Risk Management as a Driver of Quality

Transcription

1 Risk Management as a Driver of Quality Carol Levy Director of Operations Seattle Reproductive Medicine Leanora Di Uglio, CPHRM, CPHQ Director of Risk Management IntegraMed America Inc

2 How Risk Management Drives Quality Assurance Goal To identify the difference between Risk Management & Quality Improvement. To develop a better understanding of the synergy between the two disciplines.

3 RM and QI Process Risk management and quality improvement functions have similar objectives Good clinical outcomes Patient safety Efficiencies in operations Focus on process not person But the focus and process are different RM reactive -to prevent recurrence QI proactive- to prevent occurrence

4 RM and QI Process Risk Management Purpose - to minimize events that may create a liability situation for the provider and organization Quality Improvement Purpose to improve and sustain clinical and organizational performance through ongoing monitoring and measurement

5 RM and QI Processes Risk Management Steps Quality Improvement Steps Risk Identification Investigation Tracking/Trending Risk Prevention Policies, procedures Consents Risk Reduction Handling litigation Risk Transfer Insurance Define process to improve Collect and analyze data Use data to develop improvement action plan Implement changes Process, policies Ongoing measuring/monitoring for sustained performance

6 RM and QI But both support a Safe and Just Culture Acknowledges high-risk, error-prone nature of an organization s activities (RM) Blame-free environment where individuals are able to report errors or close calls without fear of reprimand or punishment (RM) Collaboration across ranks to seek solutions to vulnerabilities (QI) Willingness on the part of the organization to direct resources for addressing safety concerns (QI) AHRQ Publication No. 43; 2001

7 RM & QI Require Team Cooperation Physicians Front Desk Nurses Billing IVF Lab Diagnostic Lab Patients Educators/ Counselors

8 Risk Management Prevention is better than cure Construct appropriate atmosphere (culture) of honesty Create teamwork within and between departments (I ve got your back) Provide SOPs and training for all personnel If they don t know what is acceptable they may not know what is unacceptable Management must set example Most critical for new personnel

9 Risk Management Process Risk Identification Sources Event Reporting All departments clinical and operational Types of events Adverse event that compromises clinical outcome quality of services patient/visitor safety environment of care No harm event reaches patient but did not cause harm Near miss event caught before it reaches patient Never event should never happen (sentinel event)

10 Risk Management Process Risk Identification Sources Audits Laboratory - Chain of Custody Annual audit minimum Direct observation Review of SOPs Review documentation Whenever there are significant changes process, personnel, equipment If a sentinel event occurs

11 Risk Management Process Risk Identification Sources Audits Medical Record Audit Quarterly General documentation principles Care and treatment provided Clinical decision making Document, document, document Area specific IVF/IUI, PACU, OR Topic specific as means to improve services

12 Risk Management Process Risk Identification Sources Customer Satisfaction External / Internal Employee Satisfaction Accreditation Standards AAAHC, Joint Commission Regulatory Requirements FDA, OSHA

13 Risk Management Process What to do when an error occurs Reassure the person that reporting the error was the correct action to take (no matter how minor or major) Maintain a professional manner Identify all details of the error (if known) What happened When it happened How it happened Who it happened to (patients and personnel) Determine any immediate options for correction there may be

14 Risk Management Process Event Investigation Description of the event Identification and assessment of contributing factors Recommendations for corrective action and follow up Root cause analysis (sentinel event) Identify causes that lead to variation in performance that produced undesirable outcome Trends in root cause (Joint Commission) Communication Orientation/training Patient assessment Information management Staffing level

15 Risk Identification Risk Identification Event tracking and trending Aggregate data to identify trends for quality improvement Concentrate on high severity, high frequency

16 Risk Prevention Implementation of clinical and/or operational policies and processes that prevent recurrence of the event and/or reduce severity Informed consent Management of Abandoned Embryos Emergency management plan OSHA compliance Staff competency Credentialing/Peer review

17 Risk Reduction How to Minimize Liability Exposure Develop full and accurate policies and procedures Develop full and documented training sessions for employees Develop systems for thorough communication with patients Document patient communications Claims Management Defense Strategy

18 Risk Transfer Transfer of financial loss to third party Liability insurance Contracts

19 Quality Improvement Define and verify a process that requires improvement Changes in clinical outcomes Deviation from protocols and processes Operational Pt. complaint trends Collect data to establish baseline performance and analyze process to identify cause of variability Clinical External benchmarks CDC data % live pregnancy non-donor, donor, maternal age Singleton vs. multiple

20 Quality Improvement Analyze variation to understand causative factors Evaluate process to identify which steps are vulnerable to failure Identify fail safe measures for each failure point in the process Implement corrective action plan Involve all departments associated with process, i.e., finance, laboratory, nursing Develop corrective measures which may include: inservice or other educational programs; new or reviewed policies and procedures; staffing changes; equipment or facility modification

21 Quality Improvement Measure and monitor efficacy of corrective action plan to improve performance Measure against baseline benchmarks Success ongoing monitoring for limited time Unsuccessful re-evaluate the problem to determine corrective measures for appropriate resolution

22 The End