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Risk Management
and Healthcare
Risk Management
•Limit liabilities
•Limit financial loss
•Limit preventable harm
•A program designed to
reduce the inciden...
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
• ...
Risk Management
• Help, or at least do no
harm.
– Hippocrates
• Toxicity
• Only dose makes the
poison
• How medications
in...
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 N...
Consequential Loss
• Loss of Key Personnel
• Vehicular Accidents
• Machine or Plant failure
• Interruption of Sole
Supplie...
Property Loss
• Fire
• Weather
• Embezzlement
• Theft
• Sabotage
• Data or Record
tampering
Liability Loss
• Breach of
Confidentiality
• Breach of Contract
• Product Liability
• Professional or
Institutional Neglig...
Reduce Preventable Mistakes
Risk Management Model:
• Identify
• Assessment
• Mitigation
• Monitoring/Control
• 5 Is:
– Inv...
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
• Prob...
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...
Risk Control
• Risk Acceptance
• Exposure Avoidance
• Loss Prevention
• Loss Reduction
• Exposure Segregation
• Contractua...
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 ...
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
• Regu...
Regulations
• State
• Federal
• Professional
• ADA
• HIPPA
Risk Management and Healthcare
costs
• Malpractice insurance
• Physicians are
practicing defensive
medicine
– Risk averse
...
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 v...
Risk Management and Healthcare Organizations
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Risk Management and Healthcare Organizations

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

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Risk Management and Healthcare Organizations

  1. 1. Risk Management and Healthcare
  2. 2. 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
  3. 3. Complexities of Science Impact on Medicine and Healthcare • Specialists • 4000 medical procedures • 6000 drugs
  4. 4. 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
  5. 5. Risk Management • Help, or at least do no harm. – Hippocrates • Toxicity • Only dose makes the poison • How medications interact
  6. 6. Types of Risk • Bodily Injury • Consequential Loss • Property Loss • Liability Loss
  7. 7. Bodily Injury • Illness or injury to Patient, Visitor or Employee • Workers Compensation • Professional or Institutional Negligence
  8. 8. Consequential Loss • Loss of Key Personnel • Vehicular Accidents • Machine or Plant failure • Interruption of Sole Supplier • Disacreditation
  9. 9. Property Loss • Fire • Weather • Embezzlement • Theft • Sabotage • Data or Record tampering
  10. 10. Liability Loss • Breach of Confidentiality • Breach of Contract • Product Liability • Professional or Institutional Negligence
  11. 11. Reduce Preventable Mistakes Risk Management Model: • Identify • Assessment • Mitigation • Monitoring/Control • 5 Is: – Investigate – Inform – Influence – Interpret – Integrate
  12. 12. Identify Investigate • Data • Performance • Results based • Analysis • Fraud • Malpractice • Continuous Process
  13. 13. 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
  14. 14. Inform • Present in material form • Understand • Summarize clearly • Communicate • Alert • Get buy in and compliance
  15. 15. Mitigation/Influence • Procedures • Protocols • To reduce risks • Contracts; limit liabilities • Insurance; financing risk mitigation • Checklists
  16. 16. Risk Control • Risk Acceptance • Exposure Avoidance • Loss Prevention • Loss Reduction • Exposure Segregation • Contractual Transfer • Risk Financing
  17. 17. Insurance • Self Insurance • Commercial Insurance Coverage • Premiums • Risk financing • Latent Liabilities
  18. 18. Legal Liabilities • Malpractice • Slip and Fall • Negligence • Misconduct
  19. 19. Checklists • Better manage and handle complexity • Pause points to intervene • Cognitive Net
  20. 20. 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.
  21. 21. Atul Gawande • http://www.ted.com/talks/atul_gawande_how_do_we_h• Checklists • Cognitive net
  22. 22. Monitoring/Control Interpret/Integrate • Is it effective • Honesty and learning • Iterative process • Feedback loop • Regulations
  23. 23. Regulations • State • Federal • Professional • ADA • HIPPA
  24. 24. 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
  25. 25. IT • Medical Records • http://www.ted.com/talks/thomas_goetz_it_s_time_to_r
  26. 26. 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

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