Health information system electronic health record week 1

Chapter 1:

Risk

Management

Dynamics

Healthcare can hurt…

• In the 1970’s, the fact that receiving healthcare services can actually cause harm was brought to the forefront with the Institute of Medicine report “To Err is Human: Building a Safer Health Care System”: – In 2 studies, adverse events occurred in 2.9% and

3.7% of hospitalizations

– More than half of these adverse events were the result of preventable medical errors

– Extrapolation: > 1 million medical errors may occur each year resulting in 140,000 deaths

More data about medical errors

Studies indicate the following:

– Hospital employees recognize and report only 1 in 7 medical errors that harm Medicare patients

• Even after medical errors are reported and investigated, many hospitals do not change their practices to prevent repetition of the event

– >50% of patients treated for side effects and other medication related injuries were 65+ years old

– Continued reporting of wrong-site surgeries

What can be done?

• The Joint Commission recommended safety standards in 2001 that relate to: – Providing leadership

– Improving organizational performance

– Information management

– Patient’s rights

• It is imperative to monitor adverse events from 2 standpoints: – Quality of care

– Legal responsibility to do no harm

How do we monitor adverse events and ensure patient safety?

• Recognize and minimize instances where a medical error can occur

This is the function of Risk Management

What is Risk?

Uncertainty about future events that

may threaten the safety of patients

and the assets and reputations of

providers.

What do we mean by assets?

• People – patients, clinicians, volunteers, and employees

• Property – buildings, facilities, equipment, and materials

• Financial – revenue, reserves, grants, and reimbursement

• Goodwill – health and well-being, reputation, and stature in the community

What is Risk Management?

• Discipline for dealing with the possibility

that some future event will cause harm.

– An organized effort to identify, assess and

reduce risks to patients, visitors and staff

Objective of Risk Management

• To reduce the risk of preventable

accidents and injuries and minimize the

financial loss if one occurs

– It provides strategies, techniques and an

approach to recognizing and confronting any

threat faced by an organization.

In other words…

• What can go wrong?

• What will we do to prevent harm and in the

aftermath of an incident?

• If something happens, how will we pay for

it?

What are the risks we

are trying to protect against?

• Antitrust violations • Breach of contract • Casualty exposure • Defamation • Embezzlement • Environmental damage • Fraud and abuse • General liability

• Hazardous substance exposure

• Professional malpractice

• Securities violations • Transportation liability • Worker’s

compensation

So, what will be done?

In the Risk Management Process we will:

• Identify Risk

• Perform Risk Analysis

• Implement Risk Control/Treatment

• Finance Risk

Risk Identification

• Continuous collection of information to

search for the various liability risks such as

• Property risks

• Casualty/liability risks

• Employee benefit risks

Risk Analysis

• Evaluating past experience and current

exposure to limit the impact of risk,

keeping in mind that there are different

levels of Risk

• Severity to the individual and/or organization

• Number of people harmed or potentially

harmed

• Likelihood or frequency of occurrence

Risk Control/Treatment

• Most common function of risk management programs

• Risk Management programs should categorize potential liability into 4 categories: • Bodily injury • Liability loss • Property loss • Consequential loss

Risk Control/Treatment

• Risk Acceptance

• Exposure Avoidance

• Loss Prevention

• Loss Reduction

• Exposure Segregation

• Contractual Transfer

• There are many methods and techniques an organization can use to minimize risk:

Risk Financing

• An organization should have financing available to fund losses and implement risk management activities

– Self-insurance

– Commercial insurance

– Budgetary funds set for activities and/or losses

American Society of Healthcare Risk

Management (ASHRM)

Components in a risk management program:

– Designate risk manager

– Access to all data

– Organizational commitment

– System for identification, review and analysis of adverse outcomes

– Ability to integrate and share data

– Evaluate risk management program activities

– Provide educational programs

– Provide information on staff competency

Three Major Functions of Risk Management – Business Orientation

• Reducing the organizations’ risk of malpractice suite by maintaining or improving the quality of care

• Reducing the probability of a claim being filed

• Preserving the organization’s assets once a claim has been filed

‘Red Flag’ Areas to Watch

• Treatment Conditions

• Patient Relations

• Practice Management

• Conduct of Staff

Risk Management Tools

for Identifying Risk

• Incident Reporting

• Occurrence Reporting

• Occurrence Screening

Incident Reporting

System to identify events that are not

consistent with the routine operation of a

hospital or routine care of patients

Occurrence Reporting

A policy listing specific adverse events

that MUST be reports

• Required by some states and insurers

• Can increase identification of adverse

events to 40-60%

Occurrence Screening

System that identifies deviations from

normal procedures or expected

outcomes

• Uses criteria to identify adverse events

but does not rely on staff reporting

• Increases identification of adverse events

to 80-85%

Risk and Quality of Care

• There is sometimes overlap between these functions in the healthcare setting.

• Integrating risk management and quality assurance functions can result in:

– Maximization of the use of limited resources

– Elimination of duplication

– Developing new solutions to problems

– Facilitation of training programs

– Improvement of budget process

Specific Risk Management Functions

• Incident Identification, Reporting and Tracking

• State Mandated Incident Reporting

• Incident Review and Evaluation

• Take action to prevent recurrence of incidents

• Internal Documentation

• Credentialing and Privileging

• Patient Complaint Programs

• Risk Management Education

Summary

• Risk Management is about reducing

preventable adverse events and minimize

financial loss should such events occur.

• There are many tools available to assist

the Risk Manager.