The Role of Risk Management in Reducing Loss Prevention

The Role of Risk Management in Reducing

Loss Prevention

IEE 454 - Risk Management

Arizona State University-Tempe

December 15, 2024

Definition of the Problem

Introduction

Risk management (RM) has been defined as

the process of scheduling, classifying,

directing, and managing organizational

conduct in order to curtail the detrimental

effects of fortuitous losses at reasonable

costs on the organization.

Risk avoidance involves eliminating all losses

associated with a particular activity, loss

prevention involves reducing the chance of a

mishap occurring, and loss reduction

emphasize reducing the severity and impact

of losses once they occur. Loss prevention

techniques focus on reducing the frequency

of occurrences likely to result in claims

and/or lawsuits.

In health care, risk management has become

an important issue during the 1980s and

1990s. The complexity of the legal

environment has challenged institutions to

strengthen the practice of health care to

protect staff and hospitals from loss. Risk

management is defined as the “science for

identification, evaluation, and treatment

against the risk of financial loss. Risk

management also envisages the evaluation

and scrutiny of medical treatment to identify

and circumvent injuries to patients. It is

envisaged that in most cases of medical

malpractices, “In medical malpractice cases,

the duty owed by the defendant physician

arises from the physician-patient

relationship” (Shandell & Smith, 1990, p.1-

4).

What risk management is about?

RM is concerned with utilizing key functional

activities of the organization to reduce the

detrimental effects of accidental losses on

that organization at pre-judged and

predetermined costs. Further, the scope of

risk management can also be extended to

include aspects of recognizing, assessing,

and protecting against the risks of financial

losses that may arise due to risk

materialization.

Further, there have been paradigm shifts in

the underlying causes of fundamental issues

governing risks in patient management.

While at one time, the safeguards against

losses or damages to the financial strengths

of health care institutions and the

prevalence of a reliable treatment

environment were considered paramount,

this has now shifted in terms of greater need

for preventing harm and injury to patients by

offering them a greater degree of health care

protection and adequate safeguards against

injuries caused by neglect by concerned

health care professionals.

Thus, it can be seen that over time, the onus

has shifted from the health care

organization’s need to protect its health care

environment from outside malpractice

attacks to a more focused and perhaps

narrower need to keep the best health care

interests of the patient uppermost and to

improve the quality of service and discharge

all responsibilities vested upon the health

care workers, which, it is believed would

significantly reduce the occurrences of

medical malpractice and issues connected

therewith.

The industry’s risk manager of today faces

many new and exciting challenges. By

conventional practices, the job focuses on

safeguarding the pecuniary trust of the

organization and preserving a secure milieu.

Today, the focus has broadened to include

preventing patient injury and improving the

quality of service. The administrator and

physician must now respond and increase

the emphasis on a system that can monitor,

promote and guarantee the quality of

service. Their objective is to alleviate

malpractice judgments, cut defense

expenses, and manage the insurance

premium.

Background of the problem

The rising number of malpractice cases was

not being reduced through prompt and

speedy disposal of those cases by concerned

officials. The fundamental causes for these

issues to surface included issues arising out

of technology advancement in medicine,

which carried with it higher risks of injuries;

issues arising out of worsening relationships

between physicians and patients; and,

problems arising out of unrealistic demands

made by patients about modes of treatment

and their results.

The probability of medical errors increased

with the larger number of people involved in

inpatient care. Risk management is used to

secure the financial assets of an enterprise

against the risks of calamities by assuring

adequate economic protection and security

against perceived and imminent occurrences

of liability through appropriate risk cover

strategies, including insurance of property

and thus alleviating the possibility of

financial losses that may accrue.

The word ‘liability ‘is used in various ways,

but the general definition would be the state

of being exposed to damage, danger,

expenses, etc. The professional liability of

the hospital is an area of great risk and all

hospitals must decide on the amount of

coverage they will carry. Comprehensive loss

and exposure information must be collected

and the data analyzed before purchasing

insurance coverage. To ease the malpractice

crisis, state legislators enacted a variety of

laws designed to establish limits on the

number of awards, set up arbitration

screening panels, revised the contingency

fee systems, and modified the collateral

source rules.

Problem statement

Medical malpractice received a great deal of

attention in the early 1970s when a crisis

emerged due to the lack of availability of

liability insurance. Most insurance carriers

increased premiums at alarming rates, and

others stopped writing malpractice coverage

altogether, thereby shrinking market

capacity. The increased frequency and

severity of malpractice claims were the

primary factors precipitating these actions.

Insurers found themselves unable to

adequately predict the frequency of claims

or to adequately price this line of insurance.

Patients will have to bear the cost and

detriment caused by the lack of proper care

in the health care setting due to faults

caused by medical malpractice in health

care.

Purpose of the study

Purpose of study

The purpose of this study is to consider the

aspects of medical malpractices in a closed

environment of Wayne State University

Physician Group affiliated with the Detroit

Medical Center Hospitals in Detroit,

Michigan.

Research Questions

• Whether trusted methods are available

that could identify specific medical

outcomes of medical malpractices or

liability incurring thereon?

• What is the extent to which a risk

management program and risk managers

could make difference?

• Could gaps in physician-patient relations

impact medical malpractice?

• Could a collapse in communication in a

physician-patient relationship result in a

malpractice case?

• How could physicians avoid diagnostic

errors and lawsuits?

To prevent lawsuits against hospitals and to

prevent further injuries to the patient,

ensure compliance with state insurance

departments. Risk managers must develop a

close working relationship with the persons

who provide hands-on patient care. These

professionals are often the first to realize

that an untoward event has occurred. Risk

managers must establish an open line of

communication so that he or she is advised

of events as soon as possible. Risk managers

must develop an occurrence reporting

system that these professionals understand

and are willing to utilize.

Assumptions/Limitations

The study subject will be limited to Wayne

State University Physician Group (WSUPG)

affiliated with the Detroit Medical Center

Hospitals in Detroit, Michigan.

Definitions

Malpractice

Professional

liability

insurance

Unethical behavior during the course

of carrying out one’s official duties,

resulting in detriment, or inability to

provide the degree of care necessary

for the wellbeing of patients.

Insurance Coverage for liability arising

from the rendering of or failure to

render professional services

Risk financing

The science of evaluating all possible

elements of an institution’s financial

exposure utilizing prospective and

retrospective data and developing a

vehicle for investment or money

management that will allow for the

dollars needed in the future to pay for

the risk to be available.

Summary

Risk Management has become a growing

concern of all hospital administrators since

the 1970s. Whether the institution is profit-

motivated or not, it must be fully protected

from loss to remain competitive in the health

care industry. A program must be

established, personnel must be educated,

legal strategies must be planned, and

insurance protection must be ensured. The

goal is to provide quality service to the

patient and to avoid negligence. The hospital

should be a safe place for treatment and

improving health, not a hazardous

environment that creates further harm or

injury to the patient.

Literature Review

The industry’s risk manager of today faces

many new and exciting challenges.

According to custom, the work entails

maintenance of the financial stability of the

institution and upholding secure

surroundings. Today, the focus has

broadened to include preventing patient

injury and improving the quality of service.

The administrator and physician must now

respond and increase the emphasis on a

system that can monitor, promote and

guarantee the quality of service. Their goal is

to reduce malpractice verdicts, cut defense

costs, and control the insurance premium.

