bodily injury" and "death".which can cause injury or death to personnel or damage to or loss of material property or reputation… ”. Since health risks are a subgroup of all risks, then the definition will apply only for the portion concerning "bodily injury" and "death".which can cause injury or death to personnel or damage to or loss of material property or reputation… ”. Because health risks are a subgroup of all risks, then the definition will apply only to the portion concerning "bodily injury" and "death".
The design of a Systems Methodology to control damages in the health condition should be based on the following logic:
- Every situation (eg, company, job, project, role, location, or branch) has health risks. No one will ever know or be able to prevent everything about the health risks someone is exposed to. Health risks are not equally consequential. All situations require a balance or balance between risk and benefit. Resources for the identification, elimination and / or control of health risks are always limited. We must always strive to ensure that all health risks are either eliminated or controlled in every situation.
It becomes immediately apparent that this logic requires:
that there is some method or means to locate the really serious risks in a situation, and
that these serious risks are eliminated or controlled.
The key to solving these two premises is the establishment of a systemic strategy for risk control.
There should never be any difficulty in guaranteeing managers support from the moral point of view: "… No one in this situation should be affected by illness, disease itself or ailments as a consequence of bodily injury…". However, decision centers have no practical means of managing the moral argument.
Obviously, they agree with this statement, but how much should managers plan, from a budgetary point of view, in anticipation of this argument? How does an administrator measure performance in satisfying this argument? How could it be done to make the effort satisfy the argument?
The previously mentioned managerial dimensions, cost, performance, and timelines arise without any connection to the moral argument. A gap exists between morality and management. A bridge is necessary to convert the high and universal axiom into the rigorous language of management. The Systems Methodology (“systemic”) or the strategic system for risk control is that bridge.
You should imagine that management sits on a three-legged bench. Those three legs are cost, performance, and schedule. It is a very stable bench while each of the legs of the bench simultaneously supports the load corresponding to each one. If management neglects one leg, regardless of which leg it is, the bench becomes unstable.
If controlling health risks must depart from the mystical wonders of morality and join methodological management, then the forces of morality must be translated into cost, performance, and timelines. Each of these three legs is discussed separately below.
Defined Tasks - The Performance Leg
The first element to close the gap between morality and management is a clear and forceful statement on what must be done to eliminate or control health risks. Generally, there are a number of specific tasks, functions, activities, or types of jobs that are performed to accomplish this purpose.
Let's take the four defined tasks of a medical-hospital center in the United States (applicable to the Venezuelan reality), namely:
1.– Incident Report
All incidents, malfunctions, activities and other dangerous events must be reported, analyzed and processed in a format that allows visibility to management. Such a system requires: the design of a form of report or report that optimally satisfies the diverse requirements of all users and recipients of the processed information, that the instructions on the formats are suitable for all parties that contemplate them, the analysis of the raw data in the reporting formats, the documentation of the analyzed data for the purposes of the administrative decision-making process, and the ability to interpret the feedback of the analyzed data that must be submitted to the evaluation of the parties involved, both internal and external, in the medical-hospital center.
2. - Emergency Plans and Procedures
Disasters caused by nature, such as earthquakes, floods, lightning, tornadoes, as well as those human-related catastrophes, such as fires or plane accidents, cannot be predicted. However, responsible management requires rigorous planning of contingency plans to ensure optimal use of the resources of the medical-hospital center and thus minimize damage and loss. Such planning should include: predetermined assignments of medical personnel, the priority designation of teams and facilities for the use of emergencies, the re-ordering of priorities for patient care, in order to dispense accommodation in the influx of victims of a catastrophe to be clinically admitted,and the representation of the triage procedure. A vital part of disaster planning is the periodic rehearsal of exercises to ensure quality and promptness of responsiveness.
3. - Hazard Analysis
There is a need, occasionally, to apply special analytical techniques to identify certain hazards that would not otherwise be recognized, particularly when there is no record prior to the occurrence of claims related to this type of hazard. One of the main reasons for using sophisticated risk analysis is to identify multi-functional scenarios or situations where the potential and functional interaction between personnel, events, equipment or procedures, which create hazards, are indeed observed from the only perspective. Functional integrated from a specific position within the organizational chart. This would not be detected without the specific analytical techniques, such as Hazard Mode and Effect Analysis or <>.
