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The Role of Risk Management in Patient Safety

The Role of Risk Management in Patient Safety. Frank Federico Loss Prevention/Patient Safety Specialist Risk Management Foundation Harvard Affiliated Institutions Cambridge, MA . Medical Injuries, Mistakes, and Malpractice Claims. negligence & error. injuries due to negligence.

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The Role of Risk Management in Patient Safety

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  1. The Role of Risk Management in Patient Safety Frank Federico Loss Prevention/Patient Safety Specialist Risk Management Foundation Harvard Affiliated Institutions Cambridge, MA Risk Management Foundation, Cambridge, MA

  2. Medical Injuries, Mistakes, and Malpractice Claims negligence & error injuries due to negligence injuries & adverse events malpractice claims compensation Health care environment Risk Management Foundation, Cambridge, MA

  3. public awareness claims adverse events IOM report “near misses” patient safety noise/anecdotes RMF: Claims are the TIP of the iceberg! Risk Management Foundation, Cambridge, MA

  4. Traditional Risk Management Functions • Loss control • Point person for claims and potential claims • Claims analysis • Risk avoidance • Identification, evaluation and treatment of financial loss • Identify areas of potential risk • Incident reports • Education • Resource Materials • Guidelines Risk Management Foundation, Cambridge, MA

  5. Traditional Risk Management Functions • Links to underwriting • Interface with insurance company and regulators • May or may not be linked to QA • May be linked to General Counsel Risk Management Foundation, Cambridge, MA

  6. The Patient Safety “Explosion” 1990 1999 Narrow range of projects: Focus on legal risk management/loss prevention Focus on Patient Safety Risk Management Foundation, Cambridge, MA

  7. Risk Management in Patient Safety • Change the culture from reactive to interactive risk management • Provide leadership in the area of safety • Align the risk management process around organization key strategic imperatives • Link risk data to financial data • Link JCAHO standards to risk management plan Youngberg,B, Meeting the Challenges of Patient Safety through the design of a New Risk Management Process, ASHRM Journal Fall 2001 Risk Management Foundation, Cambridge, MA

  8. Risk Management in Patient Safety Manage risk – reactive, interactive • Mitigate risk from unexpected occurrence – to patient, to provider • Investigate and defend claims – efficiently and effectively • Prevent future errors and losses – drive performance improvement, education, and practice evaluations from data and learning • Evaluate and underwrite risk exposures – insurance and retention Risk Management Foundation, Cambridge, MA

  9. Risk Management in Patient Safety Understand risk – vulnerabilities, exposures • Code cases that lead to clinical investigation, to claim, to payment • Code and incorporate events and non-standard data • Compare data and evaluate hypotheses • Identify areas of excellence, of opportunity, of distinction Risk Management Foundation, Cambridge, MA

  10. Claims by Risk Management Issues 80% Competencies 70% 60% 50% Leadership/ Management Percent of Claims with Issue Identified 40% Non- Ins RM Issues 30% Common- ication 20% Other 10% 0% Non-Ins RM Issues No RM Issues Found Clinical Systems Communication Documentation Environmental Equipment Behavior Related Supervision Technical Skills Clinical Judgment Administrative Risk Management Foundation, Cambridge, MA

  11. Risk Management in Patient Safety Integrate risk and clinical programs – engage in improvements • Communicate and engage executives and clinical leadership • Incorporate insights from QA, care, medical management • Coordinate improvement activities – everyone reacts to the same data Risk Management Foundation, Cambridge, MA

  12. Risk Management in Patient Safety • Medication errors and harm • Readmissions • Infection rates • Unplanned extubations and re-intubations • Data from high risk areas: OB, ED, Surgery, Radiology • Deaths Risk Management Foundation, Cambridge, MA

  13. Link to Financial DataCosts of Adverse Events • Cost of ongoing care • Lost productivity for patient • “Second Victim” • Medical malpractice case • Indemnity payments • Defense costs • Premium adjustments • Defensive medicine • Reputation • Market share Risk Management Foundation, Cambridge, MA

  14. Risk management – closing the loop with data Learning Standards of care Vulnerabilities Issues Defensibility Unexpected occurrence or outcome Loss prevention Risk mitigation Assertion of claim or lawsuit Claims management and Defense Investigation Process improvement Education Regulatory compliance Medical management (peer review) Risk Management Foundation, Cambridge, MA

  15. 1999 Catalysts & First Steps 2000 Digging Deeper 2001 Revving Up 2002 Take Off • Core Curriculum development • Human FactorsIntegration • symposium • surgery observation • L&D training • HSRI formed • Reporting systems • Human Factors • dx & anti-coag projects • IOM Report • RMF develop. Patient Safety Mission • BrCa Algo • Patient Safety Advisory Group formed • Target Areasdrill down, focused analysis • Reporting • systems CRICO Bd approve pt safety mission CRICO Bd target areagrants ($50K) CRICO Bd pt safety grants ($500K) CRICO Bd update on key inits Patient Safety Explosion: The RMF Perspective MIMEPS Project Risk Management Foundation, Cambridge, MA

  16. Current Initiatives • Diagnosis • Breast Care Algorithm update • Colo-Rectal Screening model (HF) • “Missed MI” study • Surgery • Human Factors Observation study at BWH Risk Management Foundation, Cambridge, MA

  17. Current Initiatives • Obstetrics • OB Team Training at BIDMC • OB Guidelines • Incentive Rating Plan pilot • Medication Results of two CRICO-funded studies – • Ambulatory Oncology Study • Analysis of Medication-Related Malpractice Claims (Archives of Internal Medicine, Nov 2002) • Improving Medication Prescribing (NEJM April 15, 2003) Risk Management Foundation, Cambridge, MA

  18. Disclosure of Unanticipated Outcomes • Component of a safe culture • Patients want to know • Risk managers: a hindrance or a support? • May impact litigation Risk Management Foundation, Cambridge, MA

  19. Pitfalls • More data collection= more disclosure? • Increase in suits in the short run • Definition of medical error not clear • Error does not always lead to harm1 • Error does not mean negligence 1.Bates DW, et al. Incidence of Adverse Drug Events and Potential Adverse Drug Events: implications for prevention. JAMA, 1995; 274(1): 29-34 Risk Management Foundation, Cambridge, MA

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