Risk Management in Health Care Institutions

The purpose of risk management, in general, is to enhance patients' safety, prevent accidents, ensure compliance with law, and avoid legal exposure, which could lead to loss or litigation.

Health care institutions include hospitals---acute-care, long-term, specialty, rehabilitation, and veterans---nursing homes, outpatient clinics, outpatient surgical facilities, and laboratories. Institutions must address the physical facility, equipment, staff, patients and visitors, which include not only families of patients, but also, for hospitals and nursing homes, attending physicians in private practice, whose patients are being treated.

Types and Methodology

• Risk management is proactive or reactive. Proactive is preventative. Reactive is mitigating damage and minimizing loss. General risk management principles apply, but each institution must ensure its risk management system includes customized efforts, specifically designed for each institution.

  Establishing safety protocols and guidelines, including proper training and certification, where warranted, while ensuring supervision, oversight and compliance, is a necessity and a good foundation upon which to build.

  Means must be provided so employees can---even anonymously, when need be---report problems or issues to management without employees' fear of reprisal, retaliation or punishment.

  Holding regular discussions with relevant personnel to review and to learn from adverse events will assist in re-designing protocols for better prevention, while aiding in mitigating damage and loss.

Facilities

• The following are examples of security and risk management issues for buildings. Entry to and exit from, the building must be appropriately restricted. The building and equipment should be in good repair and well-maintained. Workers must take routine and adequate safety precautions, so as not to endanger others. Staff must be properly trained, and where necessary, certified and licensed.

Patient Safety

• All medical personnel---doctors, nurses, technicians, orderlies, clerks---who have direct contact with patients should be properly trained and appropriately licensed. All staff---medical and non-medical---must be fully informed about and adequately trained regarding privacy matters, and ought obey proper protocols for handling all aspects of patients' care; for example, medical records, medications, supplies (such as syringes, bandages, tanks, tubing, catheters), food and linens.

  Institutional staff dedicated to patient relations can provide a communications pathway for patients and patients' families to communicate their concerns to the administration, in order to resolve difficulties and avoid unnecessary deaths or lawsuits.

Compliance

• The institution needs ample access to legal counsel, who can keep the administration fully informed of updated regulations and laws, which affect the institution's delivery of medical services.

  The administration must ensure that all legal and accounting paperwork is filed in a timely manner.

  Not-for-profit hospitals must provide sufficient charity care to maintain the institution's tax-free status. The administration must be vigilant to ensure that all regulations are met.

  The institution should have a financial plan to cover insurance risk, including the purchase of adequate insurance coverage.

Quality of Care

• Ensuring the quality of delivered medical care acts as a deterrent to substandard work and carelessness.

  The institution's establishing of a quality assurance department and making quality of care a top priority should be the institution's keystones for risk management.