Hospital Risk Management/Health Care Policy
Minicaa
7 months ago
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files (5)HosptialApplication.docx
HealthCarePolicyAssignment.docx
HospitalRiskManagement_Scenario460.pdf
HealthCarePolicyMemoTemplate.docx
Rubric-HealthCarePolicyandProcedureDevelopment.pdf
HosptialApplication.docx
Within the Allied Health Community media, read the "Hospital: Risk Management Scenario."
In a total of 250-500 words, respond to the questions located in the scenario.
HealthCarePolicyAssignment.docx
Complete the Transitional Care Application assignment prior to beginning this assignment.
Select one conflict issue from the Transitional Care scenario in the Allied Health Community and write a new policy and procedure related to the issue that identifies methods or practices of rationally and effectively discusses issues and resolving conflict.
Write a 500-word memo to your supervisor (you may choose to use the "Health Care Policy and Procedure Memo" sample) that describes this issue and an explanation of how the new policy and procedure will resolve the issue. In the memo, include a draft of the policy and procedure. Be sure to include the research on industry standards that helped you formulate the policy and procedure.
· Memo template is attached
HospitalRiskManagement_Scenario460.pdf
HOSPITAL: Risk Management Scenario
Scenario
A rural country hospital facility provides health care services to over 35,000 citizens, with a high percentage being older Americans who have retired to this area of the country. The hospital administrator has asked the Vice President of Risk Management to attend a meeting with the senior staff next week in the Board Room. The hospital administrator has asked Vice President of Risk Management to present areas of opportunity for increasing the hospital’s risk management strategies to ensure a litigation-free environment for the facility, its patients, and its employees.
During the meeting, the Vice President of Risk Management reports that all the continuous quality improvement (CQI) minutes for the past 3 months of meetings have been reviewed. Although most areas are being adequately resolved, there are some that need more attention, especially from the senior staff. Before specifically addressing those points, the Vice President of Risk Management briefs the staff on the major areas of risk for the hospital. They are:
1. Employee-driven adverse actions against the facility 2. Medication errors 3. Surgery/Treatment errors 4. Patient falls 5. Patient elopements 6. Security breaches in secured areas 7. Inaccurate coding and billing for government/insurer reimbursements
Now that the senior staff is aware of the major areas of risk concern, you, as the administrator in charge of all hospital business operations, assign each of these areas of concern to the respective director, such as the Directors of Human Resources, Nursing, Medical, Social Services, and Facility Security. Their reports of assessment, along with recommendations for achieving full compliance and reducing the hospital’s litigation exposure, are due at the end of the month.
Questions:
1. While this situation has many areas of risk that are considered a top priority, focus on patient privacy and information disclosure (HIPAA violations). Which department is responsible for leading the initiative? As the administrator, describe your approach for managing this directive. Do you create a special projects team? How do you gather pertinent data for a category? What tools would you use? 2. How do you determine if you are meeting the industry standards for this area of risk? 3. Would you change any current policies or procedures? How and why? 4. How would you train the affected staff with regard to this area of risk? 5. What are the sanctions, penalties, or government investigations that could present a worst-case scenario if not addressed?
HealthCarePolicyMemoTemplate.docx
Health Care Policy and Procedure Memo
Grand Canyon Transitional Care Organization
MEMORANDUM
|
TO: |
INSTRUCTOR A. NAME, MHA |
|
FROM: |
STUDENT A. SAMPLE |
|
SUBJECT: |
ENTER SUBJECT |
|
DATE: |
3/29/2020 |
|
CC : |
BOSS A. SUPERVISOR, MHA |
Through my experience as the Director of Human Resources, many issues that are occurring within our organization have been brought to my attention. One of the main issues brought to my attention through complaints from employees is that our organization has many policies that are out of date. These outdated policies are not effective within the current health care industry, causing further issues within our organization. I have created a new policy and procedure pertaining specifically to the steps of creating and regularly reviewing our current policies and procedures. This is a policy that we have lacked entirely in the past, creating the need for the development of one now. The new policy will promote compliance with relevant legislation, industry and other standards, and community expectations; promote our organization to achieve strides toward the mission, vision, and values; “promote operational efficiency;” and reduce potential risks within the health care environment (Example, 2019). The policy will benefit the employees of our health care organization immensely, along with the community members to which we are providing service.