Some of the findings showed normal

circumstances within the study, but not all

injuries were due to negligence, and not all

injuries were preventable. Due to

deficiencies in prevailing systems, nearly

30% to 40% of mortality among stressed

patients could be due to avoidable issues in

medical attention, taking into account a

wrong diagnosis and delay in providing

treatment (Acute care, disability, and

rehabilitation, 2006, para.1).

These findings were based on the results of

studies concerning the incidence of injuries.

More findings prove that the severity of the

injury was more apt to be the determining

factor in deciding whether a claim would

arise. In conducted studies, it is seen that

early research is suggestive of the fact that

disabled people may not have the longevity

and inferior wellbeing as they become older

than people who have not been diagnosed

with any kind of physical or mental inabilities

(Acute care, disability, and rehabilitation,

2006, Priorities, para. 32).

The American Hospital Association (AHA)

gave guidance and it helped promote the

acceptance of risk management. Across the

country, hospitals are quietly improving the

way they provide health care services and

medical attention (Umbdenstock, 2009,

para.1).

Risk management entails the identification,

assessment, and taking of corrective

measures against threats and challenges

caused by fiscal indiscipline and, inter alia,

has issued directives to hospitals to enforce

risk management practices as a viable

solution for the impaired provision of health

services.

“All medical activities that can lead to injury

or death of any person, or damage to or loss

of property, material, or reputation must be

systematically managed regarding risk”

(Grose, 2005, para.1). This could be seen as

being within the scope of risk management.

Risk management also outlines the basic

elements of the program and directs that the

manager be someone whose training or

background was in hospital administration,

insurance, or safety engineering. This

guideline also stipulated essential

components necessary for an effective

program. This description listed mandatory

requirements but left space for modification

that would be dependent upon the unique

characteristics of the individual hospital.

“The steps of risk management are simple

and straightforward:

• Identify the risk

• Analyze and evaluate the risk

• Control or eliminate the risk

• Protect the agency and the consumers of

its services

• Manage any failures” (Risk management:

The steps of risk management, 2002,

para. 1).

In its simplest form, risk management in

health care has historically focused on

providing a safe environment for hospital

patients. With the formation of health care

systems in recent years, the scope of risk

management now expands beyond the

inpatient setting. Organizations have

affiliated components that provide not only

acute care hospitals but also the outpatient,

home care, and long-term care that patients

require.

The new structure of health care delivery

systems brings with it the obligation to

increase the scope of risk management.

“Thus, establishing expectations is a first

step in defining and delivering quality care

and services and minimizing risk in the

environment of long-term care” (Peterson,

2005, para. 1). Broadening the focus of

patient care is also a risk management

initiative. Research has emphasized the need

for recognizing that risk management now

means, the comprehension of the entire

gamut of care and devising ways and means

by which these could be improved. Normally,

patients may receive a range of care in

multiple settings from multiple providers of

care.

The continuum of care needs to be the

central theme of patient care, as paradigm

shifts occur, new policies are enforced or the

standards of care are upgraded and

refurbished to meet varying needs and

demands of patient care.

An effective risk management program

covers all aspects of hospital operations. To

achieve this goal, managers must establish

early warning systems, target clinical areas

or practices that present the greatest

exposure to liability, and implement

preventive action to minimize the risk

associated with these activities. “Several

professional regulatory agencies and other

industry associations have worked hard to

improve the quality of care provided in

nursing homes (now called nursing facilities),

the administration and governance of those

facilities, and in turn the reputation of the

overall field” (Pratt, 2009, p.73).

Risk management is primarily designed to

protect the financial assets of an

organization by assuring adequate financial

protection against potential liability through

appropriate insurance coverage, reducing

liability when untoward events occur, and

preventing those events that are most likely

to lead to liability.

The term ‘Liability’ may be defined in various

ways, but a general definition would be the

state of being exposed to damage, danger,

expenses, etc. The hospital’s professional

liability is an area of great risk and all

hospitals must decide on the amount of

coverage they will carry. Comprehensive loss

and exposure information must be collected

and the data analyzed before purchasing

insurance coverage.

First of all, it is necessary to analyze the gross

patient service volume, with relation to

inpatient and outpatient visits, and also

determine the number of employees on

staff, including full/part-time employees. It is

also necessary to review any case history of

previous losses and identify the number of

legal expenses paid therein. Evaluating loss

projections: this can be accomplished in

three steps.

1. Determine the frequency and

magnitude of the loss, the nature of the

injury sustained is the best predictor of

the value of a loss;

2. Adjust frequency averages to reflect

significant future changes in hospital’s

risk climate; and

3. Review the accuracy of loss payout

estimates.

This is to include the settlement amount and

the cost of the investigation, and defense for

both paid and reversed cases. A skilled

attorney should be retained for a second

opinion as to the estimates of case values.

No one can estimate the amount of coverage

an institution should carry, because each

case differs in each area of care. Larger

amounts of fund payouts are needed for

meeting lawsuits awarded in court

settlements. After the data has been

analyzed, a risk manager would prepare for

the future loss by purchasing insurance.

Most hospitals “overkill” the expected loss

projection and settle for the purchase of a

premium that protects against catastrophic

settlements and payoffs which are in the

millions. Insurance coverage is paid for

protection; the risk manager can further

protect the institution by ensuring all health

care providers work towards preventing loss

within the institution.

Risk managers are responsible for

developing systems to prevent injuries and

other losses within the organization.

Performance improvement actions are often

initiated in response to suggestions offered

by the risk manager. Education is also an

invaluable tool in risk management and

sometimes is the only activity required to

prevent potential safety problems. “Patient

care and accessibility to mental health

services rest not only on clinical skills, but on

a place to practice them and an organized

system supported by staff, physical facilities

and funding” (Reid, D J., & Reid, W H., 2009,

Abstract, para. 1). Risk managers in many

healthcare organizations are responsible for

developing policies and procedures aimed at

preventing accidents and injuries and

reducing the organization’s risk exposure

(Johns, 2002).

The specific policies and procedures that

constitute a risk management program in a

hospital are developed in collaboration with

the hospital’s legal counsel. Judicial

interpretation of statutory law in the court

system is a continually evolving process and

hospital leadership and governance are well-

advised to seek the advice of counsel to

ensure that risk management practices

adequately protect the organization.

Generally speaking, the infrastructure of a

risk management program is designed to

circumvent, or alleviate monetary setbacks,

allocate funds for compensation and/or

damages, and also clear the corporate image

impediments caused by legal claims and

lawsuits.

Prevention is a critical aspect of any effective

risk-management program. Staff members

need to be provided with the right kind of

training and exposure to deal with

emergencies, which may not be the result of

their actions.

In summary, risk management has become a

growing concern of all hospital

administrators since the 1970s. Whether the

institution is profit-motivated or not, it must

be protected from loss to remain

competitive in the health care industry. A

program must be established, personnel

must be educated, legal strategies must be

planned, and insurance protection must be

ensured. The goal is to provide quality

service to the patient and to avoid negligent

acts. The hospital should be a safe place, not

a hazardous environment that creates

further negligence.

Sentinel Event Statistics

This part of the study shall examine events

that have a high capacity for attracting

liability or cause for damages that result in

lawsuits. It shall also consider ways and

means by which these incidents could be

prevented. According to the cases reviewed

by the Joint Commission of Sentinel Event

National Statistics as of June 30, 2009, there

could be many kinds of surgical errors or

delays that could harm, or cause death to

patients, and thus give rise to criminal or civil

proceedings for medical wrongdoing. High

on their lists are wrong-site surgeries

(13.4%), suicides (12%), operative and post-

operative complications (11.1%), and delay

in treatment (8%). (Appendix 1 and 2)

It would be presumptuous to blame for all

kinds of errors on health care providers.

