RISK MANAGEMENT
Risk Management (RM) <ul><li>Components </li></ul><ul><ul><li>Identification and Analysis </li></ul></ul><ul><ul><li>Loss ...
A little history… <ul><li>Darling vs. Charleston Community Memorial Hospital </li></ul><ul><ul><li>1965 – Court upheld the...
Darling vs. Charleston <ul><li>Landmark case! </li></ul><ul><li>Handout </li></ul>
Response to the  Landmark Case <ul><li>1970’s medical malpractice crisis </li></ul><ul><ul><li>Increase in claims </li></u...
Risk Management (RM) <ul><li>Risk is any occurrence that might result in a loss </li></ul><ul><li>Risk can be things like ...
Risk Management (RM) <ul><li>Reduce risk and subsequent liability for injuries (loss) that occur in the health care organi...
1.Risk Identification and  Analysis <ul><li>Determine the  potential extent of liability  and the  financial impact  of an...
Occurrence Screening <ul><li>Procedure for reviewing medical records to identify documentation of any  adverse clinical ev...
Incident Report <ul><li>Written description  of any event not consistent with routine operational procedures or patient ca...
Event Report <ul><li>A  more detailed  “incident report” </li></ul><ul><li>Streamlines the process with check boxes </li><...
2. Loss Prevention & Reduction <ul><li>Controlling  preventable risks and keeping to a minimum the incidents for which the...
Loss Prevention & Reduction <ul><li>Policies and Procedures </li></ul><ul><ul><li>A way of risk control when all personnel...
Loss Prevention & Reduction <ul><li>Staff training and education </li></ul><ul><ul><li>Often seen with new employee orient...
Loss Prevention & Reduction <ul><li>Good patient assessment technique </li></ul><ul><ul><li>“only qualified patient care s...
Loss Prevention & Reduction <ul><li>Safety & Security Management </li></ul><ul><ul><li>Hazard surveillance </li></ul></ul>...
Hazardous Surveillance Report <ul><li>Handout </li></ul><ul><li>This is done  before  an incident occurs. </li></ul><ul><l...
3. Claims Management <ul><li>Managing the  legal and administrative aspects  of the HCO’s response to injury claims </li><...
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Risk Management

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  • Charleston was charged for damages. The hospital tried to claim “charitable immunity”. This case actually did away with charitable immunity. That’s why if you carry auto insurance with minimal coverage and you get in a bad accidents, the victim sues for damages beyond what your coverage is, you must pay what the insurance company won’t pay. However, now days, there is a cap for physicians’ payout when liable.
  • Loss = any damage to person, property, or rights – can be loss of physical, cognitive, emotional, wrongful death, or financial loss.
  • ANY occurrence = loss
  • Methods to assess risk and financial impact: Occurrence screening Incident reports Patient satisfaction surveys – dissatisfied, but not confrontational face to face. Use survey to help alert us to certain risks. Results in PI activities Medical Staff minutes – occurrences and incidents may end up in a peer review. Minutes will show discussion of these events. Minutes can identify risks. Infection control reports
  • Used a peer review. Health record can defend healthcare facility against malpractice or support the patient’s claim of negligence.
  • See handout. This is a plain, non-detailed form. THIS IS NEVER TO BE PUT IN THE MEDICAL RECORD! This form may be subpoenaed, but is not part of the medical record as a whole. This form helps legal counsel assess liability.
  • Although the incident/event report is not filed in the medical record, a general description the “something occurred” is documented. The detailed form is sent to RM.
  • Risk manager is particularly active in this area. Actually, the “risk control component” of risk management.
  • Equipment that malfunctions and results in pt harm or death is a huge issue
  • This is RISK FINANCING. Medical Malpractice – liability insurance required for all medical staff. Commercial – for liability; for hazards and malpractice Self – for profit facilities can look into this arrangement Settling out of court – saves court costs; in addition, patient advocates are hired. (job opening posted) The impetus for patient advocate use is financial. “De-fuse” patient to lower risk.
  • Risk Management

