Research Articles Base: Risk Management In Healthcare

Risk Assessment Patient Care and Safety

Risk Assessment: Patient Care and Safety 
200%;font-family:Arial;color:black">Introduction             The phrase “health care” is widely associated to the entire health care industry wherein nurses deliver health care. It has been emphasized that the entire health care system is responsible for the patients’ safety. In addition, this responsibility of patient safety is of great importance be it in a hospital, in the home, in a long-term care facility, in offices of physicians, in educational settings, even in the marketplace or in the industries or anywhere that a nurse provides patient care or patient support (Cummins, 2002).             Patient safety does not only involve nurses in general, but extends to the whole medical system which includes physicians, patient care team members, administrators, pharmacists and to all people who come in contact with patients or work to maintain the health care system environment (Cummins, 2005). The health care system in one complex model which must be characterized by extraordinary demands on recognizing errors and consequently providing certain solutions to prevent such errors. In addition, it must also involve extraordinary communication, transparent error policy, individual honesty and identification of the nurse’s responsibilities and duties to patients, to other nurses and to improving the health care system (Cummins, 2002).             The current health care system has a culture of tolerance for errors.  This actually means that committing an error seems to be okay. They have this “Omerta” type code of silence wherein professionals are discouraged to speak of situations where errors occur. According to Cummins (2002), the health care system’s reaction to error has been reactive instead of proactive. Tolerance, silence and proactive policy has allowed the culture accept error. But since the public expects the health care system to be perfect, the whole system must be as much as possible safe and strong and error occurrence must not be tolerated. This essay has been made in relation to health care and safety of patients. This essay mainly focuses on risk assessment wherein risk assessment is defined, analyzed and evaluated in terms of one aspect of health care of a patient. In addition, the essay will undertake a literature review relating to the chosen aspect for care evaluation. How the chosen aspect of health care will influence the quality of nursing care and the patient will also be demonstrated as well as how the whole content of the essay might influence future practice of nurses. 
200%;font-family:Arial;color:black">Understanding and Managing Risk             Risk is defined by the National Patient Safety Agency (2005) as the “combination of likelihood and consequence of hazards being realized.”  Hazards are any “situation with the potential to cause harm” (National Patient Safety Agency, 2005). In simpler terms, risk in the chance or the probability that something will happen that might damage or ruin a project (Martin, 2002). Many risks can actually be foreseen. One might feel that risk management is simply common sense. However, there will be lapses if risks are not thought of carefully. Risk management is useful as some risks are not easy to predict. Risk management is one way of planning sensibly and practically in order to lessen disruption through the provision of measures that will respond to the most probable and most damaging risks if not prevented. There are several reasons as to why there are risks. Sources of risk may be physical, technical, labor, political/social and liability. According to Martin (2002), there are four stages upon risk management. The first stage is the identification of the risk. It involves the identification of hazards that will probably affect the system and the documentation of the characteristics of the risk. The second stage is the impact assessment in which the risks are evaluated and assessed in terms of possible outcomes and potential impact. The third stage is the developing of plans that will reduce the impact of the most probable risks and ensure that these plans are implemented when necessary. The final stage is the ensuring of risks that they are kept in constant review and that the suitable plans are made if there are changes in the type and chances of impact (Martin, 2002). Patient Safety Risk Assessment Risk assessment has become a widely accepted tool in the field of medicine (Fingeret, 2005). Using risk assessment in health care will allow nurses and medical staff to take batter care for their patients.  