4. - Investigation of the Accident
Accident investigation is fast becoming a science. This consists of several different phases of the work, which is generally analyzed in sequence (although when an overlap of complex accidents could occur), namely:
the selection or assignment of researchers, factual verification, analyzing the evidence, synthesis of conclusions in relation to causality factors, and
the formation of recommendations to avoid future repetitions.
The importance of defining the tasks is due to the fact that this constitutes the “Performance Leg” of the so-called “bench” of health risk management. Therefore, these tasks must be described in explicit language, which allows someone to really measure how effectively the job is running. The use of a soft and amorphous verb, signed by terms like "coordination", "cooperation" and "participation" should be avoided in all events. These expressions represent actions that are not measurable, nor do they represent a responsibility attributable to the one that corresponds to them.
Tasks Determined by Staff - La Pata del Costo
Once a task is defined in terms of performance, it is possible and mandatory to remember that the amount of the labor force required, for the accomplishment of the task, is correctly estimated. Since the Risk Systems Methodology encompasses all the tools that make up all the managerial efforts made to control health risk, it is important that the workforce is made up of all departments and is not only representative of those departments that are directly Systems Methodology implemented. In other words, the accumulation of all the personnel of all the functions is not the personnel budgeted by a group dedicated to security and who may be responsible for its specific execution.
The work units are man-week based, but any other units would be equally appropriate.
The importance of defining the number of employees for each task performed is represented in the "cost foot" of the "bench" of health risk management. Decomposing or arbitrating other criteria for establishing the staff establishment should be avoided (for example, offering the responsible function a certain portion of another budget function).
If a task is sufficiently defined, the work required to be performed should be readily estimated, without reference to the level of effort from another organization.
Schedule Tasks - Schedule Leg
It is obvious that the effort made for a task must be given in terms of the time foreseen in a schedule. Instead of having a Plan of Periods of 1 to 24 equal spaces, it could be replaced by specific months and determine precisely how many and how many people should be working on a given task and month.
In this way, it is possible to correlate the activities carried out according to their respective dates. Those personnel who maintain a continuous effort will be clearly differentiated from those with ad-hoc activities. An auditor can appear at any time and confirm that the work is on schedule.
The importance of assigning personnel to specific tasks and subject to the times in the schedule is represented by the “Leg of the Schedule” of the “bench”. Consequently, it is imperative not only to estimate how much staff is required to undertake a task, but also to consider the implications in terms of expenditure.
To summarize, the Strategic Risk System, compiled in the Systems Methodology, is the mechanism to convert the moral argument that no one should get sick or injured, based on cost, performance and schedule units that management can effectively use in resource allocation.
Health Risk Management
A Strategic Risk System is not really systemic, unless it describes the recruitment and allocation of personnel and provides the concomitant task schedules for each of the five functions of Risk Management. There is a technical difference between "risk" and "danger". Risk is generally considered to be the combination of a hazard with its associated probabilities. However, for the purposes of this discussion, the functions of risk and hazard management can be considered interchangeable.
The five functions of Risk Management are conceived in a sequential and logical order, which progresses clockwise. Each of these functions is discussed below and separately.
Administration of Tasks Related to Risks
Control of health risks must be managed, in other words, planned, organized, directed and motivated. Therefore, a policy that commits the resources for this effort must be established openly, with sufficient dissemination and correct implementation. Additionally, only one person should be designated as the “Chief Supervisor” of this managerial effort, regardless of the title assigned to it.
The designated administrator, among other responsibilities, must select specific tasks that will control health risks and prepare the corresponding Systems Methodology. He must assign individual responsibilities to each person in the workforce. He must also manage the sequence of tasks to be performed, as well as the level of performance that is most effective. He must exercise leadership that ensures that tasks are performed fully, on time, and effectively, inspiring anyone who participates in risk management with great enthusiasm.
