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
What Students Are Saying About Us
.......... Customer ID: 12*** | Rating: ⭐⭐⭐⭐⭐"Honestly, I was afraid to send my paper to you, but you proved you are a trustworthy service. My essay was done in less than a day, and I received a brilliant piece. I didn’t even believe it was my essay at first 🙂 Great job, thank you!"
.......... Customer ID: 11***| Rating: ⭐⭐⭐⭐⭐
"This company is the best there is. They saved me so many times, I cannot even keep count. Now I recommend it to all my friends, and none of them have complained about it. The writers here are excellent."
"Order a custom Paper on Similar Assignment at essayfount.com! No Plagiarism! Enjoy 20% Discount!"