However, errors caused while transfusing

fluids, errors while administering injections

and anesthesia, deaths caused by ventilator

malfunctions, etc., do come within the

purview of due services to be rendered by

health care providers. Thus, they would be

liable for potential legal action, at the choice

of the aggrieved patient or their families.

The authors took up an empirical study on

the aspects of care of patients undergoing

treatment in three sections of a large urban

teaching hospital. Of the total 1,047 patients

being considered, 185, representing 18%

had, at least one serious unfavorable

consequence. The rate of such unfavorable

consequences increased with the patient’s

length of stay. There is a 6% probability of

adverse effects increasing with every day the

patients stay in the hospital. The highest

incidence of mistakes (28%) occurred during

the surgical intervention and daily care.

During surgery, it was 10%, and intensive

care patients were most likely to have critical

impediments caused by medical errors

(Annotated resources: Sentinel events, 2009,

para. 3).

It is anticipated that there will be an increase

in the findings of medical negligence against

physicians as a result of the change in

standards for the evaluation of medical

negligence” (Medical professional liability

insurance trends in Asia; Malaysia, n.d., p.3).

The increase in such cases is a cause for

major concern since these incidents could

trigger off suits of medical malpractices,

especially if large-scale death or injury is

involved.

Omissions and delays

In a typical medical malpractice case, the

onus would be on whether the mistake(s)

made by the nurse “amounted to deviation

from standard care” and caused harm and

detriment to the patient, or direct cause of

death to the patient (White & Traux, 2007,

p.63). In the event, the nurse was employed

by doctors as an agent, or member of the

group, these doctors or groups would also be

legally held responsible for the injuries

caused to the patient.

Utilization Management and Risk

Management

Utilization Management (UM) may need to

be integrated with Risk Management (RM)

so that coverage of aspects such as,

insurance reimbursement billing and

hospital stays (typically UM functions) work

in harmony with patient omissions and

delays in treatment, medical malpractices,

and its aftermath (typically RM functions). It

is believed that in most scenarios,

importance to RM may not be possible,

mainly due to staff shortages, and also due

to the non-critical character of its activities;

thus, RM and UM must work together, to

enhance the quality of treatment, eliminate

or significantly reduce aspects of medical

malpractice and so on.

Medical Malpractices Jury Trial Verdicts

However, it was also seen that of the medical

malpractice verdicts by jury considered

during the calendar year 2008, of the total of

nine verdicts, eight have gone in favor of the

defendants, and only one has gone in favor

of the plaintiff, or the aggrieved party. This

was a case involving misdiagnosis, which was

settled for an amount of $2,200,000

(Medical malpractice jury trial verdicts

(January 1, 2008- December 31, 2008, n.d.).

Next, it is necessary to consider the

benchmarks that need to be achieved under

the Operational Risk Management & Safety

Assessment (ORM&SA), laid down by Wells

Fargo Healthcare Group. The modus

operandi for conducting such assessment

would be in terms of assessing present

compliances and how deficiencies in the

present system to make it congruent with

desired levels could be achieved. The

assessment would also include compliance

audits and in-depth questionnaire-aided

assessments in major functional areas of

health care.

Enterprise Risk Management

Again, Enterprise Risk Management (ERM)

forms a major area of public and

governmental accountability, including in its

scope, management of emergency room,

infection control, laboratory, blood bank,

and transfusion controls. Again, critical areas

where risks of medical malpractices could be

high are obstetrics, radiology,

anesthesiology, and oncology, and pain

management. This is more sharply

accentuated in geriatrics and post and pre-

natal interventions.

According to the Wells Fargo Healthcare

group, a detailed and comprehensive view of

all medical and patient-related aspects of

patient care must be made. According to

them, “The purpose of this Operational Risk

Management & Safety Assessment (ORM &

SA) is to assist an organization in determining

how prepared it is to retain risk as well as

determine if the care that is provided to the

patient meets established standards of care

and other recognized benchmarks” (Wells

Fargo Healthcare, n.d.).

Aspects that influence quantum of coverage

Many aspects need to be considered while

taking up the question of medical

malpractice in the hospital setting. For one

thing, hospital administration needs to

decide upon the amount of coverage that it

needs to carry and this has to be laid out on

a scientific and deterministic basis. For

another, the coverage would depend upon

several variables, which may depend upon

controllable and uncontrollable factors. The

major aspects that need to be covered would

be gross patients and their service volume,

including a breakdown of inpatient and

outpatient statistics. It is also necessary to

find out the number of employees, including

health care professionals whose conduct

could have an impact and make it subject to

risks of medical malpractices.

Legal history could dictate future trends

It is evident that before a risk management

program is set into place, the history of

medical risks and their settlement in the

context of the institution needs to be

identified and assessed. It is necessary to

know cases of previous litigation regarding

medical malpractices that have been

instituted either against the institution or

against any of its constituent practitioners. If

so, it is also important to know how these

issues were dealt with and the extent, or

amount of damages that were made by the

institution, or its represented insurance

agencies, or firms. This aspect is important

since this would bring out the public image

that is associated with this particular health

care center.

Importance of public image in health care

settings

It is common knowledge that, to a very large

extent, the survival and growth of public

health care institutions depend largely upon

the public image and goodwill that it has

earned over years of providing health care

services to patients. However, even a few

instances of medical malpractices by its

constituted agents, or health care providers

would be enough to earn disrepute, which

could significantly impact its image and

potential prospects, since few patients

would be willing to visit health institutions

where the medical services are

compromised or neglected, inviting legal

complaints and actions.

Thus, many factors impinge upon the aspect

of medical malpractices, which cannot be

seen in isolation but has to be seen in the

context of the individual case studies. The

importance of a proper methodology for

seeking out how best these issues could be

addressed would form the next part of this

paper.

According to the practicing physicians at

Wayne State University Physician Group

(WSUPG), the responsibility for controlling

medical malpractices vests with the

profession itself (Prognosis E-New: Fieger,

Howard debate merit of health courts,

2005). According to the physicians, there are

reasons to believe that health courts could

be the best place where medical malpractice

issues could be sorted out.

The judges have well acquainted with

Medical Malpractice (MM) laws and with the

help of unbiased observers, the judgments

for such cases would be reasonable and in

the best industry practices. Besides, the fact

that WSUPG sets high professional standards

of medical practices could lower the rates of

such malpractices and move toward a more

transparent and patient-oriented system of

care provision.

Data Analysis

Introduction

Since January 1989, the Joint Commission on

Accreditation of Health care Organizations

(JCAHO), an autonomous agency that

assesses and evaluates the performance of

Health Care institutions and programs in the

length and breadth of the USA, has

enunciated benchmarks for patient safety.

Although JCAHO benchmarks are not key

drivers in risk management, nevertheless,

there is evidence to prove that these ethical

and commercial elements are critical to any

strategic planning models concerning risk

management. Through this, JCAHO provides

an excellent vehicle for creating a culture of

patient safety and welfare.

The goal of risk management is to reduce an

entity’s accidental loss of corporate assets,

personnel, revenue, and reputation. Each

organization’s risk management plan should

include the following components: the plan’s

objectives, key elements, responsibilities,

methods, and areas of focus for the current

year.

