Chapter 1 Flashcards
(21 cards)
Staff
Greatest commodity and greatest risk in health care
Staff competency KSAO
Knowledge
Skill
Ability
Other
RM Professional Background
Nursing
Admin
Insurance
**No lawyer or finance professional
Accidental loss
occurs by chance and is unexpected
Risk management
The process of making and carrying out decisions that will help prevent adverse consequences and minimize the negative effects of accidental losses on an organization
History of RM
Emerged during the malpractice crisis of the mid-70s health care organizations experienced rapid increase in claim costs and premiums, and major medical liability insurers left the market
Crisis prompted health care entities to develop the first risk management programs (insurance companies developed the model)
Malpractice
Improper professional actions or the failure to exercise proper professional skills by a professional advisor, such as a physician, dentist, or health care entity. Also professional misconduct, improper discharge of professional duties, or a failure to meet the standards of care of a professional, resulting in harm to another person
Sentinel event
An unexpected occurrence involving death or serious physical or psychological injury or the risk thereof, including loss of limb or function
Key structural elements of the risk management program
Authority Visibility Communication Coordination Accountability
Authority
- Risk management position must be relatively high in the organizational hierarchy (ideally should report to CEO or another member of the SMT)
- Must be able to make decisions, enable change, and be trusted with confidential/sensitive information
Visibility
i. Risk management professional should be highly-visible in the HCO
ii. Risk management professional must foster awareness of risk management practices and techniques among SMT, the governing body, medical staff, and employees at all organization levels through consciousness-raising, education, and communication
Communication
i. Risk managers should be equipped with information about mergers, acquisitions, and joint ventures early in the process to advise SMT on the risk management implications
RMP must have access to organization-wide communication system
Coordination
HCOs should establish both formal and informal mechanisms for the coordination of the risk management program with other departments
Accountability
RM professionals should be held accountable for performance
Job descriptions, performance appraisals, annual report to senior management summarizing claims, insurance, and RM program activities
Scope of RM Program
A. Patient care-related risk B. Medical staff-related risk C. Employee-related risk D. Property-related risk E. Financial risk Other risk
RM Process
- Identify and analyze loss exposures
- Consider alternative risk techniques
- Select best RM technique(s)
- Implement techniques
- Monitor and improve RM program
Risk identification
The process whereby the RM professional becomes aware of risks in the HC environment that constitute potential loss exposures for the institution
Incident reporting
Process in which employees report accidents and occurrences not consistent with normal operating routines or expected outcomes
Risk analysis
The process of determining the potential severity of the loss associated with an identified risk and the probability that such a loss will occur
Risk appetite
The amount and type of risk that an organisation is willing to take in order to meet their strategic objectives
Risk =
Impact + Likelihood