According to the National Patient Safety Agency (2005), patient safety risk assessments are “careful examinations of systems to identify factors that could potentially cause or contribute to patient harm.” Harm, as defined by the National Patient Safety (2005), may be injury, suffering, disability or even death. Patient safety risk assessments are used to facilitate decisions as to whether sufficient safety measures are being undertaken to ensure timely and safer provision of care or if further precautions are necessitated to prevent harm. The goal of the patient safety risk assessment is to ensure the patients’ safety as much as possible, making sure that they are not harmed by the actions of the of hospital staff and unsafe conditions which can result in complications, infections, longer hospital stays and unnecessary pain and suffering for both the patient and their relatives. The whole process of risk assessment seeks to respond the four simple questions:  “What can go wrong?”; “How bad?”; “How often?” and “Is there a need for action?” Please Refer to figure 1 for the outline of the four questions. src=”new_page_1_files/image002.jpg” v:shapes=”_x0000_s1025″> Figure 1: Outline of the Four Questions in Patient Safety Risk Assessment Source: http://www.npsa.nhs.uk/site/media/documents/948_HaN%20guide.pdf As the hazard is recognized, one must decide upon the significance of the hazard and if the suitable and sufficient contingencies are in place to make sure that the risk will be efficiently minimized or lessened (National Patient Safety Agency, 2005). Cardiovascular disease             Cardiovascular disease, principally heart disease and stroke is one of the leading causes of death in the world regardless of gender and racial and ethnic groups. It is a class of diseases that involves the heart and/or blood vessels (arteries and veins). Statistics show that over 50 million Americans have cardiovascular problems and other Western countries are currently facing high and rising rates of cardiovascular disease. In the United States and most European countries, it has been reported that cardiovascular diseases are the number one causes of death.             Various risk factors of cardiovascular disease include the following: age, Diabetes mellitus, Hypercholesterolemia, tobacco smoking, higher fibrinogen and PAI-1 blood concentrations, elevated homocysteine, high blood pressure, obesity, genetic factors or family history of cardiovascular disease, physical inactivity and the male sex. It is important to note that even though there is higher rate for men to have cardiovascular diseases compared to women, women also face cardiovascular disease as a number one health problem in highly industrialized countries as after menopause, risk for women increases to the rate the same for men.  Health Risk Assessment and its Development             The development of the health risk assessment as a clinical tool for the practice and field of prospective medicine has been widely used in worksite health promotion programs in order to identify and recognize cardiac and other risk factors and to plan the necessary preventive measures. A new technique has been developed to collect and analyze individual risk for specific health outcomes. This new technique is called Health Risk Assessment or Health Risk Appraisal (Zimmerman & Horton-La Forge, 1996).              According to Zimmerman and Horton-La Forge (1996), the health risk assessment basically constitutes a list of questions related to an individual’s basic behavior, demography, health history, biometry (height, weight, blood pressure and cholesterol levels). A computerized system is used to score the data, estimate the risks for specific outcomes and produce personalized feedback results for respondents. The individual results are a summary of changeable risks and suggested preventive measures (Zimmerman & Horton-La Forge, 1996).             The health risk assessment was originally introduced by Robbins and Hall as a tool that is supposedly used in clinical practice of prospective medicine; however, it has expanded as a component of worksite, university and community-based health promotion programs. In addition, a national survey published in 1989 showed that health risk assessment activities were presented in nearly about one third of all worksites and at two thirds of large worksites in the United States. Accordingly, the health risk assessments were usually used for needs assessment, health education, or as a first stage toward enrollment in follow-up health promotion and disease prevention programs (Zimmerman & Horton-La Forge, 1996). Health risk assessment in suitably viewed as a tool to increase awareness and create a “teachable moment,” an effective approach to organize and prioritize health information which may be individual or group education, and a tool for “triaging” individuals to suitable and appropriate follow-up intervention programs (Zimmerman & Horton-La Forge, 1996). Patient Care with Cardiovascular Disease             Caring for a patient with cardiovascular disease involves reducing the patients’ risk factors for the disease. As a nurse, you have to help your patient in terms of the sorts of diet that he/she will take, his/her physical activity as well as weight management. As a nurse, one must be aware of the medical history of his/her patient, in addition to the data concerning the risk factors of cardiovascular disease.             