    1. 1. RISK MANAGEMENT
    2. 2. Risk Management (RM) <ul><li>Components </li></ul><ul><ul><li>Identification and Analysis </li></ul></ul><ul><ul><li>Loss Prevention and Reduction </li></ul></ul><ul><ul><li>Claims Management </li></ul></ul><ul><li>All three of these components need to be integrated for effective RM </li></ul>
    3. 3. A little history… <ul><li>Darling vs. Charleston Community Memorial Hospital </li></ul><ul><ul><li>1965 – Court upheld the patient’s right to recover damages for malpractice from both the physician and the hospital </li></ul></ul><ul><ul><li>Established the hospital’s duty to supervise the action of independent staff physicians </li></ul></ul><ul><ul><li>Established that the hospital should have known about the care that was of unacceptable quality </li></ul></ul>
    4. 4. Darling vs. Charleston <ul><li>Landmark case! </li></ul><ul><li>Handout </li></ul>
    5. 5. Response to the Landmark Case <ul><li>1970’s medical malpractice crisis </li></ul><ul><ul><li>Increase in claims </li></ul></ul><ul><ul><li>Increase in awards </li></ul></ul><ul><ul><li>Ultimately led to increase in liability insurance premiums </li></ul></ul><ul><li>Risk Management was put in place to address incident reporting </li></ul>
    6. 6. Risk Management (RM) <ul><li>Risk is any occurrence that might result in a loss </li></ul><ul><li>Risk can be things like slippery floors </li></ul><ul><ul><li>Not necessarily direct patient care issue </li></ul></ul><ul><ul><li>Protects visitors and employees in the health care facility </li></ul></ul>
    7. 7. Risk Management (RM) <ul><li>Reduce risk and subsequent liability for injuries (loss) that occur in the health care organization’s immediate environment </li></ul>
    8. 8. 1.Risk Identification and Analysis <ul><li>Determine the potential extent of liability and the financial impact of an incident on the health care organization </li></ul><ul><li>Methodology </li></ul><ul><ul><li>Occurrence Screening </li></ul></ul><ul><ul><li>Incident Reports </li></ul></ul><ul><ul><li>Etc. </li></ul></ul>
    9. 9. Occurrence Screening <ul><li>Procedure for reviewing medical records to identify documentation of any adverse clinical events for which the HCO could be held accountable if the patient chose to seek legal recourse </li></ul><ul><li>APO (adverse patient outcome) </li></ul><ul><li>PCE (potentially compensable event) </li></ul>HANDOUT
    10. 10. Incident Report <ul><li>Written description of any event not consistent with routine operational procedures or patient care activities </li></ul><ul><li>Primary tool used to assist the HCO in early, concurrent identification and correction of problem-prone areas and in preparation for legal defense </li></ul>HANDOUT
    11. 11. Event Report <ul><li>A more detailed “incident report” </li></ul><ul><li>Streamlines the process with check boxes </li></ul><ul><li>Always needs to be reported to the next immediate supervisor </li></ul><ul><li>Will go higher up for “potential” liability discussion </li></ul><ul><li>NEVER TO BE FILED IN MEDICAL RECORD! </li></ul>
    12. 12. 2. Loss Prevention & Reduction <ul><li>Controlling preventable risks and keeping to a minimum the incidents for which the HCO might be held liable (job of risk mgr) </li></ul><ul><li>Methodology </li></ul><ul><ul><li>P & P </li></ul></ul><ul><ul><li>Staff training and education </li></ul></ul><ul><ul><li>Good patient assessment techniques </li></ul></ul><ul><ul><li>Safety & Security Management </li></ul></ul>
    13. 13. Loss Prevention & Reduction <ul><li>Policies and Procedures </li></ul><ul><ul><li>A way of risk control when all personnel are required to follow rules, policies, and procedures. </li></ul></ul>
    14. 14. Loss Prevention & Reduction <ul><li>Staff training and education </li></ul><ul><ul><li>Often seen with new employee orientation </li></ul></ul><ul><ul><li>Reinforced with inservices </li></ul></ul><ul><ul><ul><li>HIV </li></ul></ul></ul><ul><ul><ul><li>HIPAA </li></ul></ul></ul>
    15. 15. Loss Prevention & Reduction <ul><li>Good patient assessment technique </li></ul><ul><ul><li>“only qualified patient care staff” provide care </li></ul></ul><ul><ul><li>Have good protocol and good progressive care plans </li></ul></ul>
    16. 16. Loss Prevention & Reduction <ul><li>Safety & Security Management </li></ul><ul><ul><li>Hazard surveillance </li></ul></ul><ul><ul><li>Hazardous materials management </li></ul></ul><ul><ul><li>Waste management </li></ul></ul><ul><ul><li>Security (difficult to do as a public facility) </li></ul></ul><ul><ul><li>Fire Safety </li></ul></ul><ul><ul><li>Equipment Safety </li></ul></ul>
    17. 17. Hazardous Surveillance Report <ul><li>Handout </li></ul><ul><li>This is done before an incident occurs. </li></ul><ul><li>A tool to point out something that could be hazardous </li></ul><ul><li>Like an incident report but hasn’t happened yet </li></ul>
    18. 18. 3. Claims Management <ul><li>Managing the legal and administrative aspects of the HCO’s response to injury claims </li></ul><ul><li>Methodology </li></ul><ul><ul><li>Commercial insurance </li></ul></ul><ul><ul><li>Self-insurance </li></ul></ul><ul><ul><li>Combination of both </li></ul></ul>

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