The policy that I have developed is titled “Creation, Review, and Revision of Policies and Procedures Policy.” The policy and procedure will lay out specific guidelines, templates, and requirements for creating and regularly reviewing policies and procedures within our health care facility. The general steps involved in the procedure include needs analysis, development, approval, distribution, implementation, regular review, and revision (More, 2020). The health care industry is consistently transforming due to technology and other factors, creating the need for our organization to stay on top of policies creating a current, accurate, and effective environment for all of those who are involved. Overall, the policy will promote consistency, predictability, compatibility, risk mitigation, and high-quality care throughout our organization.
I believe that this new policy will not only help with eliminating the problem of out-of-date policies, but also the many other issues that have been brought to my attention by various staff members. These other issues include complaints about management, employee-related adverse actions, unfair treatment for corrective actions and progressive discipline, unfair administering of policies, a high number of medication errors, and harmful patient treatment. Although our organization has maintained a superb reputation for the last 40 years in service, our reputation and ability to perform is going to decline if we do not make the necessary changes in a timely manner. All of the issues pertain to specific policies and procedures that we have, but there is a clear need for revision to correct the actions of management and other employees. If implementation of this policy is successful, there will be a requirement for policies and procedures to be reviewed on an annual basis. This is strongly needed, as some of our policies have not been revised in years. Please consider administering this policy and procedure so that we are able to maintain ourselves as a reputable health care organization, willing and able to provide the highest quality of care for all of our patients.
I have attached the proposed policy and procedure. Please do not hesitate to contact me with any further questions, comments, or concerns.
Sincerely,
Student A. Sample
ATTACHMENT:
______________________________________________________________________________
Creation, Review, and Revision of Policies and Procedures Policy
Policy: The purpose of this policy is to create guidelines and requirements for policies and procedures that promote consistency, predictability, and compatibility throughout Grand Canyon Transitional Care Organization. The policies for the organization will be generated according to a standard template. The requirement will be that policies are reviewed annually to ensure that they are still effective and up to date.
Procedure:
A. Needs Analysis
a. Identify the need for the creation of a new policy.
b. Identify the need for the review or revision of a current policy.
B. Development
a. Determine who will be creating and writing the policy.
b. Determine who will make changes to the existing policy.
c. Create all policies in accordance with the universal format.
i. Purpose/Policy statement.
ii. Procedure that will support the enactment of the policy.
C. Approval
a. Determine who will have the power to approve the new policy or the edited policy.
b. Get approval for the policy.
D. Distribution
a. Distribute the new policy to staff members.
i. Allow time for questions, thoughts, concerns.
b. Distribute the revised policy to staff members.
i. Allow time for questions, thoughts, concerns.
E. Implementation
a. Implement the new policy within the organization.
b. Implement the revision of the policy within the organization.
F. Regular Review
a. All policies and procedures are to be reviewed on an annual basis.
G. Revision
a. If the review deems revision necessary, repeat steps A through E.
b. Step F will occur after a year.
EFFECTIVE DATE: April 1, 2020
References
Example, J. (2019). Do you need a policy on policies? Retrieved from https://www.effectivecompliance.com.au/do-you-need-a-policy-on-policies/
More, E. (2020). Do you want a procedure date? Retrieved from https://www.effectiveprocess.au/do-you-wantd-a-procedure-date/
© 2026. Grand Canyon University. All Rights Reserved.
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Rubric-HealthCarePolicyandProcedureDevelopment.pdf
Benchmark - Health Care Policy and Procedure Development - Rubric Total 80 points
Criterion 1. 1: Unsatisfactory 2. 2: Less Than
Satisfactory 3. 3: Satisfactory 4. 4: Good 5. 5: Excellent
Issue
Issue
0 points
A description of the issue is
not present.
8.84 points
A description of the issue is
present, but it lacks detail or
is incomplete.
10.2 points
A description of the issue is
present.
11.56 points
A description of the issue is
well developed.
13.6 points
A description of the issue is
thoroughly developed with
supporting details.
New Policy and Procedure
(B)
New Policy and Procedure
(C2.2)
0 points
A description of how the new
policy and procedure will
resolve the issue is not
present.