Nurses may as well use the health risk assessment to be able to be able to identify the risk factors of his/her patient. Upon knowing the risk factors of his patient, the nurse can evaluate and assess the condition and the status of his patient. Zimmerman and Horton-La Forge (1996) notes that the health care system attempts to attain integration and coordination across the continuum of care. Consequently, it requires necessary tools to identify the prevention opportunities inside and outside the acute care setting. The traditional technique to recount prevention strategies is divided into three major categories: primary prevention, secondary prevention and tertiary prevention. According to Zimmerman and Horton-La Forge (1996), primary prevention strategy involves on keeping people healthy such as health education programs and the like. Secondary prevention, however, recognizes the potential health problems at an early and more treatable stage. Meanwhile, the tertiary prevention is concerned more on patient education for the individual diagnosed with an acute or chronic condition such as a cardiovascular disease. As a nurse, one must be aware of these prevention strategies to implement on their patients. Substantial educational background and experience is needed. As mentioned earlier, wide knowledge on the risk factors of the nurse’s patient will be helpful in identifying which prevention strategy is to be implemented. If patient is not yet identified with potential health problems, nurses are to ensure the health of their patient, keeping them healthy by means of nutritional education, physical fitness, stress management and safety programs. Moreover, they must also identify and encourage alteration of behavioral risk factors such as inactivity, poor nutrition practices and unsafe driving practices (Zimmerman & Horton-La Forge, 1996). If patient is already identified with a potential health problem but still at an early stage, as nurses, they must conduct the secondary prevention strategy such as screening on blood pressure, cholesterol and mammography. Accordingly, these screenings are performed inside and outside the acute care setting (Primary prevention strategy is conducted outside acute care setting.) (Zimmerman & Horton-La Forge, 1996). Individuals diagnosed with an acute or chronic illness required the use the tertiary prevention strategy. Tertiary prevention is classified in an acute care setting and such prevention strategies include cardiac rehabilitation, diabetes management and hypertension control programs.  Identifying Risks in Patient Care             The whole process of patient care is usually involved and attached with risks. According to Ray (1995), the management of the process of patient care has four key components namely physician decision support, utilization management, consultations and education. Some of the risk in patient care may be derived from these key components. However, they are only risks of small impact to the safety of the patient. Still, they are risks that need to be kept in constant review and be provided with appropriate plans that will help reduce such risks.             One of the central concerns in patient care is the safety of their patients. Consequently, health care providers, nurses in particular, must be responsible for the health and safety of their patients. One of the greatest risks in health care management is errors committed by the health care providers which can result to harm to the patient. This harm may be injury, suffering, disability and even death. Health care providers are supposed to care and ensure the safety and health of their patients, not harm them. In addition, according to statistics, the health care system has developed a culture that tolerates errors to occur which is wrong. Because in the world of health care, they are basically involved in saving the lives of people. And there should be no room for errors that might cause harm to the patient. Therefore, errors should altogether not be tolerated in the health care system. Errors should not be okay. As health care providers, one must aim for perfection. In addition, the current health care system also has the “Omerta” type code of silence. Medical professionals are discouraged to talk about situations wherein actual errors occur. This has made the health care system reactive rather than proactive. If events are to occur wherein some of the medical staff commits errors, this should be shared between the medical personnel in order for assessment and lessening the probability that such error will occur again. Health care system should be characterized by extraordinary communication, transparent error policy, individual truthfulness and recognition of a health care provider’s responsibilities and duties to their patients, to other nurses and to the improvement of the whole health care system. Conclusions             Society is more and more attacked and bombarded with the consequences of modern medical treatment (Zalumas, 1995). Nevertheless, the work of a nurse is never change. It still focuses primarily on the safety and care for the patient. Przymusinski (2003) once said that nursing is humanistic profession. Nurses care and strive to save lives and if they can’t, nurses provide dignity until the moment of death arrives.             