Risk Management Plan

• Objectives: The main aim of the internal

regional medical monitoring unit is to

supervise risks to reduce losses, protect

resources and assets and also ensure

security, safety, and stability of condition

of staff members, care providers,

patients, and visitors. This could be in

terms of a separate unit that has been

given the responsibility of taking care of

the above-mentioned aspects, thus

allowing other care-providing units and

departments to carry out their normal

routine functions.

• Key Elements: Risk management involves

several key elements. The methods for

implementing these elements are

described later in this document. The key

elements are identifications of risk

issues, evaluation of areas of risk,

communication of risk information,

education of organizational personnel

and others, and reduction of risk.

• Responsibilities: The risk manager will be

responsible for managing risk

management activities.

These activities include:

1. 1. Coordinating insurance coverage.

2. Managing claims against the facility.

3. Interfacing with legal counsel.

4. Identifying and analyzing areas of risk

exposure.

5. Considering and proposing suitable

peril management practices.

6. Mounting and upholding an

information supervision scheme.

7. Executing and observing security,

teaching, and quality assertion agenda.

8. Inspecting, detailing, and observing

risk management data and information.

Although the risk manager has the

responsibility for this plan, risk cannot be

reduced without education and participation

by all team members. All team members are

expected to report events, follow standards

of practice, identify risk events, guide the

organizational mission, implement systems

to reduce risks, and budget monies to solve

problems. Risk managers will be available to

consult with any department or manager to

assist in a risk assessment of the

environment or system. Risk managers will

also research issues and gather additional

data to assist decision-makers in the search

for solutions. This research may include

local, state, or national data.

Methods for Carrying Out Key Elements

Identification

The methods of identification include, and

are limited to, incident reports, medical

device reports, customer comment tracking

forms, attorneys’ health records requests,

security reports, performance improvement

referrals, medical staff/peer review reports.

Safety hazard reports, supervisor reports,

documentation by staff and/or phone

conversations with individuals who feel a

need to speak about issues, and visual

inspection of all areas of the organization to

identify potential risk situations.

Committee membership and participation

are essential for risk identification. Risk

managers will assist in the credentialing

process whenever there is a request or need

to do so. Risk managers will research the

appropriate databases and assist in

obtaining profiles concerning procedures as

needed or required by the medical staff

bylaws. The aspect of Risk Management next

needs to be seen in the context of an

illustration, or example, that considers an

internal structure within the health care

setting called Regional Medical Center

(RMC). In the case of Wayne State University

Group (WSUPG), it may be the Detroit

Medical Center.

There have been many issues that arise due

to a lack of communication and

understanding between health care

providers. “Despite the complex issues we

face as academic and clinical partners,

WSUPG and the Detroit Medical Center

share a common mission “(Wayne State

University and Detroit Medical Center settle

a dispute over compensation for physician

services, 2009, para. 7).

Risk management will identify high-risk

areas due to trends in practice, advanced

changes in technology, and national data

that might highlight potential areas of risk.

The high-risk areas are the emergency

department, obstetrics, surgery, anesthesia,

critical care, and pediatrics. These areas have

the potential for creating situations that can

have a significant economic and emotional

impact on the organization. Risk

management will monitor the off-campus

sites by receiving notification of any

incidents that occur off-campus, as well as

through periodic visits by the risk manager to

each site. Maintaining information is and

always will be the foundation of risk

management. Most information will be

maintained on the computer system for ease

of data retrieval, to keep paper to a

minimum, and to make record transfers

easier and timely.

Regulatory agencies are constantly changing

guidelines, regulations, and statutes. The risk

manager will monitor changing regulations

and assist team members in implementing

practice changes pertinent to the

regulations. Agencies that may affect the

organization are JCAHO, The Centers for

Medicare and Medicaid Services (CMS), state

licensing boards, state and federal legislative

bodies, and others.

Evaluation

A major role of the risk management

department is to continuously evaluate data,

systems, processes, events, documents, and

departments or areas for risk. This can be

done through committee participation,

reporting mechanisms, such as patient

satisfaction, data and incident reports, data

trends such as needle sticks, and reported

medication errors.

The risk management department will

complete an investigation of any occurrence

and rate the risk of the event. A further

investigation will then occur, with priority

given to all events that alter an outcome for

a patient, a staff member, or a practitioner.

The method of investigation will be

determined by the event itself but could

include data collection and review. Medical

record review, committee participation,

incident report investigation, making rounds

in the area, consulting with specialists to

assist in the investigation, including other

managers, educators, insurance carriers

attorneys, law enforcement and finally the

process such as root- cause analysis, case

study, or peer review to determine what

occurred.

The leadership staff in the organization will

then be responsible for changing processes

or improving systems to reduce future

occurrences and risk. Risk analysis will also

be reported periodically to the board of

directors for its overall direction. The risk

management department will maintain

confidential records of the analysis, including

the process taken to evaluate processes that

may be causing increased risks and the

suggested actions for improvement. After

the analysis is completed, the action steps

will be implemented to solve problems or to

improve the outcome for the parties

involved. After changes have been made, a

periodic evaluation of the success of the

change will occur, and the evaluation will be

reported to senior leadership.

Communication

Communication of risk management

functions, information, data collection, and

risk assessment is an important function

within the risk management plan. The

priority for communication is to inform and

educate employees, physicians, customers,

and others of risk issues and problem-solving

processes. Confidential information will be

shared only on a need-to-know basis without

exception.

Risk management will determine the

confidentiality of certain communication

links for direct and discrete information.

Communication may be directed to any or all

of the following groups, as deemed

appropriate: administration, medical staff,

employees, patients, the board of directors,

and employees. Communication to the

board of directors will be done every

quarter. This communication mechanism will

also include performance improvement

activities related to the risk management

plan.

Education

Education regarding risk management

activities, risk reduction, opportunities, and

other ways to improve the organization is a

key element of the risk management plan.

The medical center will also participate in

collaboration with the parent organization’s

national risk management program through

involvement in the Risk Management

Incentive Program. Proven measures of risk

reduction may result in lowered liability

rates.

The measures may be in the form of general

orientation, root-cause analysis sessions,

special education programs, conferences,

medical staff meetings, employee staff

meetings, board reports, department

rounds, and informal discussions. Risk

management will be prepared to assist the

organization in national regulatory changes

that influence how the work is done.

Educational opportunities will be sought out

in the employee environment to reinforce

the principles of risk reduction.

Reduction

The outcome of any effective risk

management plan is to reduce risk. The

problem-solving process of identification,

evaluation, education, and communication

will be the mechanism for reducing risk. The

reduction of risk will provide a safer

environment for patients, staff, providers,

and visitors. Each of the activities will

identify action steps and personnel required

to resolve issues. Problem-solving activities

and their outcomes will be shared through

Areas of Focus in Fiscal Year 2008:

1. Timely incident reporting

2. Reduction of medication errors

3. Implementation of workplace

violence program

4. Data trending of resuscitation

outcomes

Attention to medical errors escalated over

five years ago with the release of the study

from the Institute of Medicine (IOM), To Err

is Human, which found that between 44,000

and 98,000 Americans die each year in U.S.

hospitals due to preventable medical errors.

By far, mistakes in hospital settings list in the

fifth and eighth spot as the main causes of

fatality, accounting for deaths of most

Americans when compared to breast cancer,

road accidents, or AIDS.

Nearly five to ten percent of patients put into

hospital settings are affected by major errors

in treatment. These numbers may

understate the problem because they do not

include preventable deaths due to medical

treatments outside hospitals (Kaiser, 2007).

