The clinical and administrative systems, processes, and reports used in risk management in the healthcare industry include those that are used to identify, monitor, evaluate, mitigate, and prevent hazards. Healthcare organizations that use risk management effectively and methodically protect patient safety as well as their assets, profitability, accreditation, levels of reimbursement, brand value, and reputation in the community.
Traditionally, healthcare risk management deployment has been focused on the critical function of patient safety and the elimination of medical errors that affect an organization's ability to achieve its goal and defend against financial liability. Yet, with the growing involvement of healthcare technologies, increased cybersecurity concerns, the rapid pace of medical science, and the industry's ever-changing regulatory, legal, political, and reimbursement environment, healthcare risk management has grown increasingly complex.
Hospitals and other healthcare systems are expanding their risk management systems from largely reactive programs that promote patient safety and prevent legal exposure to more proactive programs that see risk through the lens of the entire healthcare ecosystem. Healthcare organizations and risk managers must do the following to manage the healthcare risk comprehensive approach:
- Identify Risk: It is difficult to identify all of the hazards a healthcare entity faces since risk management entails managing uncertainty, and new risks are continually developing. Healthcare risk managers, on the other hand, can identify dangers and potentially compensatory occurrences that would otherwise be difficult to foresee by using data, institutional and industry knowledge, and by involving everyone — patients, staff, administrators, and payers. For that, Risk Implementer Training can be required to help to understand the key elements and the approach of risk management as well as the steps involved in the risk management process for various management systems.
- Quantify & Prioritize Risk: To allocate resources and assign tasks based on risks, it is critical to score, rank, and prioritize risks based on their chance and impact of occurrence after they have been recognized. Heat maps and risk matrices, which can be used to illustrate hazards and encourage dialogue and group decision-making, can be used to achieve this.
- Investigate & Report Sentinel Events:Described by the Joint Commission as "any unanticipated event in a healthcare setting resulting in death or serious physical or psychological injury to a patient or patients, not related to the natural course of the patient's illness," Sentinel Events are those that cause death or serious physical or psychological harm. When a sentinel event happens, prompt action and careful inquiry take care of any immediate patient safety concerns while lowering potential hazards. An established plan encourages personnel to respond in a controlled, calm manner. It also ensures that corrective actions may be taken, implemented, and assessed. Not all sentinel incidents are the result of mistakes. But, to achieve transparency and comprehensive review, healthcare organizations must create a climate of mutual respect, trust, and cooperation among employees and leadership.
- Perform Compliance Reporting: Sentinel events, prescription errors, and medical device malfunctions are just a few examples of the precise event types that federal, state, and national regulatory organizations like the Joint Commission mandate reporting of. The risk management documents must be noted, coded, and reported incidents like wrong-site or patient surgery, work injuries, prescription errors, etc.
- Capture & Learn from Near Misses & Good Catches: "Near misses" and "good catches" occur when errors or negative outcomes are prevented by good fortune or human intervention. The easiest method to recognize and minimize risk is frequently through these. So that preventative measures and best practices may be implemented, healthcare professionals should create a culture that fosters reporting.
- Think Beyond the Obvious to Uncover Latent Active failures that are evident and simple to spot, such as when a nurse administers the incorrect dosage of medication to a patient. On the other hand, latent faults are frequently concealed and can only be found through analysis and careful inspection. Was it difficult to read the patient's chart because of the lighting? Was the nurse rushing because there were too many patients with high acuity? Examine deeper and less obvious causes while determining what led to a negative experience.
- Deploy Proven Analysis Models for Incidents: Investigation of Latent failures, causes, and linkages between hazards are all understood using models for accident analysis. For instance, medical errors frequently result from understaffing and weariness. The effectiveness and efficiency of risk management are increased by using well-established models. The Sharp and Blunt End Assessment of Clinical Mistakes model and accident analysis models are both applied to risk management in the healthcare industry. Detailed frameworks are used in FMEA, or Failure Mode and Effects Analysis, as well as Root Cause Analysis, to assist identify the causes and effects of medical errors.
- Invest in a Robust Risk Management Information System (RMIS): There are many solutions available for reporting and managing risk. These systems include resources for recording occurrences, monitoring risk, reporting trends, comparing data points across industries, and benchmarking data points. Reports can be generated, among other things, for losses, incidents, open claims, and lost time from injuries to employees. By increasing efficiency through readily available and dependable solutions and reducing overall costs by automating repetitive operations, RMIS may significantly improve risk management.
- Find the Right Balance of Risk: Financing/Transfer/Retention The strategies used by a company to effectively and efficiently finance loss brought on by risk are known as risk financing. It encompasses risk retention techniques like self-insurance and captive insurance as well as risk transfer often accomplished through insurance policies.