Risk management in healthcare

1. Definition & Goal

2. Governance Oversight

Responsibilities

3. Professional Liability

4. Risk Management-Org. wide PI

5. Program Components

6. Org.wide Early Warning

System

7. The Written Plan

8. RM & Accreditation

RISK MANAGEMENT

Slides:Mujeeb C [email protected]

Based on “The Healthcare Quality Hand Book”

By Janet A. Brown



Responsibilities





System

7. The Written Plan


1. Risk Management in Healthcare..

• A formal attempt to control liability, prevent financial loss, and protect the financial assets of the organization

• The reduction or elimination or potential financial loss due to damage, theft, misplacement of property, or patient injury (potentially compensable events)

• The prevention of and/ or the identification, evaluation, and treatment of, financial loss.



Responsibilities





System

7. The Written Plan


2. Governance Oversight Responsibilities• Approve & support RM Program• To Establish policies to minimize risk• To know interaction between QM programs & RM

including physician involvement• Ensure antitrust laws are followed

• To know how the risk is addressed.• Degree of risk• Amount of risk

shared/transferred to insurance companies

• Major changes in insurance program

• Exposure under insurance programs

• Adequacy of malpractice ins by independent practitioners

• Adequacy of education efforts on risk reduction & prevention

• Monitor areas of organizational risk• Liability• Clinical Risk (Occurrence

Data, QI Team actions, Patient Safety Activity)

• Employee Safety• Workers Compensation• Property Preservation• Improper& Inadequate

credentialing & licensure verification

• Improper/Inadequate Patient Care/Practitioner review



Responsibilities





System

7. The Written Plan



Basic Duties of Care and Liabilities The concept of Negligence



Responsibilities





System

7. The Written Plan



Basic duties of direct providers (Independent Practitioners)• Comply with statutory duties (Drug Laws)• Obtain proper consent for medical care• Render standard care as that of like providers

Liabilities of physicians/independent practitioners• Lack of Documentation• Work ups not complying accepted standards• Acts of others if exercising control (borrowed servant or captain of the ship)• Mistaken identification• Misdiagnosis, Wrong Diagnosis• Treat out of scope of services• Abandonment• Failure to seek Consultation/Refer• Failure to obtain result of diagnostic tests done• Infection Control• Premature discharge/dismissal




Responsibilities





System

7. The Written Plan



Liabilities of Nurses• Inconsistent administration of drugs• Failure to follow physician orders• Failure to report significant changes • Failure to take correct verbal or telephone orders• Sponge/instrument miscount at OR• Patient burns• Patient falls• Failure to report defective equipment• Failure to follow established nursing procedures• Negligent handling of patient valuables




Responsibilities





System

7. The Written Plan



Negligence – Lack of Proper care

In malpractice, proper care is judged by peers..

Is based on Defined standard established by law to protect other against harm

Negligent ConductDoing what a reasonable person would not do..

Gross Negligence Failure to act while the risk is known, resulting adverse impact or death.

Contributory Negligence Proven contribution by the patient/plaintiff towards his/her harm

Burden of proof for negligence

Duty:Ensure a safe transactionProtect from foreseeable harmProtect from malpractice

Breach of DutyBased on policies & ProceduresReasonable standards of care

Measurable Harm(Injury)

CausationBreach of duty caused the injury




Responsibilities





System

7. The Written Plan


4. Risk Management as Organization wide Performance Improvement Process

Integration with Quality Management

• RM as key component of quality management umbrella• Good outcomes requires good quality management – RM

requires good outcome• RM emphasizes “Harm prevention”, so does QI• Both QM & RM are designed to gather information on

undesirable events or trends• Both QM & RM share..

• Reduce problems in patient care & maximize safety

• Concern for prevention of harm/loss• Require data: Incidents, indicators, RCA FMEA,

patient feedback, complaints, surveillance (Infection/safety/security)

Claims history

Longer the length of stay for a patient in a hosptial, the higher the risk of a healthcare associated event.



