CAU Risk Management Process Essay


Describe steps in the risk management process, risk management tools, and relationship of risk to healthcare quality.
Some resources:
Agency for Healthcare Research and Quality
American Society for Healthcare Risk Management
Quality Control Based on Risk Management – A Concept Whose Time Has Arrived
What is risk management I helatchare and why it is important What is Risk Management in Healthcare – And Why Is It Important? · RiskonnectChapter 1:
Healthcare can hurt…
• In the 1970’s, the fact that receiving healthcare
services can actually cause harm was brought
to the forefront with the Institute of Medicine
report “To Err is Human: Building a Safer Health
Care System”:
– In 2 studies, adverse events occurred in 2.9% and
3.7% of hospitalizations
– More than half of these adverse events were the
result of preventable medical errors
– Extrapolation: > 1 million medical errors may occur
each year resulting in 140,000 deaths
More data about medical errors
Studies indicate the following:
– Hospital employees recognize and report only 1 in
7 medical errors that harm Medicare patients
• Even after medical errors are reported and investigated,
many hospitals do not change their practices to prevent
repetition of the event
– >50% of patients treated for side effects and other
medication related injuries were 65+ years old
– Continued reporting of wrong-site surgeries
What can be done?
• The Joint Commission recommended safety
standards in 2001 that relate to:
– Providing leadership
– Improving organizational performance
– Information management
– Patient’s rights
• It is imperative to monitor adverse events
from 2 standpoints:
– Quality of care
– Legal responsibility to do no harm
How do we monitor adverse events and
ensure patient safety?
• Recognize and minimize instances where a
medical error can occur
This is the function of Risk Management
What is Risk?
Uncertainty about future events that
may threaten the safety of patients
and the assets and reputations of
What do we mean by assets?
• People – patients, clinicians, volunteers,
and employees
• Property – buildings, facilities,
equipment, and materials
• Financial – revenue, reserves, grants,
and reimbursement
• Goodwill – health and well-being,
reputation, and stature in the community
What is Risk Management?
• Discipline for dealing with the possibility
that some future event will cause harm.
– An organized effort to identify, assess and
reduce risks to patients, visitors and staff
Objective of Risk Management
• To reduce the risk of preventable
accidents and injuries and minimize the
financial loss if one occurs
– It provides strategies, techniques and an
approach to recognizing and confronting any
threat faced by an organization.
In other words…
• What can go wrong?
• What will we do to prevent harm and in the
aftermath of an incident?
• If something happens, how will we pay for
What are the risks we
are trying to protect against?

Antitrust violations
Breach of contract
Casualty exposure
Environmental damage
Fraud and abuse
General liability
• Hazardous substance
• Professional
• Securities violations
• Transportation liability
• Worker’s
So, what will be done?
In the Risk Management Process we will:
• Identify Risk
• Perform Risk Analysis
• Implement Risk Control/Treatment
• Finance Risk
Risk Identification
• Continuous collection of information to
search for the various liability risks such as
• Property risks
• Casualty/liability risks
• Employee benefit risks
Risk Analysis
• Evaluating past experience and current
exposure to limit the impact of risk,
keeping in mind that there are different
levels of Risk
• Severity to the individual and/or organization
• Number of people harmed or potentially
• Likelihood or frequency of occurrence
Risk Control/Treatment
• Most common function of risk management
• Risk Management programs should categorize
potential liability into 4 categories:
• Bodily injury
• Liability loss
• Property loss
• Consequential loss
Risk Control/Treatment
• There are many methods and techniques an
organization can use to minimize risk:
• Risk Acceptance
• Loss Reduction
• Exposure Avoidance • Exposure Segregation
• Loss Prevention
• Contractual Transfer
Risk Financing
• An organization should have financing
available to fund losses and implement risk
management activities
– Self-insurance
– Commercial insurance
– Budgetary funds set for activities and/or losses
American Society of Healthcare Risk
Management (ASHRM)
Components in a risk management program:
– Designate risk manager
– Access to all data
– Organizational commitment
– System for identification, review and analysis of
adverse outcomes
– Ability to integrate and share data
– Evaluate risk management program activities
– Provide educational programs
– Provide information on staff competency
Three Major Functions of Risk
Management – Business Orientation
• Reducing the organizations’ risk of malpractice
suite by maintaining or improving the quality
of care
• Reducing the probability of a claim being filed
• Preserving the organization’s assets once a
claim has been filed
‘Red Flag’ Areas to Watch
• Treatment Conditions
• Patient Relations
• Practice Management
• Conduct of Staff
Risk Management Tools
for Identifying Risk
• Incident Reporting
• Occurrence Reporting
• Occurrence Screening
Incident Reporting
System to identify events that are not
consistent with the routine operation of a
hospital or routine care of patients
Occurrence Reporting
A policy listing specific adverse events
that MUST be reports
• Required by some states and insurers
• Can increase identification of adverse
events to 40-60%
Occurrence Screening
System that identifies deviations from
normal procedures or expected
• Uses criteria to identify adverse events
but does not rely on staff reporting
• Increases identification of adverse events
to 80-85%
Risk and Quality of Care
• There is sometimes overlap between
these functions in the healthcare setting.
• Integrating risk management and quality
assurance functions can result in:
– Maximization of the use of limited resources
– Elimination of duplication
– Developing new solutions to problems
– Facilitation of training programs
– Improvement of budget process
Specific Risk Management Functions
• Incident Identification, Reporting and Tracking
• State Mandated Incident Reporting
• Incident Review and Evaluation
• Take action to prevent recurrence of incidents
• Internal Documentation
• Credentialing and Privileging
• Patient Complaint Programs
• Risk Management Education
• Risk Management is about reducing
preventable adverse events and minimize
financial loss should such events occur.
• There are many tools available to assist
the Risk Manager.

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