8.84 points
A description of how the new
policy and procedure will
resolve the issue is present,
but it lacks detail or is
incomplete.
10.2 points
A description of how the new
policy and procedure will
resolve the issue is present.
11.56 points
A description how the new
policy and procedure will
resolve the issue is well
developed.
13.6 points
A description of how the new
policy and procedure will
resolve the issue is
thoroughly developed with
supporting details.
Draft of Policy and
Procedure
Draft of Policy and Procedure
0 points
The draft of the policy and
procedure is not present.
8.84 points
The draft of the policy and
procedure is present, but it
lacks detail or is incomplete.
10.2 points
The draft of the policy and
procedure is present.
11.56 points
The draft of the policy and
procedure is detailed.
13.6 points
The draft of the policy and
procedure is thorough.
Research
Research
0 points
A description of research on
industry standards that
helped formulate the policy
and procedure is not
included.
8.84 points
A description of research on
industry standards that
helped formulate the policy
and procedure is present,
but it lacks detail or is
incomplete.
10.2 points
A description of research on
industry standards that
helped formulate the policy
and procedure is present.
11.56 points
A description of research on
industry standards that
helped formulate the policy
and procedure is clearly
provided and well developed.
13.6 points
A description of research on
industry standards that
helped formulate the policy
and procedure is thoroughly
developed with supporting
details.
Concepts
Concepts
0 points
Main concept is not clearly
identified, and subconcepts
do not consistently branch
from the main idea.
3.64 points
Main concept is not clearly
identified, and few
subconcepts branch
appropriately. Limited
understanding of assignment
is apparent.
4.2 points
Main concept is easily
identified, and few
subconcepts branch from the
main idea. Only a basic
understanding of assignment
is present.
4.76 points
Main concept is easily
identified and most
subconcepts branch from the
main idea. An original and
creative concept fulfills the
parameters of assignment.
5.6 points
Main concept is easily
identified, and subconcepts
branch appropriately from
the main idea. Projects
exhibit the process of
creative thinking and the
development of an individual
style.
Synthesis
Synthesis
0 points
Synthesis does not
successfully integrate ideas,
images, or objects to form a
cohesive whole. The
combination of elements is
not logical or verifiable.
5.2 points
Synthesis integrates ideas,
images, or objects
inadequately. The
combination of elements is
not logical.
6 points
Synthesis integrates ideas,
images, or objects but does
not fully form a cohesive
whole. Combination of
elements at times is
confusing.
6.8 points
Synthesis integrates ideas,
images, or objects to form a
cohesive whole. Combination
of elements is logical and
justified.
8 points
Synthesis is distinctive.
Synthesis shows careful
planning and attention to
how disparate elements fit
together. The combination of
elements is verified.
Mechanics of Writing
(includes spelling,
punctuation, grammar, and
language use)
Mechanics of Writing
(includes spelling,
punctuation, grammar, and
language use)
0 points
Surface errors are pervasive
enough that they impede
communication of meaning.
Inappropriate word choice or
sentence construction is
employed.
5.2 points
Frequent and repetitive
mechanical errors distract
the reader. Inconsistencies in
language choice (register) or
word choice are present.
Sentence structure is correct
but not varied.
6 points
Some mechanical errors or
typos are present, but they
are not overly distracting to
the reader. Correct and
varied sentence structure
and audience-appropriate
language are employed.
6.8 points
Prose is largely free of
mechanical errors, although
a few may be present. The
writer uses a variety of
effective sentence structures
and figures of speech.
8 points
The writer is clearly in
command of standard,
written, academic English.
Documentation of Sources
Documentation of Sources
(citations, footnotes,
references, bibliography, etc.,
as appropriate to assignment
and style)
0 points
Sources are not documented.
2.6 points
Documentation of sources is
inconsistent or incorrect, as
appropriate to assignment
and style, with numerous
formatting errors.
3 points
Sources are documented, as
appropriate to assignment
and style, although some
formatting errors may be
present.
3.4 points
Sources are documented, as
appropriate to assignment
and style, and format is
mostly correct.
4 points
Sources are completely and
correctly documented, as
appropriate to assignment
and style, and format is free
of error.
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