Risk Managementand Healthcare

Risk Management

•Limit liabilities •Limit financial loss•Limit preventable harm•A program designed to reduce the incidence of preventable accidents and injuries; to minimize the financial loss to the institution should and injury or accident occur

Complexities of ScienceImpact on Medicine and Healthcare

• Specialists• 4000 medical

procedures• 6000 drugs

Preventable Harm

• 2 million pick up infections in the hospital (nosocomial) because there is no basic hygiene protocol

• 99,000 die in the US each year of nosocomial infections.

• 300,000 die each year of preventable harm

Risk Management

• Help, or at least do no harm.– Hippocrates

• Toxicity• Only dose makes the

poison• How medications

interact

Types of Risk

• Bodily Injury• Consequential Loss• Property Loss• Liability Loss

Bodily Injury

• Illness or injury to Patient, Visitor or Employee

• Workers Compensation• Professional or

Institutional Negligence

Consequential Loss

• Loss of Key Personnel• Vehicular Accidents• Machine or Plant failure• Interruption of Sole

Supplier• Disacreditation

Property Loss

• Fire• Weather• Embezzlement• Theft• Sabotage• Data or Record

tampering

Liability Loss

• Breach of Confidentiality

• Breach of Contract• Product Liability• Professional or

Institutional Negligence

Reduce Preventable MistakesRisk Management Model:

• Identify • Assessment• Mitigation• Monitoring/Control • 5 Is:– Investigate– Inform– Influence– Interpret– Integrate

IdentifyInvestigate

• Data• Performance• Results based • Analysis• Fraud• Malpractice• Continuous Process

Assessment/Analysis• Prioritize• Low hanging fruit• Efficacy: what would be

most effective• Risk: identify risk• Probability: of

occurrence • Factor: High, Medium,

Low• Cost/Benefit Analysis

Inform

• Present in material form

• Understand• Summarize clearly• Communicate• Alert• Get buy in and

compliance

Mitigation/Influence

• Procedures• Protocols• To reduce risks• Contracts; limit

liabilities• Insurance; financing risk

mitigation• Checklists

Risk Control

• Risk Acceptance• Exposure Avoidance• Loss Prevention• Loss Reduction• Exposure Segregation• Contractual Transfer• Risk Financing

Insurance

• Self Insurance• Commercial Insurance

Coverage • Premiums• Risk financing• Latent Liabilities

Legal Liabilities

• Malpractice• Slip and Fall• Negligence• Misconduct

Checklists

• Better manage and handle complexity

• Pause points to intervene

• Cognitive Net

The Pronovost Checklist

• Central venous catheters are used for medications, blood, and fluids and nutrition and can stay in for days or weeks. But bacteria can grow in the line and spread an infection that kills one in five patients that contract it.

• Wash hands with soap and water

• Wear sterile clothing• Clean patients skin• Avoid veins in arms and

legs; use chest.• Check line for infection

each day.

Atul Gawande

• http://www.ted.com/talks/atul_gawande_how_do_we_heal_medicine.html

• Checklists• Cognitive net

Monitoring/ControlInterpret/Integrate

• Is it effective• Honesty and learning• Iterative process• Feedback loop• Regulations

Regulations

• State • Federal• Professional• ADA• HIPPA

Risk Management and Healthcare costs

• Malpractice insurance• Physicians are

practicing defensive medicine– Risk averse – Order every conceivable

test

• Driver of inflated costs• Specialist and lack of

PCPs

IT

• Medical Records• http://www.ted.com/ta

lks/thomas_goetz_it_s_time_to_redesign_medical_data.html

Best way to manage Risk?

• Provide better care• Share information• Identify best practices• Measure outcomes• Define value• Outcomes that matter

to patients/cost = value• Identify dimensions of

quality