Nursing and health care are associated in such ways that it cannot be separated. It is the nurse’s job and responsibility to provide care and safety for the patient. Upon the conception of this essay, one can assess various aspects in nursing health care that certainly needs to be modified such as tolerance, silence and proactive policy which somehow breeds a culture to accept error.             Modifying this aspect in the health care system is the first step for change. It will improve patient safety and care. Nurses will be able to deliver the necessary requirements needed in health care. How to modify these aspects of health care will start by the implementation of change. It needs to be modified because as mentioned earlier, there should be no room for errors in the health care system. Thus, there is a need for aiming for perfection as the lives of the nurses’ patients are in their hands. The nurses and the medical staff have the opportunity to play as gods by holding the lives of their patients.             The modification of the health care system will apply to all nurses in general. The whole culture for tolerance of errors must indeed be stopped. In addition, there should be extraordinary communication between the medical staff, including nurses, physicians, administrators, pharmacists and basically all people whose work involves patient safety and care and maintains the environment of the health care system.             I repeat, there should also be a transparent error policy in the health care system, as well as truthfulness and recognition of a nurse’s responsibilities and duties to their patients and to other nurses, too.  With this, the whole health care system will be improved and be able to bring out and provide the needs of their patients.             Upon concluding this essay, as a nurse, I will strive hard to achieve perfection if the nursing profession. In order to bring out and provide an ideal patient care and safety, certain aspects in the nursing practice will also be greatly improved such as accuracy of patient identification, efficiency in communication among other medical staff, safety of using high-alert medications and of using infusion pumps and clinical alarm systems. Moreover, there should be elimination of wrong-site, wrong-patient and wrong-procedure surgery as well as lessening the risks of health-care acquires infections. Credit:ivythesis.typepad.com

Risk Assessment Patient Care and Safety

Risk Assessment: Patient Care and Safety Introduction The phrase “health care” is widely associated to the entire health care ...

Improving Quality in Health care Services in PHCs: Task and Risk Management

George Foundation: PHC Project Improving Quality in Health care Services in PHCs Task and Risk Management Quality has been a topic of attention in American health care since the early years of this century (Donabedian, 1989). Although quality has not been neglected in the intervening years, the focus on quality is a fairly recent phenomenon, beginning in the late 1980s (O’Leary and Walker, 1994). Since then, quality has become a front-and-center issue for providers, payers, and patients. One of the largest influences on the current environment is the growth of quality-management programs, which began to diffuse after World War II in the industrial sector (Laffel and Blumenthal, 1989). During the 1980s, the focus on quality spread beyond the shop floor to the upper echelons of management in manufacturing and white collar businesses (Gehani, 1993). Concerns about the growth of health care costs and rising utilization also spurred interest in quality as a means of controlling spending growth and improving service (O’Leary and Walker, 1994). The article by Burner and Waldo (1995) in this issue suggests that overall health care spending growth may be slowing somewhat, but still keeps the United States on its long-term, trajectory of devoting increasing shares of the Nation’s output to health care. In addition, the rising number of uninsured, the rapid acceleration of government health spending, and the sheer economic force of the health care sector have stimulated an interest in quality as a way to control costs and increase access to care (Teisberg, Porter, and Brown, 1994). Employers, providers, governments, and consumers are becoming more vocal about their opposition to paying more for health care, facing restricted access to care, or receiving less appropriate care. Public payers in particular are insistent on the quality and accountability of the services they finance (Lansky, Butler, and Waller, 1993). This has brought quality concepts to the forefront of health care, in terms of ensuring value for the dollar spent and customer satisfaction, suggesting the relationship between quality and system efficiency. Dynamic changes in the health care industry also have contributed to the rise of the health care quality movement. Continued mergers, consolidation of health plans, and growth of managed-care arrangements have created a highly competitive environment. In order to compete and survive, health plans must provide high-quality, low-cost care (Furse et al., 1994). At the same time, the changes in health care markets, providers, and sites of care also present other kinds of quality issues. For example, rapid emergence of new health care markets creates opportunities for entrance of entities, including payers, with limited skills or firms that are too overextended in startup phases to provide appropriate, high-quality care (Teisberg, Porter, and Brown, 1994).   