Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words.

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Health Medical


. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words.

2. Your Critique (50%)

What is your reaction to the content of the articles?

What did you learn about Risk Management Activities and Tools?

What did you learn about Legal Standards and Risk Management related with OSHA and HIPAA?

Did these Chapter and articles change your thoughts about Risk Management in Employment? If so, how? If not, what remained the same?

3. Conclusion (15%)

Briefly summarize your thoughts & conclusion to your critique of the articles and Chapter you read. How did these articles and Chapters impact your thoughts on Regulatory Environment,and InstitutionalImperative ?

Evaluation will be based on how clearly you respond to the above, in particular:

a) The clarity with which you critique the articles;

b) The depth, scope, and organization of your paper; and,

c) Your conclusions, including a description of the impact of these articles and Chapters on any Health Care Setting.

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Chapter 1: Risk Management Dynamics 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 providers. 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 it? What are the risks we are trying to protect against? • • • • • • • • Antitrust violations Breach of contract Casualty exposure Defamation Embezzlement Environmental damage Fraud and abuse General liability • Hazardous substance exposure • Professional malpractice • Securities violations • Transportation liability • Worker’s compensation 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 harmed • Likelihood or frequency of occurrence Risk Control/Treatment • Most common function of risk management programs • 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 outcomes • 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 Summary • 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. Chapter 2: Regulatory Environment Most Regulated Industry • Health Care is one of the most regulated industries in the US. • It is vital to be aware of and understand what regulations may affect the facility. Standards Statements concerning proper procedures taken in a given situation: • Explicit or implicit • National or local • Validated or Consensual • Used or ignored • Periodically updated or static Legal Standards • Judicial system (court decisions) provides initiative for implementing standards public health rules – Disease reporting requirements – Immunizations – Worker’s comp – Licensing of professionals Federal Mandatory Regulations • CMS • OSHA • HIPAA • EMTALA • Mammography Quality Standards Act • Safe Medical Devices Act • MedWatch • MWTA • EPA State Mandatory Regulations • Professional Licensure of Providers • Smoke-free Workplaces • Smoke-free Environment • Violence Prevention State Mandated Risk Management Legislation • • • • • Risk Management Responsibility Governing Body Involvement Risk Identification Risk Analysis Risk Management Education State Mandated Risk Management Legislation • • • • Sharing Information Patient Grievance Procedures Immunity and Confidentiality for Providers Risk Management Follow-up Procedures Reimbursement Standards Payers set their own standards for reimbursement • Fee for service • Negotiated fees • Capitation • Prospective payment • RBRVS Medicare Incentives to Improve Quality • Evidence based medicine in now generally accepted as essential to effective and safe medical practice. • This link was presented in 2 seminal works from IOM: – Crossing the Quality Chasm – To Err Is Human Deficit Reduction Act 2003 and Beyond • • • • Pay for Posting Pay for Performance Value Based Purchasing Scores and Withhold Determination False Claims Act • Anti-fraud activities • Lawsuits • Revocation of Medicare participation Practice Guidelines • Accreditation Programs develop standards and facilities can voluntarily apply for review – Joint Commission on the Accreditation of Healthcare Organizations (Joint Commission) – National Committee for Quality Assurance (NCQA) • Many equate facility accreditation with quality – Medicare accepts a JCAHO accreditation as evidence that a hospital meets Medicare conditions of participation Summary • IGNORANCE of the Law is no excuse • Know the regulations – Identify which ones are pertinent to the facility – Ensure that appropriate policies are in place – Document compliance
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Institutional affiliation




Risk Management in Health Care Institutions
Chapters and Article Summary and Their Critical Review
In risk management in health care institutions unit, many aspects of safety and risk
prevention were covered. For instance, in chapter one, which dealt with risk management
dynamics, several key issues in light of risk management were discussed. To begin with, there is
broad acceptance that more than one million errors in the medication processes are evident every
year, a factor which results in over 140 000 preventable deaths per year. Going by this, it has
been acknowledged that the hospital staff only reports one percent of these occurrences, thus
limiting adequate development of the remediation measures (chapter 1)
This chapter has focused on what can be done in order to enhance data collection of these
events, and subsequently be able to dress the issue through proper administrative steps. Towards
this, proper ...

I was having a hard time with this subject, and this was a great help.


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