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Risk Management and Healthcare Organizations

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John Cousins
John Cousins

Managing risk in healthcare organizations presents a unique set of challenges.

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Risk Management and Healthcare
Risk Management •Limit liabilities •Limit financial loss •Limit preventable harm •A program designed to reduce the incidence of preventable accidents and injuries; to minimize the financial loss to the institution should and injury or accident occur
Complexities of Science Impact on Medicine and Healthcare • Specialists • 4000 medical procedures • 6000 drugs
Preventable Harm • 2 million pick up infections in the hospital (nosocomial) because there is no basic hygiene protocol • 99,000 die in the US each year of nosocomial infections. • 300,000 die each year of preventable harm
Risk Management • Help, or at least do no harm. – Hippocrates • Toxicity • Only dose makes the poison • How medications interact
Types of Risk • Bodily Injury • Consequential Loss • Property Loss • Liability Loss
Bodily Injury • Illness or injury to Patient, Visitor or Employee • Workers Compensation • Professional or Institutional Negligence
Consequential Loss • Loss of Key Personnel • Vehicular Accidents • Machine or Plant failure • Interruption of Sole Supplier • Disacreditation
Property Loss • Fire • Weather • Embezzlement • Theft • Sabotage • Data or Record tampering
Liability Loss • Breach of Confidentiality • Breach of Contract • Product Liability • Professional or Institutional Negligence
Reduce Preventable Mistakes Risk Management Model: • Identify • Assessment • Mitigation • Monitoring/Control • 5 Is: – Investigate – Inform – Influence – Interpret – Integrate
Identify Investigate • Data • Performance • Results based • Analysis • Fraud • Malpractice • Continuous Process
Assessment/Analysis • Prioritize • Low hanging fruit • Efficacy: what would be most effective • Risk: identify risk • Probability: of occurrence • Factor: High, Medium, Low • Cost/Benefit Analysis
Inform • Present in material form • Understand • Summarize clearly • Communicate • Alert • Get buy in and compliance
Mitigation/Influence • Procedures • Protocols • To reduce risks • Contracts; limit liabilities • Insurance; financing risk mitigation • Checklists
Risk Control • Risk Acceptance • Exposure Avoidance • Loss Prevention • Loss Reduction • Exposure Segregation • Contractual Transfer • Risk Financing
Insurance • Self Insurance • Commercial Insurance Coverage • Premiums • Risk financing • Latent Liabilities
Legal Liabilities • Malpractice • Slip and Fall • Negligence • Misconduct
Checklists • Better manage and handle complexity • Pause points to intervene • Cognitive Net
The Pronovost Checklist • Central venous catheters are used for medications, blood, and fluids and nutrition and can stay in for days or weeks. But bacteria can grow in the line and spread an infection that kills one in five patients that contract it. • Wash hands with soap and water • Wear sterile clothing • Clean patients skin • Avoid veins in arms and legs; use chest. • Check line for infection each day.
Atul Gawande • http://www.ted.com/talks/atul_gawande_how_do_we_h• Checklists • Cognitive net
Monitoring/Control Interpret/Integrate • Is it effective • Honesty and learning • Iterative process • Feedback loop • Regulations
Regulations • State • Federal • Professional • ADA • HIPPA
Risk Management and Healthcare costs • Malpractice insurance • Physicians are practicing defensive medicine – Risk averse – Order every conceivable test • Driver of inflated costs • Specialist and lack of PCPs
IT • Medical Records • http://www.ted.com/talks/thomas_goetz_it_s_time_to_r
Best way to manage Risk? • Provide better care • Share information • Identify best practices • Measure outcomes • Define value • Outcomes that matter to patients/cost = value • Identify dimensions of quality
Risk Management and Healthcare Organizations

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