Homework

Integrating Risk Management,

Quality Management, and

Patient Safety into the

Organization

Chapter 2

Peer Review Privilege Statutes

• Designed to improve health care systems & define best-practice recommendations for clinical providers

• Promote and protect candid review of care – Documents shielded from discovery in many

jurisdictions if created or used by applicable committee under statute

– Can also be used by medical staff to conduct morbidity and mortality reviews

– Must fit within statute to be privileged Risk managers (RM) has a key role in ensuring compliance

Peer Review Privilege Statutes

• Risk managers can use the peer- review privilege to shield

from discovery the results of the quality and safety reviews

conducted as part of their investigations into adverse patient-

care events.

• Risk managers maintain vigilance throughout the organization

to guarantee that processes be conducted within the framework

defined by their jurisdiction’s peer- review statutes

• Risk Managers can ensure a steady flow of information

between departments to improve patient care while protecting

their institutions from exposure to liability by ensuring

applicability of their state’s peer-review- privilege statutes.

Medical Staff and Quality Monitoring Initiatives

• The Joint Commission requires active participation from medical staff

• Performance improvement standards require:

– Ongoing professional-practice quality evaluations

– Active participation in measurement, assessment and improvement of a variety of quality-care metrics

– Data collection requires close coordination between medical staff and risk and quality departments.

General Competencies

• Patient Care: must be able to provide patient care

that is compassionate, appropriate, and effective for

the treatment of health problems and the promotion of

health

• Medical/ clinical knowledge

• Practiced-based learning and improvement

• Interpersonal and communication skills: must

demonstrate skills that result in the effective

exchange of information and collaboration with

patients, their families, and health professionals.

General Competencies

• Professionalism: residents must demonstrate a commitment to

carrying out professional responsibilities and an adherence to ethical

principles. Residents must demonstrate: Compassion, integrity, and

respect for others; • responsiveness to patient needs that supersedes self- interest; • respect for patient privacy and autonomy; • accountability to patients, society, and the profession; and • sensitivity and responsiveness to a diverse patient population,

including but not limited to diversity in gender, age, culture, race,

religion, disabilities, and sexual orientation.

• Systems-based practice: Residents must demonstrate an awareness

of and responsiveness to the larger context and system of health

care, as well as the ability to call effectively on other resources in

the system to provide optimal health care.

Theory of Corporate Negligence

• 1. Duty- Hospital must exercise reasonably

care to ensure physicians are qualified to

perform privileges requested

• 2. Breach- failing to adopt state licensing or

applicable accreditation standards

• 3. Causation- but for the hospital’s failure to

exercise reasonable care, the injury would not

have happened

Defending the Hospital

• In corporate negligence suit, RM must assess whether jurisdiction’s peer-review statutes allow an organization to waive privilege & produce documents normally shielded from discovery in malpractice cases

• RM may consider working with the medical-staff to develop credentialing documents that are transparent, accessible, & separate from for-cause peer-review analysis

• To avoid liability, RM must ensure that the current credentialing process meets applicable requirements

Early Warnings for Litigation

• A close, collaborative relationship between the risk

and quality departments, as well as others (patient

relations/advocacy, billing, the HIPAA office

&medical records) provides opportunities for quick

problem identification and allows for early

interventions with patients and family members

• The two early warnings signs of possible liability are:

Patient Complains and Medical Records

Patient Complaints

• A proactive and responsive patient relations

office can often intervene early during a

patient’s hospital stay to counter negative

patient, friend, or family impressions of care

• An organization’s billing office is another

outlet for patients to voice their concerns

related to patient care

Medical Records

• Charts are routinely requested for case-review

analysis and abstraction

• Role in identifying adverse events and quality-of-

care concerns increased exponentially with the

implementation of the CMS “Never Events”

– October 2008

– Focuses on many health-care-acquired conditions

(HAC)

Post-Event Management & Media

Relations

• Quick response to Plaintiff’s use of media outlet can be key to mitigate reputational damage

• If RM or clinical provider has reason to believe an adverse patient-care event may become a media event, the media relations team should review the details and consider drafting an appropriate response