This presentation will give you an idea on how to develop strategies for loss prevention and control at healthcare settings.

1. Dr. Mohamed Mosaad Hasan
MD, MPH, CPHQ, CPPS, GBSS

2.  Discuss various aspects of patient, employee and
environmental safety.
 Explain workers’ compensation from a risk manager’s
perspective.
 Define the purpose of a medical record.
 Explain five legal essentials of a contract.
 List and explain three elements of a risk management
review of an organization’s mergers, acquisitions, and
divestitures
 Create a list of exposures that deal with organizational
advertising liability.

3.  Job descriptions with quantifiable physical-based
criteria.
 Employee pre-placement physical evaluations.
 Baseline examinations.
 Specific skills required for position.
 Employee health program.
 Accident prevention program.
 Interaction with injured employee.

4.  Provide sure, prompt, and reasonable income and
medical benefits to work-accident victims.
 Provide remedy and reduce court delays, costs, and
workloads arising out of personal injury litigation.
 Eliminate payment of fees to lawyers and witnesses.
 Encourage maximum employer interest in safety and
rehabilitation.
 Promote study of causes of accidents.

5.  Risk Control and Loss Prevention
– Proactive program; not just reactive.
– Accident prevention plans.
– No retaliation for reporting.
– Accidents, illnesses, and near misses are
Investigated.
– Feedback on program effectiveness.
– Safety orientation and training.

6. Other Issues
– Pre-placement Program;
 Drug screens and physical exams.
– Post-employment Programs
 Employee assistance and wellness programs
– Ergonomics - the science of designing work tasks to fit
the employee rather than forcing the employee to
adapt to the job requirements.

7. Management ofWorkplace Risk
– Employment handbook.
– Employee orientation process.
– Harassment policy.
– Protection against violence in the workplace.
– Regulations of wages and working hours.
– Drug and alcohol testing.
– Guidelines for personnel records.
– Educational programs that address provider and
staff behavioral issues.

8. Human capital risks – refers to employee events and
behaviors that occur both in and out of the workplace
that prevent employees from being on the job or
being fully productive, and that negatively affect
operational and financial results.
– Leadership issues.
–Work processes.
– Employee attraction and selection.
– Absence/health and wellness.
– Employee retention.

9. Components of an Effective Absence Management
Program
– Return to work programs.
– Medical case management.
– Absence reporting.
– Absence tracking.
– Disability prevention.
 Disease Management
 Employee Health &Wellness Programs
 Safety & Accident Prevention
 Employee Assistance Programs

10. Safety Program and Environment of Care (EOC)
– Mission and policy statement.
– Membership of the EOC Committee.
– Subcommittees of the EOC Committee.
– Role and responsibilities of the safety officer.

11.  Purpose: To ensure that buildings, grounds, equipment and
systems pose no hazards to occupants
Prevent accidents
Maintain safe conditions for patients, families, visitors, and
staff
Reduce and combat hazards and risks
 Facility Inspections
– periodic
use of checklists
by whom: “safety officer”
unit leaders
‘real estate’ owners/occupants
including laboratory and radiology

12.  Preventive program
Periodic evaluations
How often
Recording of findings
Initiate corrective actions/ work requests/ etc.
Forward findings to the hospital safety committee
 Active program
Management of accidents: staff, visitors, and patients
Incident reports; format or form
Employee accidents; form
To safety officer
To safety committee

13.  Role of Safety Committee to analyze data
Forward data /analysis to Quality Improvement
Committee
 Coordination with Lab and X-ray safety programs
 Training program
– management of hazardous material
- training in safety awareness.

14. Purpose:To protect the security of the staff, visitors, patients
Responsibilities:
 Security Officer – responsibilities……….
 Department and other leaders responsibilities
 Unit leader responsibilities………..
Access to hospital
 Control of entrances and exits
 Check points in hospital
 After-hours checks
 Sporadic, random checks

15. Coordination with Police – communication, phone numbers
Identification Badges and pictures
Requirement for staff
Visitor badges
Contractor badges
Volunteers identification
Telemonitoring of corridors, Parking lots, garages, etc.
Screening/detecting – visitors, families, contractors, etc.
Periodic drill to challenge effectiveness
Security alert code

16. Purpose:To ensure all occupants of the organization’s facilities
are safe from fire and smoke
To Follow laws and inspections by local authorities
Reduction of risk
 Guidance on storage of flammables.
 Types of cabinets; locations; central location; warning
signage
 Guidance on location(s) of storage
 Guidance on how to store
 Fire safety checklist for monitoring (by hospital fire
specialist, unit supervisors, etc)
 Report of monitoring to hospital safety group

17. Managing risk during adjacent or internal construction
 Safe exits maintained.
 Signage for altered fire exit routes.
 Orientation of construction workers (e.g, hospital is no-
smoking facility, safety practices).
Early warning detection
 Alarms (wall boxes, phones, triggers).
 ‘Codes’ and meaning.
 Fire number to report or alert system to initiate.
 Automatic monitors/reporting.
External notification
Automatic, someone’s responsibility.

