HSA 4502-Risk Management

HW Assignment# 1

Chapter 2

1. Explain Peer Review Privilege Statutes

2. Describe Quality Monitoring Initiatives

3. What is the Theory of Corporate Negligence?

4. What is Early Warnings for Litigation?

5. Describe a Post-Event Management & Media Relations

Chapter 4

1. Describe the Risk Management Department from Figure 4-2. List some of the Analysis of

Strengths, Weaknesses, Opportunities, and Threats

2. Define and briefly explain Risk Assessment, Risk Finance, and Risk Control abilities

3. From Exhibit 4-2 list the major changes evident in the External Environmental Assessment

4. Describe briefly the five Goals that support the critical success factors for healthcare

organizations

5. Describe briefly the five Strategic Initiatives and tactics

Chapter 6

1. Name the four-tiered the IOM report’s recommended

2. Name the five duties in the Patient Safety and Quality Improvement Act of 2005?

3. Define the ultimate goal of this act. Why do you think this act it is important?

4. What does the National Quality Forum pursuit?

5. Name the professional societies that are setting standards in order to improve patient safety

(third tier)

6. Name the purpose of the report created by AHRQ in order to evaluate Hospitals
Patient Safety: The Past

Decade

Chapter 6

Institute of Medicine:

Four Tier Approach

1) Leadership and Knowledge

2) Identifying and Learning from Errors

3) Setting performance standards and

expectations for safety

4) Implementing safety systems in health care

organizations

Leadership & Knowledge – Tier 2

Patient Safety and Quality

Improvement Act of 2005 (PSQIA) Duties:

• Provide for the certification and recertification of Patient Safety Organizations

• Collect and disseminate information related to patient safety

• Establish a patient safety database

• Facilitate development of consensus among health care providers, patients, & interested parties concerning patient safety and recommendations to improve patient safety

• Provide technical assistance to states that have medical -error reporting systems, assist states in developing standardized methods for data collection, and collect data from state reporting systems for inclusion in the patient safety database

Leadership & Knowledge- Tier 2

National Quality Forum

• Established in 1999

• Goal: improve the quality of American health

care by setting national standards

• Members include hospitals, physicians,

businesses and policymakers & national, health,

government, and consumer organizations

committed to specific, measurable actions and

goals for performance measurement and public

reporting regarding patient safety

Setting Performance Standards and

Expectations for Patient Safety- Tier 3

• Professional groups already working to improve patient safety:

– American Medical Association (AMA)

– National Patient Safety Foundation (NPSF)

– American Nurses Association (ANA)

• IOM Recommendations:

– Professional societies that make a clear commitment to improving patient safety.

– Food and Drug Administration (FDA) increase attention to the safe use of drugs and devices

Creating Safety Systems Inside Health

Care Organizations- Tier 4

• The Joint Commission- established the

National Patient Safety Goal program in 2002

with the first set of goals taking effect in

January 2003

• Developed the national patient safety goals

(NPSGs)

– 13 goals with multiple elements of performance

AHRQ

• Developed a tool to assist hospitals in evaluating how well they establish a culture of patient safety within their institution

– Hospital staff provides opinions about patient safety, medical-error and adverse-event reporting

– Purpose:

• (1) allow hospitals to compare themselves with each other

• (2) facilitate internal learning in patient safety improvements

• (3) assist hospitals in identifying strengths and areas for improvement

• (4) show trends in patient safety over time
Integrating Risk Management,

Quality Management, and

Patient Safety into the

Organization

Chapter 2

Peer Review Privilege Statutes

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

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

jurisdictions if created or used by applicable committee under statute

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

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

Peer Review Privilege Statutes

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

from discovery the results of the quality and safety reviews

conducted as part of their investigations into adverse patient-

care events.

• Risk managers maintain vigilance throughout the organization

to guarantee that processes be conducted within the framework

defined by their jurisdiction’s peer- review statutes

• Risk Managers can ensure a steady flow of information

between departments to improve patient care while protecting

their institutions from exposure to liability by ensuring

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

Medical Staff and Quality Monitoring Initiatives

• The Joint Commission requires active participation from medical staff

• Performance improvement standards require:

– Ongoing professional-practice quality evaluations

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

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

General Competencies

• Patient Care: must be able to provide patient care

that is compassionate, appropriate, and effective for

the treatment of health problems and the promotion of

health

• Medical/ clinical knowledge

• Practiced-based learning and improvement

• Interpersonal and communication skills: must

demonstrate skills that result in the effective

exchange of information and collaboration with

patients, their families, and health professionals.