If deaths due to medical treatment outside

hospitals are considered, the figures may be

larger. Most often, medication errors can be

attributed to one or more of the following:

• Faulty prescribing, monitoring, or

refilling practices

• Inappropriate formulas

• Improper documentation

• Inadequate communication

How can physicians avoid diagnostic errors?

Expert physicians have to

investigate/document all patient complaints

and maintain a comprehensive record of the

patient’s history by implementing a template

to ensure consistency and thorough

evaluation and documentation. Physicians

should avoid allowing age to become a

determining factor in the evaluation of a

diagnosis. Review results from a previous

diagnostic exam and promptly pursue

further diagnostic studies. Also, ensure that

a diagnostic tracking system identifies

delinquent follow-up. Handwriting should be

legible and easy to understand. Legibility

issues are resolved through the use of

electronic prescription ordering and record

keeping.

The use of preprinted prescriptions for

frequently prescribed compounds is another

effective method of providing easily read

prescriptions and avoiding illegible orders.

Physicians should avoid verbal orders. If

verbal orders must be given, physicians

should repeat the order, spell the name of

the medication, and ask for the order to be

repeated to verify understanding.

Alternatively, consider the use of fax

transmission of prescriptions to the

pharmacy to provide a written document

that can be maintained in the patient’s chart

(JACHO, 2005).

What are the risk exposures and hazards?

Clinical judgment is a risk exposure for

physicians. Many factors underpin a general,

or specific lack of data needed to reinforce a

physician’s clinical diagnosis about patient

care. They may include, among others, a

partial or mistaken history, excess

dependence on referring physician’s

diagnosis without independent evaluation,

inability to get a consultation,

misinterpretation of diagnostic studies,

insufficient office systems to monitor test

results, cognitive prejudice, inadequate

supervision of personnel and scarce

knowledge.

How can corrective actions be

implemented?

To enhance the security aspects for patients

and disallow mistakes, the Government

should set up a National compulsory

unfavorable occasion reporting system so

that health care settings disseminate

information that can assist them in

correcting wrong systems and procedures.

Computer prescriptions could significantly

reduce errors in dispensing drugs and

medicines.

This would assist doctors in dealing with

issues arising out of indecipherable

handwriting and by routinely examining for

mistakes or unsuitable drug usage.

Despite a ruling by the Institute of Medicine

in 2006 that preventable medication error

costs $3.58 billion annually, just 5% of

hospitals have taken concrete steps to check

such occurrences. Health care settings could

also help by evolving systems that could

control workweeks of professionals to

diminish errors arising out of tiredness and a

need for rest.

The Institute of Medicine (IOM) report called

for a 50 percent reduction in medical errors

by 2004. Unfortunately, it is not possible to

quantify the number of errors today, and

therefore, impossible to determine if the

goal has been met. The number of errors

remains high and there are many issues

around substandard quality in addition to

error. The 1999 IOM report focused

primarily on errors in hospitals, but errors

occur in other settings, such as ambulatory

care and nursing homes (Bleich, 2005).

Quite often, avoidable errors may occur due

to mistakes in recommending drug intakes or

consumption of drugs. Eliminating

medication errors need to be seen in the

light of a national agenda for alleviating

medication errors premised on statistical

data regarding the regularity and economic

costs of such errors and proof of the

effectiveness of a range of preventive tools

(Preventing medication errors: Quality

chasm series, 2009, para.1).

Hospitals and other health care

organizations decrease medical errors by

using expertise, improving processes,

identifying mistakes that cause damage, and

building a customs of security. Empirical

studies have shown that Computerized

Physician Order Entry (CPOE) helps obviate

medication errors. It involves entering drug

orders directly into a computer system

rather than on paper or orally (Vantage

Professional Education, 2006). It is believed

that the use of computer software for

generating physicians’ orders is useful in

alleviating mistakes arising out of medical

errors or misrepresentations.

Various conducted studies have reinforced

the need for greater use of computerized

patient order entry (CPOE) which obviates

ambiguity in handwriting, decimal points, or

acronyms. All matters are processed digitally

under this system, thereby dramatically

reducing the chances for manual errors and

difficulties in deciphering the handwriting of

health care professionals.

Today, most Americans don’t believe the

nation’s quality of care has improved. As a

result, “as studies continue to point out the

high rate of medical errors and their

devastating effect on millions of citizens,

many groups are making an effort to get

patients more involved in protecting

themselves” (News: New online brochure

hopes to get patients more involved in

protecting themselves, 2005). The

probability of occurrence of various kinds of

medical errors is immense. Thus, the main

objective is in reducing the number of

possible medical errors in various types of

health care centers. Much work remains to

be done and there is still much to be learned

but the important issue is that systems,

process improvements, and

recommendations are now being set into

place (Vantage Professional Education,

2006).

Doctors being human, the public needs to

empathize with them for errors that could be

made. But it is well within their command to

reduce such errors to minimal levels. Firstly,

a new technology that could significantly

alleviate the probability of errors needs to be

evidenced. However, till such time such

errors are sought out and permanently

decreased, these would continue to be the

main areas of medical care.

Summary and Conclusion

Summary

The purpose of this future research is to

determine ways to create a safer patient

environment and awareness of safety

practices among employees. Physicians play

a vital role in reducing the prevalence of

medical errors. Physicians should provide

leadership to make patient safety a priority

and to increase staff awareness of potential

patient safety threats.

The problem statement dealt with the high

cost of malpractice insurance premiums.

Since the 90’s the nation’s health care bill

has added $7 billion to the cost. The

information received from the Institute of

Medicine stated that by 2010 there should

be a 50% reduction in medication errors. The

continuation of committee reviews,

implementing policy and procedures, checks

and balances, education, and effective

communication can avoid diagnostic errors.

To achieve these goals, much work lies

ahead.

For this future online survey questionnaires

and interviews would be conducted with

several respondents chosen specifically for

this purpose. They formed an unbiased

cross-section of health care professionals,

members of the nursing community,

physiotherapists, and other therapists who

were involved in the process of health care

delivery.

The underlying factor is that the best

interests of the patient need to be always

considered and needs to be benchmarked

against the best industry practices both in

terms of a measure of care and the risk

management commitments and

responsibilities that are taken in group and

individual settings. Insurance companies and

underwriters also play major roles in

assessing health care insurance and its

settlements due to accident or medical

malpractices.

Where conflicts arise in the context of the

delivery of health care, especially sharing of

patient responsibility, medication, and such

other issues, the underlining factor should

be whether these issues are capable of

causing detriment to the health and welfare

of the patients and lowering the degree of

care. If so, it needs to be eschewed and

patient care programs need to be enforced.

There is a need for trusted methods to be

developed and enforced that could consider

the impact of medical malpractices in the

present state, and ways and means need to

be developed that could enhance patient

service and care, both in qualitative and

quantitative terms. There is a need for

utmost trust and confidence to be exercised

from both sides, to foster an environment of

risk management and its smooth and

effective transition into the administrative

health care functioning of care centers.

In the event risk management is not given

due importance, even a single incident of

medical malpractice could considerably

impinge upon the financial viability,

goodwill, and prospects of health care

institutions. The depletion of financial assets

by way of damages and penalties, indulging

in litigation aside, would have far-reaching

implications on the authenticity and

reputation of the institution.

