ASHRM recognition program at the member and fellow level. The criteria for the diplomate designation have not been finalized. The program will serve as a means of providing profes- sional recognition to individuals meeting established criteria in the categories of education, job experience, length of service, and other related achievements.

“Perinatal Risk Management: Understanding and Preventing the Multimillion Dollar Claim,” has been finalized and brochures have been mailed. The program was presented in Philadelphia in May, and will be presented in Houston in June and in San Francisco in September.

was reviewed and approved. The board members commented that the

A new ASHRM seminar, entitled

The agenda for the annual meeting

Education Committee has done an excellent job in putting together a program providing practical, specific information that responds to the needs of ASHRM members. The meeting, entitled “Tracking Trends Through the Eighties,” will be held August 25-28 in Chicago. Brochures were to be mailed by the end of May.

The board.also approved the soci- ety’s participation as the primary cosponsor of a teleconference entitled “Medical Malpractice Claim Preven- tion and Insurance Management.” The teleconference, scheduled for November 14, will offer practical in- formation on causes of and possible ways to reduce hospital and physician liability.

The board offered recommenda- tions concerning activities to be taken in response to the medical malpractice

crisis. These actions represent a n effort to have ASHRM recognized as a primary source of information and expertise on risk management and insurance issues. The board proposed the establishment of three “blue rib- bon” task forces to identify and pro- pose solutions to the important issues within the areas of loss preven- tion/control, professional liability insurance, and legislative and tort reform.

Finally, the board heard a report on the AHA Task Force on Quality Out- come Indicators. This task force is trying to establish and define out- come indicators that can be used in all hospitals to assess the quality and appropriateness of patient care. The task force hopes to produce a management paper for distribution to all .4SHRM member hospitals.

‘Employment at will’ and ‘wrongful discharge’: Important issues in employment law

The following article was contributed by Suzanne Elshult, manager, Labor Relations and Benefits, at Pac2fic Medical Center, Seattle. Changes in interpretations of employment law have made it mandatory that hospital risk management and human resources departments work in close cooperation not only in terms of ade- quately insuring risks but in develop- ing the appropriate policies and pro- cedures to address employment issues,

If you have further questions about this topic, please contact Suzanne Elshult, human resources, or Dwight Burke, risk manager, at Pacific Medical Center, Seattle, 206/326-4042.

Hospital human resources and risk management departments must address yet another frontier of liability.

Prior to the 1970s, the right of employers to hire and fire employees for arbitrary reasons went largely unchallenged except when union agreements or other contracts af- fected the employment relationship. In the past 10 years, “employment at will” and “wrongful discharge” have become highly controversial issues in employment law, making it essential for both human resources managers and risk managers to keep their insti- tutions abreast of legal developments, potential liabilities, and insurance coverages. Today those professionals must translate the evolving law and insurance mechanisms into day-to-day person- nel policies and procedures for super- visors and managers.

Employment at will and wrongful discharge are commonly referred to

as two countervailing aspects of the same general phenomenon. The former describes the traditional rela- tionship between employees and employers under which an employee not covered by a union contract or any other employment contract can be hired or fired for any reason. Wrongful discharge, on the other hand, pertains to the growing protec- tion and rights such employees have in being able to sue for damages in cases of unjust discharge.

tial legal awards for wrongful discharge, coupled with the unwill- ingness and decreasing capacity of insurers to provide certain types of coverage, suggest that employers are not accurately assessing their liabil- ities before a personnel action is taken. They pay for their mistakes later. A single large judgment can not only seriously affect the self-insured retention of the institution but prob-

continued on page 8

The increasing number of substan-

Perspectives in Hospital Risk Management Volume 5 Number 3 Summer 1985 ~ ~~~~ ~ _ _ _ _ _ _ _ ~ ~ ~ ~ ~

Published quarterly by the American Society for Hospital Risk Management of the American Hospital Association, 840 N. Lake Shore Dr., Chicago, IL 60611.

