Download - Risk Management and Healthcare Organizations
Risk Managementand 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 ScienceImpact 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 MistakesRisk Management Model:
• Identify • Assessment• Mitigation• Monitoring/Control • 5 Is:– Investigate– Inform– Influence– Interpret– Integrate
IdentifyInvestigate
• 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_heal_medicine.html
• Checklists• Cognitive net
Monitoring/ControlInterpret/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/ta
lks/thomas_goetz_it_s_time_to_redesign_medical_data.html
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