General Competencies

• Professionalism: residents must demonstrate a commitment to

carrying out professional responsibilities and an adherence to ethical

principles. Residents must demonstrate: Compassion, integrity, and

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

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

religion, disabilities, and sexual orientation.

• Systems-based practice: Residents must demonstrate an awareness

of and responsiveness to the larger context and system of health

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

the system to provide optimal health care.

Theory of Corporate Negligence

• 1. Duty- Hospital must exercise reasonably

care to ensure physicians are qualified to

perform privileges requested

• 2. Breach- failing to adopt state licensing or

applicable accreditation standards

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

exercise reasonable care, the injury would not

have happened

Defending the Hospital

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

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

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

Early Warnings for Litigation

• A close, collaborative relationship between the risk

and quality departments, as well as others (patient

relations/advocacy, billing, the HIPAA office

&medical records) provides opportunities for quick

problem identification and allows for early

interventions with patients and family members

• The two early warnings signs of possible liability are:

Patient Complains and Medical Records

Patient Complaints

• A proactive and responsive patient relations

office can often intervene early during a

patient’s hospital stay to counter negative

patient, friend, or family impressions of care

• An organization’s billing office is another

outlet for patients to voice their concerns

related to patient care

Medical Records

• Charts are routinely requested for case-review

analysis and abstraction

• Role in identifying adverse events and quality-of-

care concerns increased exponentially with the

implementation of the CMS “Never Events”

– October 2008

– Focuses on many health-care-acquired conditions

(HAC)

Post-Event Management & Media

Relations

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

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

Planning for a Changed

Health Care Delivery System

Chapter 4

FIGURE

4–1

Strategic

Planning

Model

Terms

Important to understand the following terms:

-Critical success factor

-Goals

-Objectives

-Strategic initiatives

Identification of Core

Strengths and Values • Analysis of Departmental Strengths and

Weaknesses

– Risk manager should carefully and honestly evaluate

the current strengths and weaknesses of the department

and the individuals working to support the risk

management program in the organization

– Determine if and where other safety-oriented functions

are occurring & how RM can work collaboratively to

maximize the effectiveness of all patient safety efforts

FIGURE 4–2 Risk Management Department—Analysis of

Strengths, Weaknesses, Opportunities, and Threats

Identification of Core

Strengths and Values

Risk Assessment- comprises abilities:

1. To assess particular environments and situations that pose a threat of risk to patients, health care providers, or the

organization

2. To understand the root-cause-analysis process in order to

identify the true systemic components contributing to risk

3. To use data to estimate the economic value to the risks

assessed, and to minimize existing risks

Identification of Core

Strengths and Values

Risk Finance – comprises abilities: • To evaluate a variety of commercial insurance products to

determine which is most appropriate for the risks assessed

• To analyze the capability of the organization to assume some

of the financial risk and transfer the rest in a manner that

allows for the most sound financial portfolio for the

organization

Identification of Core

Strengths and Values

Risk Control- comprises abilities:

• To design unique and creative approaches to minimizing the

risks that are identified

• To relate to multiple persons through education to ensure that

all who contribute to the organization understand key risk

management and patient safety concepts

• To understand the legal process and to assist in achieving the

most favorable resolution of a claim or incident

Key Success Factors for

Risk Management Goal 1- Develop comprehensive methodology for identifying

& managing the multiple systemic factors that cause or contribute to risks associated with managing patient care across the continuum

Goal 2- Be positioned to accept appropriate levels of financial risk and become less reliant on the turbulent financial and insurance markets

Goal 3- Achieve a leadership position within the health care delivery system through development of creative and comprehensive risk management programs and services that focus on system support and provider accountability

Key Success Factors for

Risk Management

Goal 4- Foster systemic mindfulness by creating a

non-punitive accountable culture where

information about errors is shared to enhance

learning and drive change

Goal 5- Promote a process that supports and

monitors rational, ethical, and safe practices, as

well as the appropriate use of technology

Risk Management Strategic

Initiatives and Tactics

• First Strategic Initiative- develop and implement a set of services that will support the organization’s ability to manage the risks of patients across the continuum

• Second Strategic Initiative- assist the organization in its ability to collect, analyze, and report information that will enable it to identify, analyze, quantify, and control risk, and to advance a culture of safety

Risk Management Strategic

Initiatives and Tactics

• Third Strategic Initiative- assist the organization in identifying the appropriate markets and products that can be used to transfer the risks associated with the health care organization’s business to a third-party partner

• Fourth Strategic Initiative- expand programs and services that help to identify new areas of risk created by all aspects of the health-care-system’s operation

Risk Management Strategic

Initiatives and Tactics

• Fifth Strategic Initiative- develop and

implement a set of services that assist

members of the healthcare organization to

manage clinical and financial risk


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