Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Risk management in healthcare

11,742 views

Published on

Risk Management Training Slides.
Slides prepared based on "The Healthcare Quality Handbook" by Janet A Brown. Very useful health care quality reference for CPHQ exam preparation. For more slides, contact ckmujeeb@hotmail.com

  • DOWNLOAD FULL BOOKS, INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. PDF EBOOK here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... 1.DOWNLOAD FULL. doc Ebook here { https://tinyurl.com/y6a5rkg5 } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, Cookbooks, Crime, Ebooks, Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD FULL eBOOK INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. doc eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. PDF eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. doc eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookeBOOK Crime, eeBOOK Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • DOWNLOAD FULL eBOOK INTO AVAILABLE FORMAT ......................................................................................................................... ......................................................................................................................... 1.DOWNLOAD FULL. PDF eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. doc eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. PDF eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. EPUB eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... 1.DOWNLOAD FULL. doc eBook here { https://tinyurl.com/y3nhqquc } ......................................................................................................................... ......................................................................................................................... ......................................................................................................................... .............. Browse by Genre Available eBooks ......................................................................................................................... Art, Biography, Business, Chick Lit, Children's, Christian, Classics, Comics, Contemporary, CookeBOOK Crime, eeBOOK Fantasy, Fiction, Graphic Novels, Historical Fiction, History, Horror, Humor And Comedy, Manga, Memoir, Music, Mystery, Non Fiction, Paranormal, Philosophy, Poetry, Psychology, Religion, Romance, Science, Science Fiction, Self Help, Suspense, Spirituality, Sports, Thriller, Travel, Young Adult,
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Risk management in healthcare