Moreover, it could also compromise on the

faith and reliance placed by patients and

their careers, insurance companies,

underwriters, and a host of other

intermediaries and firms that do business

with such institutions. Thus, it is very

important and intrinsic that health care

institutions, however small they may be,

need to have a robust and pro-active risk

management system in place, not only to

safeguard the assets of the institution from

being frittered away in long and expensive

legal cases but more significantly, to protect

the best interests of the customers, clients,

and patients who are depending upon them

in more ways than one.

The outcome of the deliberations with risk

manager respondents may also reinforce the

fact that a two-way communicating system

between provider and patient is very

important, and underpins the degree of trust

and confidence each places on the other for

the safe delivery of services and the right

attitude to getting well.

Conclusions

This future research would focus on ways

and means by which patient health could be

made a number one priority and aspects of

risk management in health care be closely

monitored through the implementation of

regular control mechanisms designed to

keep events of risks at the barest minimum.

The survey being an ongoing process that

needs to consider contemporary health

settings and characteristics at the time of the

research program, it has been well-advised

to be taken up during the time of future

research for achieving the most accurate

results.

The main aspects that advanced and

improved health care assume in the present

context is in devising ways and means and

strategic decision making which envisages a

heightened sense of comfort and health

assurance for patients and also enhancing

their standards of safety and security in

terms of lesser susceptibility to injuries,

greater comfort zones and ensuring the

overall high standards of providing care that

would not only ensure congenial patient

treatment atmosphere but also afford them

the desired degree of care which they are

entitled to.

While individual strategies and health

enforcement policies and practices vary

from one health care institution to another,

the fact remains that there are important

broad-based guidelines that need to be

adhered to, if a genuine improvement in the

current health care standards is desired.

This included the clear judgment of the

qualitative and quantitative aspects of

medical malpractices. “If malpractice is

judged inaccurately or is not clearly defined,

doctors may carry out excessive tests and

procedures to be able to cite as evidence

that they were not negligent. Likewise, if

malpractice is defined clearly but too broadly

or if awards tend to be too high, doctors may

engage in defensive medicine, inefficiently

restrict their practices, or retire.” (Limiting

tort liability for medical malpractice, 2004,

para.9).

Both these situations, from the perspective

of patients, are unwelcome, and thus the

administration needs to take care that the

patients’ rights and treatment are given the

Number One priority, no matter what

situational demands may be. For achieving

this goal, it is also necessary that there

should be a clearer and transparent

communication network between patient

and provider, which in effect, reduced the

risks of treatment dramatically. But the

communication system also needs to be

suggestive of seeking the overall well-being

of the patients and not only in terms of

securing the provider from a risky position.

It is believed that Medication errors, arising

possibly out of tort of negligence could also

be a major aspect of medical malpractices.

The only redeeming factor could be that the

errors may have arisen advertently and not

due to the gross mistake of the persons

concerned. However, it is the duty of

manufacturers of drugs to inform the

medical fraternity/ consumers about the

potential dangers of their products, etc. This

could be in the form of product literature

that accompanies the medication and

information that is passed on to the health

care practitioners during deliberations with

drug product manufacturers’

representatives.

Again, it would also be incumbent on the

part of physicians to explain drug reactions

and contraindications to patients before

administering drugs to them. Informed

consent is a crucial aspect of medical

practice and the consumers do have every

right to know about the risks and dangers

involved in using such drugs. It is also within

the ambit of consumers to refuse such drugs

that they feel could cause further health

detriment to them, and physicians need to

respect these decisions.

Another critical aspect that needs to be

enlightened is that physicians need to have

the complete background and medical

history of patients before prescribing drugs

to them. The risks of allergies could be fatal

as was seen in the case of “Harris County

Hospital District v. Estrada 872 S.W.2d 759

(Tex.1993).” (Learning objectives, 2000).

“Yet, in another important case with a

somewhat different thrust, a patient died

from an allergic reaction to a prescribed

medication. Plaintiffs for the deceased

alleged negligence. The court agreed,

concluding that the defendants failed in their

responsibility to thoroughly investigate and

review potential allergic reactions for the

deceased patient.” (Informed consent: What

every pharmacist should know: Legislative

and regulatory history, 2010, para.4).

Thus, the aspect of medical errors along with

medical malpractices could be a major

aspect in risk management, which could

indeed be suitably guarded against, through

pro-active and strategic management

decision making. Increased use of

technology like computer prescriptions

could significantly reduce medical errors to

the barest minimum and could thus reduce

the liability of physicians. Besides, more

efforts need to be made to “prevent

medication errors by maintaining adequate

stock levels of drugs on patient care units,

and ensuring that health care providers

order their patients’ drugs during regular

pharmacy hours whenever possible.”

(Granville & Rogers, 2000, p.38).

In the years to come, Medical malpractice

insurance (MMI) could be a major tool that

ensures the financial security of physicians

during the performance of their medical

functions. However prohibitive the costs of

MMI may be, it is perhaps one of the options

available to physicians against risks of

potential financial disasters in the form of

lawsuits, or medico-legal cases. It is seen that

many doctors may take recourse to unethical

processes to save their practice.

“In the health-care industry, many doctors

report ordering unnecessary tests to avoid

lawsuits” (Gryphon, 2008, para.18).

In the years to come, what is needed is to be

able to strike a right balance between the

need to keep patients’ needs uppermost

paramount and the need for the medical

profession to develop stratagems for risk

management and avoidance of potential

medical malpractices. “The issues of medical

liability, patient safety, and just

compensation for the medically injured

seem to be caught in a vicious cycle.”

(Bovbjerg & Raymond, 2003, p.22).

Many patients thus lose the right to their

legitimate claims along with the distorted

procedures and even many patients who

have the rights find themselves unable to

enforce them. There is a need for reform,

and rightly so, in seeking and establishing

norms by which the just claims of majority

claimants could be expedited, normalcy and

trust restored into the system that has long

been vitiated by governmental interference

and other bureaucratic interventions that

need to do much more in terms of seeking a

just and equitable settlement of patient

claims and insurance settlements.

“Medical malpractice law is intended to

provide physicians with an incentive to

reduce errors. Regrettably, there are two

good reasons to doubt that it currently does

a credible job. First, researchers have been

unable to detect a significant deterrent

effect. Second, physicians simply do not

believe that tort law rewards improved

quality.” (Making hospitals accountable:

Hospital-level liability could revive the

dormant deterrent power of tort liability,

2009, para.16).

Under such circumstances, it is necessary

that risk management in the health care

arena needs to be given the due importance

that is due and also undertakes ways and

means by which these aspects could be

enforced with a greater degree of

empowerment and credibility. Besides, the

aspects of patient care and comfort need to

be attended to, not only as a course of

professional ethics and being part of the

physicians’ responsibilities but also in terms

of the moral duty which physicians owe to

their patients and their caregivers.

It is the attitude of the parties that need to

undergo radical changes from the present

bellicose and confrontationist to one of

relative understanding and compatibility

within the health care provider industry. This

could, in effect, ensure a greater degree of

harmony in patient-physician relations and

could pave the way for a greater degree of

efficiency and health care effectiveness

within the industry.

Thus, Health care risk management is a

procedure that needs to be constantly

audited and monitored by the workforce

regularly. The basis of this practice is through

disallowing the occurrences of incidents.

Pro-active dedication endeared by medical

staff as well as unflinching loyalty is critical

ingredients for the success of health care

management programs. Every subsection is

liable for disallowing dangers and controlling

risks within its parameters.

Since the costs associated with occupational

medical errors and malpractice is increasing

dramatically in recent years, it has become

imperative to effectively take care of

intricate risk issues and patient safety. The

sources of additional costs could be

explained in terms of ineffective lawsuit

expenditures, insurance costs, heightened

contacts with clinical methods,

differentiation in medical care, and

insufficient support systems.