Opinions expressed in this newsletter are not necessarily those of the American Society for Hospital Risk Management or the American Hospital Association

~~~~~ ~ ~ _____ - President: Jane Bryant, Greenvllle Hospital System, Greenville, SC President-elect: James Holzer, J D , Ritk Mandgement Foundation of the Harvard Medical Institutions, Cambridge, MA Society director: David Meyers, American Hospital Association, Chicago Staff associate: Hattie Grimsley, American Hospital Association, Chicago Newsletter Department editor: Peg Schultz Veach, American Hospital Association, Chicago

~ ~ ~~ ~~ ~~ ~

ASHRM Publications Committee: Trudy Goldman, ARM (chairman), University of Illinois, Chicago, 11. Cary Dwight Burke, Pacific Medical Center, Seattle, WA Charlotte Deneen, R.N., Mount Diablo Medical Center, Concord, CA Steven MacLauchlan, North Broward Hospital District, Fort Lauderdale, FI. Janice Rader, St. Luke’s Hospital, Bethlehem, PA R. Stephen Trosty, J .D., Ohio Hospital Association, Columbus, OH

2 Perspectives in Hospital Risk Management Summer 1985 01985 by the American Hospital Association

given, only to hme the patient die before the medication or treatment

“’willful conceAnent.” There should be a factual account of the incident.

dent report w x completed.

was actually given. rn Use English grammar: Punctuate for clarity. Mean what you say and say what you mean. Never hesitate to refer to a dictionary. rn Report all incidents: The occur- rence of an incident must appear in the record to avoid an allegation of

not an expression of opinion. No liability should be admitted; for example, it is improper to chart, “I gave aspirin instead of Tylenol.” Rather, a statement such as, “Tylenol 500 mg was ordered. Aspirin 10 grains was given,” should appear in the record. Never chart that an inci-

Finally, testimony given m q months or years after the f x t w i l l be inferred as testimony from “conven- ient memory.” Let the record spenk for itself as to the care provided. Remember, “One line of f‘ided ink is worth more than a thousand memories.” rn

“Employment law” continued from page 2

ably will affect renewal if not avail- ability of coverages in the future.

minate employees, additional time, energy, and resources must be invested in educating managers and supervisors, particularly those who feel uncomfortable assuming respon- sibility for personnel decisions. Without good information about the law, employers can make very costly mistakes. They need to know that they owe a duty of good faith and fair dealing to all employees, in- cluding probationary, union, and nonunion employees.

employment at will doctrine has important implications for the human resources policy and practices of every employer. To minimize ex- posure to wrongful discharge suits, a multifaceted approach such as the following is necessary:

As it becomes more difficult to ter-

The slow but steady erosion of the

1. Inform and raise the awareness of managers and supervisors at all levels so that they consistently and as a matter of course address the potential liability of their employment actions.

2 . Audit all personnel policies and procedures to ensure that they con- form to the appropriate state and federal laws. For example, managers can prevent wrongful discharge claims by ensuring the following:

rn That the contents of personnel files are shared with employees at all times and that specific and accurate reasons for terminations or other disciplinary actions are given rn That written materials such as employee handbooks, policy manuals, and employment applica- tions, as well as verbal statements in the course of the interviewing and hiring procedure, do not include language to be construed as a prom- ise of job security or tenure or other- wise limit the flexibility of managers to manage rn That formal disciplinary and per- formance evaluation procedures are in place and are followed consistently throughout the organization

Modern employees are educated, are aware of their rights, and want more involvement in all aspects of the employment relationship, in- cluding greater participation in business decisions. In this respect,

the erosion of the employment at will doctrine could be viewed as a microcosm of a greater whole. Increasing employee-employer sensi- tivity to issues of fairness and employee demands of expanded con- trol over hiring and firing issues are not likely to disappear in the near future. Given this development, both human resources and risk manage- ment departments must jointly shoulder the burden of assisting supervisors and managers in becom- ing more sensitized to and informed about employment law issues. Transi- tion to a system in which discipline and termination are viewed as poten- tial sources of liability should be facilitated. The overall impact of emerging employment law on the future of business is hard to assess, but the effect of a failure to respond appropriately will be the worst of all possible worlds-constant legal entanglements, demoralized work force, large judgments, high turnover, and the unavailability of appropriate insurance coverages.

By contrast, a work force managed in an informed and judicious manner frees the employer from personnel issues to work at the real task of health care delivery.

Affiliated chapter report

The following article was written by Cary Dwight Burke, risk manager f o r Pacific Medical Center, Seattle, and vice-president of the Washington Health Care Risk Management Society.

The Washington Health Care Risk Management Society was organized and bylaws were approved by charter

members on March 13, 1984. One year later, the membership numbers 37, and the chapter has just com- pleted its first annual educational seminar, which was an overwhelming success.

primary purpose of the Washington society is to enhance the safety and quality of health services for the benefit of patients, visitors, and employees, as well as to advance and develop the professional practice of health care risk management.

As with other chapters, the

Officers of the society are LeAna Osterman (president), assistant administratodrisk manager, Univer- sity Hospital, University of Washington, Seattle; Dwight Burke (vice-president), risk manager, Pacific Medical Center, Seattle; and Ellen Holm (secretary-treasurer), claims administrator, Group Health Cooperative, Seattle.

chapter’s activities and meetings, contact LeAna Osterman at

For information concerning the

206/548-6303. rn

8 Perspectives in Hospital Risk Management Summer 1985