With the lack of a rigorous organizational policy, a designated executive and active in its responsibilities, and a structured plan with great rationality, the other functions of health risk management cannot be effectively performed.
Identification of Risks
Health risks must be identified before any action can be taken regarding them. Identification is the "backbone" in the control of health risks. Risk scenarios are a brief description of a combination of accident-causing factors that can lead to the disease itself.
Such "causal factors" could be described as the "anatomy of an accident". The purpose of health risks is to provide a means of accentuating conditions that would lead to either illness or bodily injury.
Obviously, risk scenarios are not an end in themselves. The intention that exists in them is to provoke preventive actions and in this way allow management to act instead of reacting to risks. Consider the preventive actions that could be proposed for the following three scenarios, occurred in reality and reported within a universe of 2,500 files, denoting completed claims, in a medical-hospital center, namely:
(1) During a heavy stormy rain and late at night, a distracted person, rushing to enter the clinic to visit their son who had only recently been admitted for serious injuries, approaches the automatic doors. He pauses before the open door, turns back with his eyes in the dark to locate someone to accompany him, but the doors, previously alluded to, close. His glasses cracked, severely lacerating his two eyes, making him blind for life.
(2) A patient in a semi-private room (with two beds) is mistaken for a nurse, who was on her night shift to replace the nurse who really knew the patient's condition. She injected a totally contraindicated drug. The patient had a <> and then the death.
(3) A physician, prior to the application of a heart catheter to a patient, was verifying the equipment in a laboratory to perform this particular application when he (the physician) reaches a container of compressed hydrogen. In the process, he loses control when he holds said container and it falls to the ground, escaping all the gas and causing an explosion due to the electrical equipment that operates inside the laboratory.
One of the advantages of “risk scenario management” is that it is not limited to the events that have occurred. This practice, without discarding the previous history, the contribution of the imaginable, but of the sinister not yet happened, for example, under the additional rigors of Murphy's Law.
To ensure that scenarios for all aspects of a system are prepared, it is important to use a “Functional Block Flowchart” (FFB) for each function in the situation being controlled. By assigning a quota of scenarios to be written for each "block" in the "FFB" by those who execute the functions, there is a low probability that some aspect will be ignored.
There are other obvious advantages in managing risk scenarios against those identification methods. Let's consider the following example. Most safety programs (such as posters, signs, films, and training programs) are designed to sensitize personnel to observe and avoid dangerous conditions.
Implementing such programs very rarely reaches a high percentage of the staff for whom this type of activity is directed. There is a contrast in the impact of avoided risk scenario planning that permeates every functional person who is expected to prepare risk scenario planning. Instead of giving banal messages, with "slogans" related to the dangers, everyone is pondering the real possibilities of risks that they have planned themselves. The common credibility gap between a security poster and the viewer simply cannot exist between a planned scenario and its author.
While identifying thousands of health risks is critical, this is only the beginning of a foundation. There is no one way a manager can afford to rule out some of the risks already identified. These risks have to be identified by their significance.
Identified Risk Assessment
It is important that the identification of risks is not inhibited by the importance of each risk. Otherwise, the creative thinking necessary to put possible risks into perspective would be interfered with by concern about the degree of importance.
On the other hand, the time comes, when appropriate, to identify, classify and rank the importance of risks. Each risk is evaluated against three measures of importance. As might be expected, these three measures correspond to "The Bench of the Three Legs of Management", previously explained. The severity of the hazard represents "performance", while the probability or frequency of the occurrence is indicated by the "schedule", as well as the resources required to establish control are represented by "cost".
The ranking criterion shows how these measures are used in the hospital setting. Each danger scenario is assigned three letters, each to establish the corresponding measure of importance.
The letter allocation method involves carrying out a subjective evaluation, since the historical data of the respective scenarios does not exist. However, any decision-making process depends on subjective risk estimates.
Once the three letters have been assigned, it is possible to capture in perspective all the risk scenarios under what is called the “Hierarchical Risk System”. The concept of the Hierarchical Risk System has been applied in many different situations. Therefore, more details on its elaboration can be obtained in other works by specialized authors.