The challenges have never been greater, the

workforce is never smaller, the technology

more complicated, and patient demands

never higher. Despite all these tensions,

healthcare professionals and those who

assist them in managing the risks associated

with their responsibilities must continue to

remember that, everyday patients and their

families entrust their lives to them.

Physicians owe it to their patients to be

worthy of that trust.

Most healthcare risk managers look forward

to the opportunities ahead and are

dedicated to managing their organization’s

risk and enhancing patient safety. The future

is fraught with peril and great risk but also

great reward. Those risk managers who

accept change and think of new ways to

embed risk management principles into their

organizations to help create meaningful and

sustainable change will prosper. Those who

do not should get out of the field of medicine

right now.

Physicians, clients, politicians, and others are

very much alarmed about the rising levels of

medical wrongdoings and their indemnity

issues.

Medical malpractice and malpractice

insurance continue to be issues of great

concern to physicians, consumers,

legislators, and others. Much of the

deliberations about increasing malpractice

insurance premiums have focused upon

limiting the damage awards in malpractice

cases and some thoughts have been fostered

on the need for reforms in the insurance

sector. Another concern that has received

less public notice in malpractice discussions

of recent years is patient safety.

Safety of patients refers to the gamut of

rules, practices, and systems that govern the

need to circumvent medical injuries, and the

stratagems to obstruct medical mistakes

need to be imbued in norms of patient

welfare. Increasing medical malpractice

insurance premiums are a growing concern

in the American healthcare system. Many

physicians, professional organizations, and

lawmakers claim that the tort system

encourages frivolous lawsuits and jackpot

verdicts. To prevent a major dearth in

healthcare access, strict malpractice liability

restrictions, including caps on non-economic

damages must be mandated.

There are doubts whether a likely and total

solution for the recalcitrant malaise of

malpractices could be easily found. But if

true reforms are to be implemented in real

terms in the health care industry, it is

imperative that the reality of past failures be

understood and a more rational and

practical solution be worked out, that would

remedy the present ills, including the

prevalent tardy, costly and unjust systems

now prevailing. The ability to implement

health care reforms is a critical area,

implementation of reform packages mustn’t

be vitiated by the incompetence of

administrators to address shortcomings in

malpractice systems, which does act as a

barrier in enforcing constructive changes in

the health care industry.

Health care professionals need to find

avenues for making their vision on quality

assessment and physicians need to find a

way to make their perspective on quality

measurement and up-gradation. A change in

attitudes, skills, and associates is needed.

The success of doctors in taking care of these

assets and avoiding conflict areas with

patients would vitally affect both the future

of the profession and quality dimension and

progress in the U.S. health care system. An

alteration in how the healthcare professional

communicates with patients about harmful

medical errors has begun. Within ten years,

it is believed that the rapport between

patient and provider would be more

transparent, communicative, and robust.

Once patients are made aware of the

detrimental effects of errors in medicines

and their implementation by providers is

effectuated, it would be a step in the right

direction in renewing public confidence in

the genuineness and uprightness of the

health care system.

Risk Management symbolizes an ever-

moving procedure in a health delivery

system that can result in improved patient

care and reduced accountability. An

important mechanism of the process

includes nurturing a good relationship with

the patient, obtaining approval after

appraising all facts, practicing within

established guidelines, and careful

documentation. A triumphant risk

management program can also cause a

fruitful Continuous Quality Improvement

plan. An efficient risk management practice

does not ignore risks. Having effectual and

operational risk management shows an

insurer that your business is devoted to

decreasing and eliminating loss. It also builds

a better risk insurance mechanism for your

organization.

Risk management involves policies,

processes, and procedures that identify

potential operational and financial losses,

prevent losses whenever possible and lessen

the effects of losses that cannot be

prevented. Some of the steps that are

involved with risk management are

identifying and analyzing potential risks,

preventing and reducing the effects of

accidents, medical errors, and other injuries

and losses. Risk management must include a

heightened sensitivity to provide a safe

environment and address the emotional

needs of patients. Good relationships with

patients are very important in preventing

malpractice suits. Public relations for health

care professionals are a challenge. It is not

only a good medical practice but it is at the

very core of the problem of medical

malpractice.

Risk management is primarily designed to

protect the financial assets of an

organization by assuring adequate financial

protection against potential liability through

appropriate insurance coverage. The main

objective of risk monitoring is to reduce the

chances of identified detrimental risks. This

could be attained by enjoining risks

management into the plans.

In real terms, implementing

recommendations would envisage the

injection of several new inputs required by

physician groups to enforce the

recommendations. These could be in terms

of making provision for additional resources,

assets redistribution, realigning and

reallocating manpower and needed

workforce towards a more well defined and

charted course of action, in line with

recommendations, and above all aspects of

outside management intervention and

control in the proceedings of health centers

through outside holdings. There are

sufficient advantages in pursuing this course

of action for improved overall control and

monitoring of activities could be gained and

also raising the bar as far as improved

patient management health care

intervention techniques are concerned.

Recommendations

This study is future to be conducted using a

closed study survey of the aspects of medical

malpractices in the closed environment of

Wayne State University. For this research, it

would be necessary to conduct online

internet interviews with members of the

medical and health care providing faculty of

this institution. This would be in the form of

questions asked to them regarding their

perceptions of medical malpractices and

how to tackle such issues.

Future draft of questionnaire survey

instrument

Future draft of survey instrument:

A future random sample of 50 physicians will

be selected from the given sample

population by lots. In this survey, 25

respondents will be physicians of multiple

specialties and 25 members of the health

care team consisting of physiotherapists,

nurses, counselors, and other health care

service providers employed by WSUPG.

It is important that in a future research

survey on a sensitive topic like medical

malpractices, the prior permission of the

employers as well as aspects of ethical

consideration like privacy and confidentiality

of the information gained is also established

before the survey results are released.

Moreover, it is also necessary that the

research team declares that the data

collected would only be used for research

and not commercial usage for profits, etc.

The future research methodology will

involve first ascertaining the background of

respondents, their age, and experience, and

work duration with Wayne State University

Physician Group. The main aspects that will

need to be realized during this survey will be

in terms of identifying specific medical

outcomes or results, the role of risk

management, and specifically risk managers

in combating and alleviating areas of medical

malpractices. Besides, the gaps in physician-

patient relationships and how this could

contribute to larger incidences and

occurrences of medical malpractices are also

major areas that need to be addressed

through this survey.

Perhaps one of the major factors this survey

needs to concern itself with is the quality of

medical service provided could determine,

to a large extent, the aspects of probable

medical malpractice claims. Where there are

errors, lack of care, errors on the part of the

medical and nursing staff, without rejoinder

of risk management, the degree of

occurrences of medical malpractice cases

could indeed be high when compared to

safer, well detailed and planned quality and

degree of care provided to patients. There

are also aspects that in many cases, the

injuries sustained through medical

malpractice may go undocumented or

unclaimed, due to a lack of knowledge and

understanding among patients regarding the

modus operandi of filing of claims and their

eventual disposal by courts or relevant

authorities.

Thus, along with the knowledge of what

constitutes a case of medical malpractice

and how it comes about, it is also necessary

that patients are enlightened about the

various technical and non-technical aspects

of medical malpractice and how it impacts

the acuity of care. This research

methodology also needs to consider age,

gender, kind of illnesses for which the

aspects of medical malpractice arise, and

also the steps taken by the patients to

counter and be compensated for known

cases of medical malpractice and its

monetary value according to nature and

degree of injury sustained.