  1. 1. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation Slides: Mujeeb C Kandy ckmujeeb@hotmail.com
  2. 2. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Risk Management in Healthcare.. • A formal attempt to control liability, prevent financial loss, and protect the financial assets of the organization • The reduction or elimination or potential financial loss due to damage, theft, misplacement of property, or patient injury (potentially compensable events) • The prevention of and/ or the identification, evaluation, and treatment of, financial loss.
  3. 3. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 2. Governance Oversight Responsibilities • Approve & support RM Program • To Establish policies to minimize risk • To know interaction between QM programs & RM including physician involvement • Ensure antitrust laws are followed • To know how the risk is addressed. • Degree of risk • Amount of risk shared/transferred to insurance companies • Major changes in insurance program • Exposure under insurance programs • Adequacy of malpractice ins by independent practitioners • Adequacy of education efforts on risk reduction & prevention • Monitor areas of organizational risk • Liability • Clinical Risk (Occurrence Data, QI Team actions, Patient Safety Activity) • Employee Safety • Workers Compensation • Property Preservation • Improper& Inadequate credentialing & licensure verification • Improper/Inadequate Patient Care/Practitioner review
  4. 4. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 3. Professional Liability Basic Duties of Care and Liabilities The concept of Negligence
  5. 5. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation Basic Duties of Care and Liabilities The concept of Negligence Basic duties of direct providers (Independent Practitioners) • Comply with statutory duties (Drug Laws) • Obtain proper consent for medical care • Render standard care as that of like providers Liabilities of physicians/independent practitioners • Lack of Documentation • Work ups not complying accepted standards • Acts of others if exercising control (borrowed servant or captain of the ship) • Mistaken identification • Misdiagnosis, Wrong Diagnosis • Treat out of scope of services • Abandonment • Failure to seek Consultation/Refer • Failure to obtain result of diagnostic tests done • Infection Control • Premature discharge/dismissal 3. Professional Liability
  6. 6. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation Basic Duties of Care and Liabilities The concept of Negligence Liabilities of Nurses • Inconsistent administration of drugs • Failure to follow physician orders • Failure to report significant changes • Failure to take correct verbal or telephone orders • Sponge/instrument miscount at OR • Patient burns • Patient falls • Failure to report defective equipment • Failure to follow established nursing procedures • Negligent handling of patient valuables 3. Professional Liability
  7. 7. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation Basic Duties of Care and Liabilities The concept of Negligence Negligence – Lack of Proper care In malpractice, proper care is judged by peers.. Is based on Defined standard established by law to protect other against harm Negligent Conduct Doing what a reasonable person would not do.. Gross Negligence Failure to act while the risk is known, resulting adverse impact or death. Contributory Negligence Proven contribution by the patient/plaintiff towards his/her harm Burden of proof for negligence Duty: Ensure a safe transaction Protect from foreseeable harm Protect from malpractice Breach of Duty Based on policies & Procedures Reasonable standards of care Measurab le Harm (Injury) Causation Breach of duty caused the injury 3. Professional Liability
  8. 8. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 4. Risk Management as Organization wide Performance Improvement Process Integration with Quality Management • RM as key component of quality management umbrella • Good outcomes requires good quality management – RM requires good outcome • RM emphasizes “Harm prevention”, so does QI • Both QM & RM are designed to gather information on undesirable events or trends • Both QM & RM share.. • Reduce problems in patient care & maximize safety • Concern for prevention of harm/loss • Require data: Incidents, indicators, RCA FMEA, patient feedback, complaints, surveillance (Infection/safety/security) Claims history Longer the length of stay for a patient in a hosptial, the higher the risk of a healthcare associated event.
  9. 9. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 5. Program Components 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management
  10. 10. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation Loss Prevention & Reduction • Risk identification & measurement • Risk assessment and prediction • Risk handling o Risk Financing o Risk Control  Risk Avoidance  Risk Shifting  Risk Prevention • Communication & Education 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management 5. Program Components
  11. 11. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management Claims Management • Action on potential compensable events (PCEs) • Tracking PCE reporting • Tracking of asserted claims • Determination of settlement authority • Settlement negotiations • Defense attorney interface • Interrogatories • Settlement conferences • Trial preparation • Closed claim analysis • Professional liability/malpractice issues • Loss history • Expenses 5. Program Components
  12. 12. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management Organization Safety & Security Programs • Preventive maintenance/equipment management • Hazard communication & surveillance • Employee “Right to Know” • Waste Management • Security measures • Fire and disaster preparedness • Utilities management 5. Program Components
  13. 13. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management Patient Relations Programs • Patient representatives/advocates • Patient education • Safety Education & Feedback • Patient rights • Patient Responsibilities • Patient Grievances Response system • Patient Satisfaction measurement 5. Program Components
  14. 14. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management Contract & Insurance Premium Review • Requirements • Loss history • Premium discounts for effective quality management • Risk shifting • Financing structure/deductibles 5. Program Components
  15. 15. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management Employee Programs/Workers’ Compensation • Loss history/patterns • Lost work days • Education 5. Program Components
  16. 16. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 1. Loss prevention & reduction 2. Claims management 3. Safety / Security programs 4. Patient relations programs 5. Contract and insurance premium review 6. Employee programs/workers’ compensation 7. Resource and support system review 8. Linkage with quality and utilization management Resource & Support System Review • Process, equipment, and staffing related risks • Budgetary requests for safety related programs or materials • Policies/procedures 5. Program Components
  17. 17. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 6. Organization wide Early Warning System An organization wide system to screen all patients for real or potential adverse incidents, issues, and occurrences that might result in increased risk to the organization or corporation and/or less than optimal quality of care. Purpose: Adverse patient Occurrences (APOs) Unexpected, Untoward events with actual or potential negative impact on the patient Potentially Compensable Events (PCEs) Those APOs that might become claims – based on the degree of actual or potential negative impact on the patient; PCE status determined by the risk manager
  18. 18. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 6. Organization wide Early Warning System Types of Systems • Generic Screening • Occurrence Reporting • Event Reporting • Incident Reporting • Patient Safety data screening Use of Occurrence/incident reports in physician peer Review
  19. 19. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 7. The Written Plan Components of Risk Management Plan Document Policy & statement of purpose Goals Scope of the program Authority and responsibilities Confidentiality and conflict of interest policies Data sources and referrals Documentation and reporting mechanisms Integration of activities and information
  20. 20. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 7. Risk Management & Accreditation Standards: Part of “GLD, QPS, MCI” • Leaders are responsible for short and long term planning, setting performance improvement priorities, and having a mechanism in place to adjust priorities in response to unusual or urgent events. • Leaders allocate adequate resources for, and measure and assess the effectiveness of, performance improvement and patient safety improvement activities. • Potentially high risk processes for data collection include: • Medication Management • Operative and other invasive procedures • Blood and blood product use • Restraint and seclusion use • Behavior management and treatment • Resuscitation process and outcomes • The organization has processes to mange clinical/service and non clinical data and information that is useful in decision making • Data and reports are used for communication and continuity of patient care and operations and for other purposes, including litigation and risk management activities.
  21. 21. 1. Definition & Goal 2. Governance Oversight Responsibilities 3. Professional Liability 4. Risk Management- Org. wide PI 5. Program Components 6. Org.wide Early Warning System 7. The Written Plan 8. RM & Accreditation 7. Risk Management & Accreditation Survey Expectations • Delegate responsibilities of RM • Receives periodic reports on adverse occurrences, sentinel events, actions taken and results, progress related to patient safety improvements, preventi ve efforts and educational efforts. Governing body participation • Identify areas of potential risk in clinical aspects • Develop criteria to identify specific cases • Design of programs that mitigate risks Physician participation • Operational linkages • Shared risk management information Linkages
  22. 22. Thank You

×