The importance of the Hierarchical Risk System lies in using it as a decision-making instrument to enable the efficient allocation of resources for the elimination or control of hazards from a systemic and complete point of view. Additionally, the identified risks have been evaluated based on their significance.
Control of Significant Risks
It is not enough to identify the risks and rank them according to their importance. If this task is limited to these actions, the health risks would be as severe both at the time of their identification and when the process began.
Health risks are either eliminated or controlled even when this elimination or control cannot be exercised over each of them. It is economically unfeasible to propose the control of all health risks. The sixth logical foundation of systems strategy only emphasizes that risks must be eliminated or controlled. The Hierarchical Risk System provides management with a tool to begin allocating, under a rational basis and prior to the occurrence of claims in an orderly manner, started by the most critical of each of the health risks.
The risk control process consists of four sequential steps:
1) Resource Management.
The cost in the elimination or control of health risks can be easily calculated through the Hierarchical System of Risks. Proceeding from the upper to the lower section in such a hierarchy, it facilitates the task that the resources evaluated for each identified risk must be assigned or ignored.
There will not be enough resources to eliminate or control all identified risks, therefore management should avoid allocating resources at any point not specified in the Hierarchical Risk System.
The level of interruption must be subjectively weighted. Additionally, it is neither alterable nor easy to determine. This is probably based on two reasons: that all the resources for risk control, which are economically feasible, have already been used, or the risk stage has been reduced to a tolerable level.
2) Implementation of an Action.
The resources used or dedicated to risk control must be translated, with the respective appropriate funds, into specific preventive actions. Senior management must direct the implementation of these actions. This implementation cannot be ambiguous and, at the same time, must guarantee that it is capable of objectively supervising the aforementioned actions. Without the direction of active management towards preventive and pertinent actions, a serious process of control of health risks will hardly take place.
3) Measurement of Shares.
The preventive actions implemented may or may not be effective, as planned. Consequently, external supervision or supervision is essential to establish permanent validation of the objectives and goals that guarantee the effectiveness of preventive actions. The risk control measurement criterion constitutes an excellent basis to implement the said validation.
4) Redirection of Resources.
The supervision of preventive actions will allow scrutiny of whether the actions evaluated are effective or counterproductive. On some occasions, management must redirect the implementation of other preventive actions. These actions may be the result of reconsideration of previously declined or recently created measures, as well as other optional preventive actions.
It should be obvious that the action taken in Step 4 is subject to the scrutiny of Step 3, so that there is a guaranteed confirmation that the health risks are really being controlled.
Financing Uncontrolled Risks
Illnesses and accidents will occur despite the fact that the risk control program is the best in the world. The greatest human effort often fails. Consequently, the systemic approach to control health risks must include provisions for losses incurred as a consequence of uncontrolled risks.
There are three classes of risks that will result in losses: the risks for which the preventive action taken was ineffective, the risks that were considered insignificant (which were below the level recommended in the Hierarchical Risk System), but which they were consummated consequently (concatenated or indirect provocation), and the risks that were not foreseen. For these three classes of risks, there must be an ideal financial situation that allows compensation for losses.
The alternatives available for financing losses, due to health risks, will vary due to the type of loss and nature of the company or institution in which the loss occurs. The following forms of financing are normally viable:
- The direct assumption of the loss, financially deducted according to generally accepted accounting practices within an unquestionable technical-legal framework. Establishing preventive reserves or injecting more capital into those that already exist. Assuming the debt. Medical Benefit Plans (totally differentiated insurance) or insurance policies. Pool contingent reserve funds or use a captive insurance company. Legal transfer of risks through contracts.
conclusion
Controlling health risks is no longer required to be a moralistic crusade. The reasoning and the Systems Methodology, in terms of costs, performance and schedules, are available to managers to control Health Risks.
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Intellectual property is the exclusive property of Andrés Eloy Agostini D., with the express exception of the citations mentioned in this work, mostly taken from the works listed in the section "Bibliographic Source". All rights reserved. It is forbidden to copy, partially or totally, through any means, electronic or not, without the prior written and express authorization of the Author. This material is not intended, in whole or in part, for profit, express or otherwise, either directly or indirectly.