Responsibilities





System

7. The Written Plan





Responsibilities





System

7. The Written Plan


Loss Prevention & Reduction

• Risk identification & measurement• Risk assessment and prediction• Risk handling

o Risk Financingo Risk Control

Risk Avoidance Risk Shifting Risk Prevention

• Communication & Education




Responsibilities





System

7. The Written Plan


Claims Management

• Action on potential compensable events (PCEs)

• Tracking PCE reporting• Tracking of asserted claims• Determination of settlement

authority• Settlement negotiations• Defense attorney interface

• Interrogatories• Settlement conferences• Trial preparation

• Closed claim analysis• Professional

liability/malpractice issues• Loss history• Expenses




Responsibilities





System

7. The Written Plan


Organization Safety & Security Programs

• Preventive maintenance/equipment management

• Hazard communication & surveillance• Employee “Right to Know”• Waste Management

• Security measures• Fire and disaster preparedness• Utilities management




Responsibilities





System

7. The Written Plan


Patient Relations Programs

• Patient representatives/advocates• Patient education• Safety Education & Feedback• Patient rights• Patient Responsibilities• Patient Grievances Response system• Patient Satisfaction measurement




Responsibilities





System

7. The Written Plan


Contract & Insurance Premium Review

• Requirements• Loss history• Premium discounts for effective quality

management• Risk shifting• Financing structure/deductibles




Responsibilities





System

7. The Written Plan


Employee Programs/Workers’ Compensation

• Loss history/patterns• Lost work days• Education




Responsibilities





System

7. The Written Plan


Resource & Support System Review

• Process, equipment, and staffing related risks

• Budgetary requests for safety related programs or materials

• Policies/procedures




Responsibilities





System

7. The Written Plan


6. Organization wide Early Warning System

An organization wide system to screen all patients for real or potential adverse incidents, issues, and occurrences that might result in increased risk to the organization or corporation and/or less than optimal quality of care.

Purpose:

Adverse patient Occurrences (APOs)Unexpected, Untoward events with actual or potential negative impact on the patient

Potentially Compensable Events (PCEs)Those APOs that might become claims – based on the degree of actual or potential negative impact on the patient; PCE status determined by the risk manager



Responsibilities





System

7. The Written Plan


6. Organization wide Early Warning System

Types of Systems

• Generic Screening• Occurrence Reporting• Event Reporting• Incident Reporting• Patient Safety data screening

Use of Occurrence/incident reports in physician peer Review



Responsibilities





System

7. The Written Plan


7. The Written Plan

Components of Risk Management Plan Document

Policy & statement of purpose

Goals

Scope of the program

Authority and responsibilities

Confidentiality and conflict of interest policies

Data sources and referrals

Documentation and reporting mechanisms

Integration of activities and information



Responsibilities





System

7. The Written Plan


7. Risk Management & Accreditation

Standards: Part of “GLD, QPS, MCI”

• Leaders are responsible for short and long term planning, setting performance improvement priorities, and having a mechanism in place to adjust priorities in response to unusual or urgent events.

• Leaders allocate adequate resources for, and measure and assess the effectiveness of, performance improvement and patient safety improvement activities.

• Potentially high risk processes for data collection include:

• Medication Management• Operative and other invasive procedures• Blood and blood product use• Restraint and seclusion use• Behavior management and treatment• Resuscitation process and outcomes

• The organization has processes to mange clinical/service and non clinical data and information that is useful in decision making

• Data and reports are used for communication and continuity of patient care and operations and for other purposes, including litigation and risk management activities.



Responsibilities





System

7. The Written Plan


7. Risk Management & Accreditation

Survey Expectations

• Delegate responsibilities of RM

• Receives periodic reports on adverse occurrences, sentinel events, actions taken and results, progress related to patient safety improvements, preventive efforts and educational efforts.

Governing body participation

• Identify areas of potential risk in clinical aspects

• Develop criteria to identify specific cases

• Design of programs that mitigate risks

Physician participation

• Operational linkages• Shared risk

management information

Linkages

Thank You

Risk management in healthcare

Health & Medicine

Transcript of Risk management in healthcare