History, Credentials, Teamwork

Transcription

1 History, Credentials, Teamwork

2 Risk Management evolved from insurance management Called Risk Management because involves more than just insurance Healthcare Risk Management began mid 1970 s Medical malpractice crisis emphasized need AMA founded Hospital Association of Risk Managers (HARM) in 1973

3 Steven Salman Developed self-insurance program Met with AHA members to discuss availability and costs Glenn Troyer Invited Salman to OSU to speak Layton Severson Claims manager for state s only insurer for physicians and hospitals (JUA)

4 Ohio Society of Healthcare Risk Managers 1978 First state hospital risk managers society Florida 1976 Required internal risk management programs in hospitals, ambulatory surgery centers and other facilities

5 Early 1980 s Recommendation to form a society within AHA 1979 American Society of Hospital Risk Managers meeting March 1980 Steven Salman first president, Glenn Troyer third president Ohio Chapter began as an affiliate 1981

6 Mid 1980 s Name changed to American Society for Healthcare Risk Management Focus on DRG implementation, identifying potential losses and prevention and OB/GYN liability Occurrence report popularized EMTALA passed Joint Ventures Infection Control standards-aids crisis

7 Early 1990 s Risk management plans; risk assessments, peer review New standards for long-term care and home care Increased cost of medical malpractice insurance Americans with Disability Act National Practitioner Databank Advance Directives Safe Medical Device Act EMTALA revisions Development of formal modules educational certificate program

8 Mid 1990 s New legislature and policy changes: malpractice reform, medical device tracking requirements New guidelines Occupational Safety & Health Administration, CDC Patient Self-Determination Act and healthcare and insurance reform

9 Late 1990 s Benchmarking Corporate Compliance Violence in the workplace Medication error prevention & device tracking Informed consent Patient rights; privacy and confidentiality Grievance process First CPHRM examination 2000 National Healthcare RM week; third week of June

10 Early Millennium Patient Safety emerges Sentinel events and RCA Disclosure of unanticipated outcomes The Barton Certificate Program in Healthcare Risk Management Traditional medical malpractice coverage reduced; organizations formed captives

11 Late 2000 s Collaboration with other professional societies Leadership role on color-coded wristbands Supports TJC requirements on advocacy, cultural competence, communication & staff effectiveness ASHRM Exchange established Numerous books and publications

12 Cyber Liability & Insurance Coverage Electronic Health Record & Litigation Telemedicine Aging physicians The Other Providers: NP s PA s Unknown; Ebola

13 Nursing degree Bachelor or Master s degree; RM degrees Strong management skills Familiarity with laws regarding medical malpractice liability Florida requires healthcare risk managers to be licensed

14 Certified Professional in Healthcare Risk Management(CPHRM) Preparation Modules Handbook/Study Guide Self-Assessment Examination Pre-conference review Examination Loss Prevention Risk Financing Operations Claims management Regulatory/Accredita tion Compliance Bioethics

15 Visibility Highly visible Easily accessible Communication Risk Management plan Teach principles Recognition Demonstrate worth Resources Act as a resource Use experts as resources

16 Participate in Board of Trustee meetings, Quality meetings Medical Staff meetings and provide education on RM issues, trends etc, Meet regularly with senior leaders Make rounds so staff know who you are Participate on committees and education programs Be involved in new services Follow through and meet deadlines Be active in professional associations and organizations

17 Take human factors into account Be transparent and inclusive Be dynamic and responsive to change Be part of decision making process Address uncertainty and assumptions Be capable of continual improvement and enhancement Create a risk management plan Be a change artist Create value; resource to mitigate risk

18 Demonstrate your value how do you quantify what doesn t happen because it was prevented? Correlate a decrease in malpractice claims Demonstrate a reduction in reported adverse events in conjunction with implementation of specific targeted strategies

19 Responsibilities are diverse Risk identification, investigation and reduction Maintains risk statistics; collects, evaluates and distributes data Compliance with regulatory agencies Makes recommendations to prevent occurrences Work closely with hospital legal counsel In-services and orientation

20 Risk is uncertainty that a loss or losses will occur Risk management is clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury to patients, staff and visitors and the risk of loss to the organization Proactive or reactive Proactive is avoiding/preventing risk Reactive is minimizing loss or damage after an adverse event

21 Identification, assessment, and prioritization of risks followed by coordinated and economical application of resources to minimize, monitor, and control the probability and/or impact of unfortunate events or to maximize the realization of opportunities Constant state of change

22 Coming together is a beginning Keeping together is progress Working together is success Henry Ford

23 Patients & Families Physicians Nurses Therapists Technicians Plant Engineers Compliance Regulatory Agencies Finance Attorneys Insurance Companies Administration Infection Control Human Resources Quality Management Pastoral Care Pharmacists Board of Trustees

24 Pharmacy & Therapeutics Infection Control Blood Usage Medical Record Review Quality Credentials & Privileges Ethics Patient Safety/Safety Products Research Contract Review Medical Executive Radiation Therapy/Cancer

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