18. Suppression
 Automatic closure of fire doors.
 Automatic ventilation control or shutoff.
 Sprinkler systems.
 Fire hoses, extinguishers.
 Fire door requirements (location in long corridors,
stairwells, etc., construction of doors).
Responsibility for shut off of O2 and other gases and utilities.
Inspection of equipment – frequency of testing, maintenance
of equipment.

19. Education of staff in:
 Fire response (? Use of an acronym – “RACE”)
 Fire equipment use (? Use of an acronym – “PASS”)
 Responsibilities and methods of evacuation of patients
 Management of patient support equipment (oxygen, IV’s,
ventilators, temp control, etc)
 Testing and documentation of successful learning and
understanding
Plan for twice-a-year testing including
 Management of patients, visitors
 Use of alerting and suppression equipment
 Localized or general responses
 Documentation of exercise, participants, critique, lessons learned
 Report to safety and leadership
Orientation for new staff to fire and smoke safety

20. Purpose: Emergency Response Plan – Plan(s) to respond to
natural, manmade disasters and epidemics.
External plan: working with community resources -:
 Police – directing traffic, allowing hospital personnel to
pass Special ID for staff identification.
 Communication – backup systems between hospital and
municipality, etc.
 Security – limiting access to property, guards at doors, etc
 Civil defense.
 News – determining news ‘room’ or location, hospital
spokesman
 Ambulance services
 Testing recall system

21. Internal plan:
 Triage (entry) points in hospital.
 Triage methodology and supplies.
 Identification of teams, membership of teams and
numbers of teams.
 Identification of location of teams within hospital.
Communication with staff
 Command center.
 Special phones for staff.

22. Notification of inpatients
 Who is responsible?
 What is told?
 How
Bed space utilization
 What is done to create space in hospital for admissions?
 Cancellation of all surgery?
 Movement of or discharge of inpatients?Who decides?
New locations?
Registration supplies/pre-prepared charts at entry and
surgery areas.

23. Training of staff – frequency, trainers, location, etc.
Testing of staff: Yearly exercise to include:
 Documentation of attendees during exercise
 Follow-up critique of exercise (or real life disaster)
 Report of exercise and critique to
-hospital safety – to improve plans
-leadership – for budget, planning

24. Plan addresses:
 Hazmats
 Chemotherapy
 Radioactive materials and waste
 Hazardous gases and vapors management
 Medical and infectious wastes
Preventive management plan for each type of hazmat
describes:
 Proper use of Hazmat
 Proper handling of Hazmats (various color bags,
containers)
 Proper storage of Hazmats
 Proper destruction or removal of Hazmats

25. o Minimal equipment
required to handle various
Hazmats.
o Minimal equipment
required for spills, exposure
to Hazmat
 Spill kits
 Personal equipment
o MSDS sheets at site of
Hazmats.
o Proper labeling of
Hazmats/ wastes.
o Method to report incidents.
o Surveillance to ensure
compliance -
 periodic evaluations
 checklist
 forward to safety officer
and committee

26.  Purpose: To ensure that medical equipment is
available for use and functioning properly.
 Definition of medical equipment – priorities, life-
sustaining vs. non life-sustaining.
 Inventory of all equipment – numbering tag system
 Who performs?
 What process?
 Where recorded

27.  Inspection of equipment
 By manufacturer or supplier
 By hospital
 Self, bio-maintenance, or contract
 By priority (category) including frequency and scope of
inspection
 Documentation of inspections
Tagging of equipment and required information on tag
Logging in central book (? and at location site of equipment)
Testing of equipment
 By category
 Per manufacturer’s instructions
 Before infrequent use, when coming out of storage
 Documentation of testing

28.  Preventive maintenance requirements
By whom? How recorded?
 Equipment brought into hospital for evaluation, trial? (responsibilities
of hospital, bio-maintenance, salesmen, staff, etc.)
 Training of staff on equipment
 Defibrillators for code responses.
 Use of ‘laboratory’ equipment in hospital by non-lab personnel
(glucometers, etc.).
 Monitors, perfusion pumps, etc., in work area.
 Other equipment staff uses and maintains

29.  Quality control procedures and documentation
 Equipment management team
 To prioritize purchases vs. hospital mission and strategic
plan
 To address upgrades and replacements
 To address problem areas
 Representative from or liaison with Safety group
 Data collected Forwarded to
 Safety committee,
 leadership (planning, budgeting),
 quality oversight committee.

30.  Purpose:To ensure that electrical, water and other utility
systems are maintained to minimize the risks of operating
failures.
Identification of areas of vulnerability for failure in:
 Lighting/illumination
 Refrigeration
 Life support
 Water
 Dialysis service
 Sterilization of supplies
 Ventilation
 Plumbing lines, others.

