Risk management in healthcare aims to limit liabilities, financial loss, and preventable harm. It identifies risks, assesses them, implements mitigation strategies, and monitors controls. Key risks include nosocomial infections, medical errors, and liability issues. Checklists are effective for managing complexity and reducing errors. Overall, the best way to manage risk is by providing high-quality, value-based care through measuring outcomes, sharing best practices, and focusing on what matters most to patients.

1. Risk Management
and Healthcare

2. Risk Management
•Limit liabilities
•Limit financial loss
•Limit preventable harm
•A program designed to
reduce the incidence of
preventable accidents and
injuries; to minimize the
financial loss to the
institution should and injury
or accident occur

3. Complexities of Science
Impact on Medicine and Healthcare
• Specialists
• 4000 medical
procedures
• 6000 drugs

4. Preventable Harm
• 2 million pick up
infections in the
hospital (nosocomial)
because there is no
basic hygiene protocol
• 99,000 die in the US
each year of nosocomial
infections.
• 300,000 die each year
of preventable harm

5. Risk Management
• Help, or at least do no
harm.
– Hippocrates
• Toxicity
• Only dose makes the
poison
• How medications
interact

6. Types of Risk
• Bodily Injury
• Consequential Loss
• Property Loss
• Liability Loss

7. Bodily Injury
• Illness or injury to
Patient, Visitor or
Employee
• Workers Compensation
• Professional or
Institutional Negligence

8. Consequential Loss
• Loss of Key Personnel
• Vehicular Accidents
• Machine or Plant failure
• Interruption of Sole
Supplier
• Disacreditation

9. Property Loss
• Fire
• Weather
• Embezzlement
• Theft
• Sabotage
• Data or Record
tampering

10. Liability Loss
• Breach of
Confidentiality
• Breach of Contract
• Product Liability
• Professional or
Institutional Negligence

11. Reduce Preventable Mistakes
Risk Management Model:
• Identify
• Assessment
• Mitigation
• Monitoring/Control
• 5 Is:
– Investigate
– Inform
– Influence
– Interpret
– Integrate

12. Identify
Investigate
• Data
• Performance
• Results based
• Analysis
• Fraud
• Malpractice
• Continuous Process

13. Assessment/Analysis
• Prioritize
• Low hanging fruit
• Efficacy: what would be
most effective
• Risk: identify risk
• Probability: of
occurrence
• Factor: High, Medium,
Low
• Cost/Benefit Analysis

14. Inform
• Present in material
form
• Understand
• Summarize clearly
• Communicate
• Alert
• Get buy in and
compliance

15. Mitigation/Influence
• Procedures
• Protocols
• To reduce risks
• Contracts; limit
liabilities
• Insurance; financing risk
mitigation
• Checklists

16. Risk Control
• Risk Acceptance
• Exposure Avoidance
• Loss Prevention
• Loss Reduction
• Exposure Segregation
• Contractual Transfer
• Risk Financing

17. Insurance
• Self Insurance
• Commercial Insurance
Coverage
• Premiums
• Risk financing
• Latent Liabilities

18. Legal Liabilities
• Malpractice
• Slip and Fall
• Negligence
• Misconduct

19. Checklists
• Better manage and
handle complexity
• Pause points to
intervene
• Cognitive Net

20. The Pronovost Checklist
• Central venous
catheters are used for
medications, blood, and
fluids and nutrition and
can stay in for days or
weeks. But bacteria can
grow in the line and
spread an infection that
kills one in five patients
that contract it.
• Wash hands with soap
and water
• Wear sterile clothing
• Clean patients skin
• Avoid veins in arms and
legs; use chest.
• Check line for infection
each day.

21. Atul Gawande
• http://www.ted.com/talks/atul_gawande_how_do_we_h• Checklists
• Cognitive net

22. Monitoring/Control
Interpret/Integrate
• Is it effective
• Honesty and learning
• Iterative process
• Feedback loop
• Regulations

23. Regulations
• State
• Federal
• Professional
• ADA
• HIPPA

24. Risk Management and Healthcare
costs
• Malpractice insurance
• Physicians are
practicing defensive
medicine
– Risk averse
– Order every conceivable
test
• Driver of inflated costs
• Specialist and lack of
PCPs

25. IT
• Medical Records
• http://www.ted.com/talks/thomas_goetz_it_s_time_to_r

26. Best way to manage Risk?
• Provide better care
• Share information
• Identify best practices
• Measure outcomes
• Define value
• Outcomes that matter
to patients/cost = value
• Identify dimensions of
quality