The main questions that are future to be

asked of the respondents will be as follows:

1. What are the major determinants for

assessing the causes and impacts of

medical malpractices?

2. How does the aspect of

communication, or lack of it, affect the

health of patients?

3. Are the risks of litigating damages in

the areas of medical malpractices real?

4. What are the main purposes of

Medical malpractices insurance?

5. What role does objectivity and

pragmatism play in government medical

malpractices?

6. How can blame be attributable and

accountable in malpractice cases?

7. How the aspects of errors and

mistakes could be detected and avoided?

Analysis

Further, the findings of the research

proposal may prove that the majority of the

issues arising are due to a lack of

communication between the people

involved- the patients, care providers, and

the public in general. Moreover, it is seen

that patients place trust and reliance on the

advice and course of medication offered by

professional health care specialists, and

therefore, if malpractices or lack of care is

established, it could well be ending in

lawsuits in which the party at fault would

have to pay up a large sum as compensation

for damages and also other compensation as

decided by the Courts. Besides, several other

aspects, like the degree of care that was

necessary to exercise, that which was given

and the gaps in treatment are all major

aspects that impact the patient’s perception

and attitude towards caregivers.

The future respondents may mention that

the legal protection may be sought to be

made available to patients, especially those

needing long-term intensive care as a major

aspect. Often, health care professionals are

overburdened with cases, and the lack of a

suitable patient care ratio may also tend

caregiving to be marginalized, specialized

and individual care may, more often than

not, be the privilege of the affluent class.

The results of the survey seem to indicate

that more degree of care needs to be taken

by providers in the health care industry to

avoid patient litigation and cases of medical

malpractice. “The purpose of medical

malpractice insurance is twofold:

1. to protect health care practitioners

from the negative economic

consequences of being found negligent

in their medical practices; and

2. to provide compensation for

individuals who suffer harm from

negligent doctors” (Medical malpractice

insurance rates, 2003, Purpose of

medical malpractice insurance, para.2).

Coming to the legal aspects that govern

medical malpractices and their invocation, it

could be said that while laws may exist, they

need to be applied contextually to achieve

results. It could also be seen that more

emphasis needs to be placed on the

objectivity part of treatment and not it’s the

subjective part. Further, it is also seen that

more relevance and importance needs to be

given to the right modes of treatment and

follow the standard and specified methods,

rather than depend upon methods that are

open to controversy or are not well

opinionated.

The next aspect that needs to be considered

in the context of medical malpractice could

be in terms of how blame could be

attributable and accountable and how they

are presented in a court setting. It is seen

that proper maintenance of official records

of patients and their profiles needs to be

made available on request too

risk managers and insurance companies. The

records and database speak volumes about

the degree of care and medication that has

been followed, and through maintenance of

proper records and archives, risk managers

would be in a much better position to

ascertain losses and pin accountability. This

could also be in terms of the fact that greater

impact and risk management practices need

to be imbued to gain better resource

allocation to patients.

Coming to the aspects of how errors and

risks could be pinpointed, it could be said

that the documents available to insurance

companies, risk managers, and appropriate

management concerns could, to a large

extent, determine the amount and scope of

losses and how the compensatory amounts

could be gained. Further, it is also possible

that a more focused and deeper insight to be

established that could address the finer

issues that underpin medical malpractices in

the context of the health care industry.

From the future deliberations with health

risk managers and their views on the aspects

of risk management, it is abundantly clear

that there needs to be a sound and plausible

health care management system that could

address all facets of patient-provider caring

and also create a congenial and positive

health care environment that could enhance

patient treatment and early recovery.

Moreover, it is seen that in the current

settings, it is important that a cohesive and

well-structured risk management plan,

addressing all major areas of public health

accountability and patient care, irrespective

of the specifics of the case and local

influences, need to be formulated and

executed to save future litigation and

redundant health care costs. Thus, “all

health care providers must focus on

enhancing the effectiveness of their risk

management programs” (Effective health

care risk management programs, n.d., p.8).

Those who are unable to do so would be

marginalized for failing to provide suitable

patient safety protections and would surely

find insurance coverage for professional

liabilities and injuries difficult to obtain and

enforce.

Thus, it is not only in the best interest of the

patients but also that of the provider

institution to enforce a disciplined and well-

rounded risk management policy that could

attend to all areas of patient care and its

implications on the accidental aspects of

health care business. Providers who neglect

or undermine such schemes may be

seriously disadvantaged over time and may

find themselves in a deeper quagmire than

before.

For the Risk Management Program to remain

successful, the researcher also recommends

the enforcement of a robust action plan that

envisages, among others, the setting up of a

National Center for Patient Safety. This

would ensure the development of an error-

free reporting system that guarantees

confidentiality and privacy of patients’

records. It also helps in raising the bar about

performance standards and safety

commitments within health care

professional groups and accreditation

boards.

Keeping in view the key factor of ensuring

the best health and welfare interests, health

care centers must implement a high degree

of safety standards at the level of patient

care delivery systems. There is the need for

constant internal audit and monitoring to

ensure that these factors are being

consistently delivered and sustained through

prudent and judicious planning and

organizing of patient welfare programs,

before, during, and after the provision of

health care services in an institutionalized

setting.

How do our recommendations match with

things being carried out in the Wayne State

University Group?

The need for a constructive and patient-

centric approach has been at the heart of our

recommendations, combined with a sound

and plausible health care safety

management system that could address all

facets relating to the provision of optimum

patient-provider care systems.

Hospital administration has adopted many

schemes to update quality and patient

security during the duration of stay in

hospital settings.

This has also been the guiding principle of

the Wayne State University Physician Group.

Moreover, aspects like planning and

organizing individualistic patient care, and

safe caring which has been mentioned in this

study, are regularly practiced at this health

care setting at WSUG.

One of the major recommendations that

could be given is that the patient’s best

interests supplant other factors, especially in

the case of elderly, or very young patients,

who may not possess the wherewithals to

take care of their health and well-being,

Health is an aspect whose importance is only

known after a

life-threatening crisis develops. Thus, it

becomes necessary to inculcate pro-active

and pre-emptive measures to circumvent, or

even prevent such occurrences as humanly

possible. The preventive aspect of health

care is even more significant than ultimately

curing diseases, especially when many kinds

of ailments do not carry ID cards when it is

ushered into the lives of patients and their

apparent well-being. Diseases are quite

capable of causing more detriment than

could be visualized and given

encouragement and support through

medical malpractice and high uncovered

risks could provide more than what patients

and their care providers could have

bargained for.

Instrumentation

Questionnaire Survey (considered in analysis

section)

The main survey questions to be asked of the

respondents will be as follows:

1. What are the major determinants for

assessing the causes and impacts of

medical malpractices?

2. How does the aspect of

communication, or lack of it, affect the

health of patients?

3. Are the risks of litigating damages in

the areas of medical malpractices real?

4. What are the main purposes of

Medical malpractices insurance?

5. What role does objectivity and

pragmatism play in government medical

malpractices?

6. How can blame be attributable and

accountable in malpractice cases?

7. How the aspects of errors and

mistakes could be detected and avoided?

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Appendix 1

Joint Commission National Statistics of

Sentinel Events.

Appendix 2

Joint Commission National Statistics of

Sentinel Events.

The Role of Risk Management in Reducing Loss Prevention

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