31.  Monitoring for performance or failure: in hospital, In units, In
pieces of specific equipment.
 Provision of emergency power and water for these systems
 Generators (size, load, number, backup, fuel).
 Reservoirs (size, location, duration of supply).
 Testing of equipment
 Generators: frequency, under load, not under load, documentation
and reporting.
 Water/reservoirs: frequency, type (bacteriologic, chemical
analysis).
 Dialysis equipment; (bacteriologic, chemical analysis).
 Documentation and forwarding of reports (safety committee,
leadership).

32.  Preventive maintenance
 Analysis of failures
 Monitoring
 Documentation and reports
 Forwarding of reports:
To safety committee
To leadership
To quality and patient safety oversight committee.

33.  Environmental Issues
– Underground storage tanks.
– Aboveground storage tanks.
– Asbestos removal.
– Disposal of hazardous waste.
– On-site medical waste incinerators.
 Environmental Issues in Acquisitions
– Inspection of the property.
– Records review.

34. Four Steps
– Prevention: establish excellent internal reporting
systems
– Preparation: develop an effective, comprehensive
emergency response plan
– Implementation/response: practice the plan so
everyone knows the steps and their roles
– Recovery: manage the financial, physical, and
emotional challenges expeditiously.

35. Requirements
–The Joint Commission requires at least one drill
annually.
–Tabletop drill does not fulfill requirement for a drill.
– Each drill should be evaluated with identified concerns
addressed appropriately.

36. Purpose of the Medical Record
– Primary communication medium for planning,
coordinating, and orchestrating patient care.
– Legal document.
– Defense against malpractice claims.
– Basis for many other important activities.

37. Documentation
– State statutes,
– Professional practice standards,
– Specific health care facility protocols,
–Third party payers,
– Accrediting organizations,

38.  New variations of old concerns introduced by new
information technologies.
 Electronic Patient Records
– Confidentiality and security issues
– Accessibility and durability
– Accuracy and evidentiary concerns
– Security.

39. Risk Manager’s Role
– Monitor to assess quality of documentation
– Communicate regularly with the Medical Records
Committee
– Educate the clinical staff

40.  Contract: an agreement between two or more persons
that creates an obligation to do or not do a particular
thing.

41. Five Legal Essentials
–The parties to the contract are competent
–The contract represents mutual understanding
between the parties
–There is consideration; a bargained-for exchange of
legal value exists between the parties
–The contract is documented in writing if required for
legal enforcement in the state
–The purpose or object of the contract is legal

42. Confidentiality Provisions
– Confidentiality and privacy issues
– Negligent disclosure
– Legal counsel for developing sample confidentiality
provisions

43. Contract File Management
– Reviewing or filing
– Insurance certificates.
–Tickler system
– Policy and procedure development

44.  Directors and Officers’ Liability Prevention
 Mergers, Acquisitions, and Divestitures
 Partnerships, JointVentures and Collaborative
Relationships
 Advertising

45.  Determination of potential areas of board liability
exposure: discrimination, hazardous management,
medical staff.
 Assessment of the degree of liability exposure in
such areas: credentialing and privileging.
 Implementation of corrective action to minimize
liability exposure in high risk areas or activities: revise
policies and procedures.

46. Concept of Successor Liability
– Stock acquisition: normally the acquiring company
assumes all legal liabilities
– Asset purchase: normally there is no transfer of
liability
– Successor liability: the acquiring company can be
held liable for the torts of the target company’s
previous owners.

47. Key Steps in the Due Diligence Process
– Determine what information is crucial
– Assign responsibility for data gathering and collect
information.
– Organize the various pieces of information and
analyze the exposures to loss.
– Assess the loss prevention and risk financing
programs
– Evaluate effectiveness of organization’s risk
management policies and procedures
– Express in summary form the key issues

48.  Partnership: voluntary contract between two or more
competent persons to place their money, effects, labor
and skill or some or all of them in lawful commerce or
business, with the understanding that there will be a
proportional sharing of the profits and losses between
them.
 Joint Venture: a legal entity in the nature of a partnership
engaged in the joint pursuit of a particular transaction for
mutual profit.
 Collaborative relationship: those in which parties
cooperate in an endeavor related to the needs of one or
the other or both.

49.  Evaluating Potential Business Partners
– Areas of Focus
 Compliance
 Directors and officers’ coverage
 Document review
 Environmental assessment
 Errors and omissions
 General liability
 Product liability
 Professional liability
 Property coverage
 Workers’ compensation

50.  Regulatory Implications
False advertising might be proven if there is no
competent and reliable scientific evidence to support
the claims made.

51. Managing Advertising Liability Exposures
– Know the standards related to health care advertising.
– Know the organization’s marketing philosophy.
– Partner with the marketing director.
– Review proposed advertising initiatives.
– Avoid statements about success rates or outcomes.