How to Balance Patient Rights With Risk Management

Balancing patient rights with risk management needs is one of the most challenging facets of health care today. Practitioners must ensure that all of the patient's rights are preserved, while ensuring that this patient and all of the patients and workers in the facility are not exposed to any undue risk factors. Striking an appropriate balance between individual rights and the responsibilities of the organization is a challenge that pays excellent dividends for the health care organization.

Things You'll Need

• Daily census
• Patient safety materials
• Risk management information
• Federal patient-care and privacy guidelines
• Incident reports and customer complaints
• Insurance company care requirements
• Accreditation agency care requirements

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Instructions

Preparation

• 1

  Collect incident reports and customer complaints from the last day, week, month and year, along with daily census reports from the last day, week, month and year. Incidents and census reports will provide you with a baseline. You will learn where you are today, so that you can plan where you need to go to improve preservation of patient rights while improving risk management.

• 2

  Collect professional materials consisting of risk management information, Federal patient-care and privacy guidelines, insurance company care requirements and accreditation agency care requirements. These materials will be invaluable as you develop a risk management plan. By considering insurance company care requirements and accreditation agency care requirements, you will avoid future challenges to the agency's status.

• 3

  Familiarize yourself with all of the professional materials that have been collected. All of these materials have a critical bearing on the financial success of the organization. Each of the reports that have been collected should be reviewed; they provide vital information.

Analyze the Current Situation

• 4

  Compile a list of population trends and the changes that have occurred in utilization over the past year. Review and list patient admission numbers over the past year, and determine the length of stay. Investigate how bed decisions are made, including the priorities for hospitalization, expected delays, and average stay. These factors together comprise the bed need of the care facility.

• 5

  Prepare to graph the information you have compiled. Risk factors should be assigned a weight before they are graphed. The size of the practice, the age of the practitioners, competition from other hospitals, the percentage of the patients that come from outside of the primary service area and the percentage of physicians who accept insurance assignments are all risks and should be given a weight. Each specialty should be assigned a risk in this manner.

• 6

  Graph the information, utilizing a bubble system. Net revenue should be graphed on the X axis. Risk factors should be graphed on the Y axis. The resulting graph will provide a visual depiction of the areas of the health care organization that are most at risk.

• 7

  Compile a general list of patient complaints. Divide the complaints into general areas. Complaints regarding food, feeling that the rules are unfair, room complaints, privacy complaints and genuine health care complaints should all be categorized.

• 8

  Compare the list of patient complaints to certification or accreditation requirements, to Federal patient-care and privacy guidelines and to insurance company requirements. Determine the number and type of violations. Determine where the genuine violations occurred, and the circumstances.

Develop a Patient Rights and Risk Management Plan

• 9

  Compare the patient rights violation list and the risk management assessment to determine the level of violation in the high risk units of the service organization. Determine if there is a particular time or shift during which the violations occurred. Prepare a list of any service units with repeated violations.

• 10

  Use the violations list and the risk management assessment to develop a plan of improvement for the health care organization. Compile a report on findings and distribute the report to the organization's quality assurance program, if any. If there is no quality assurance program, approach upper management with suggestions for implementation.

• 11

  Develop a follow-up plan and schedule the time required to monitor the plan. Schedule a regular time to review progress. Use each year's year-end results to develop a new baseline.