George Foundation, in example, attempts to implement a project on the improvement of the quality healthcare services in the PHCs in India. Implementing a plan is not an easy job. There such things to consider before a project can be implemented. A project plan should first be done. In addition, tasks and risks of the project initiation to project implementation should be carefully identified, assessed and mitigate appropriately. Below is the list of the tasks that George Foundation is to do when starting their project. Tasks <li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Infrastructure Restoration</li> Ø      furbish existing PHCs Ø      connection of electricity <li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Staffing</li> Ø      Hiring of staff including paramedics, trained nurse or physician’s assistant, laboratory technician, and qualified medical doctors Ø      Training of staff <li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Technology enhancement</li> Ø      Installation of solar panels or diesel generators Ø      Installation of software system called EDPS2000 on computers <li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Capability Testing</li> Ø      Testing on-site medical laboratory capability <li class="MsoNormal" style="text-align: justify; line-height: 200%"> 	Health Education</li> Ø      Posters and audio-visual demonstrations Ø      Community programs 6. Diagnostic capability enhancement Risk Management             Risks are defined as the possibility of loss or injury, a dangerous element or factor, or a degree of probability of loss (Webster’s New Collegiate Dictionary, 1980). Risks imply an element of action or process that might result in negative result. According to Allen (2004), risks arise because of limited information and uncertainty about the future.             Risk management involves identifying all risks faced by a company, analyzing and quantifying these risks, and then determining the optimal means of limiting, absorbing, or transferring these risks. Managing risk effectively, especially with major transportation projects, requires implementing a structured, well-thought-out risk management plan (Allen, 2004). Although managers cannot eliminate risk entirely, they can minimize uncertainties by monitoring a project’s risks, developing strategies to mitigate them, and establishing fallback positions and contingencies. Risk management also can lead to more creative and efficient management techniques.              Table 1. Risks Identified, Assessed and Mitigation Strategy of the Project 			Risk 			Risk Level 			L/M/H 			Likelihood of Event 			Mitigation Strategy 		Project Size   		  		  		Person Hours 		H: 		Over 20,000 Certainty 		Assigned Project Manager, engaged 		consultant, comprehensive project management approach and communications 		plan 		Estimated Project Schedule 		H: Over 12 months Certainty 		Created comprehensive project timeline 		with frequent baseline reviews 		Team Size at Peak 		H: 		Over 15 members Certainty 		Comprehensive communications plan, 		frequent meetings, tight project management oversight 		Number of Interfaces to Existing 		Systems Affected 		H: 		Over 3 Certainty 		Develop interface control document 		immediately Project 		Definition 		    		  		Narrow Knowledge Level of Users M: 		Knowledgeable of user area only Likely 		Assigned Project Manager(s) to assess 		global implications 		Available documentation clouds 		establishment of baseline M: 		More than 75% complete/current Likely 		Balance of information to be gathered 		by consultant 		Project Scope Creep L: 		Scope generally defined, subject to revision Unlikely 		 		Scope intially defined in project plan, 		reviewed monthly by three groups (Project Manager and Steering 		Committee) to prevent undetected scope creep  		Consultant Project Deliverables unclear L: 		Well defined Unlikely 		Included in project plan, subject to 		amendment  		Vendor Project Deliverables M: 		Estimated, not clearly defined Somewhat likely 		Included in project plan, subject to 		amendment  		  		  		Cost Estimates Unrealistic L: 		Thoroughly predicted by industry experts using proven practices to 15% 		margin of error Unlikely 		Included in project plan, subject to 		amendment as new details regarding project scope are revealed  		Timeline Estimates Unrealistic M: 		Timeline assumes no derailment Somewhat likely 		Timeline reviewed monthly by three 		groups (Project Manager and Steering Committee) to prevent undetected 		timeline departures 		  		  		Number of Team Members Unknowledgeable 		of Business L: 		Team well versed in business operations impacted by technology 		 Unlikely 		Project Manager and consultant to 		identify knowledge gaps and provide training, as necessary Project 		Leadership     		  		Steering Committee existence 		 L: 		Identified and enthusiastic Unlikely Frequently seek 		feedback to ensure continued support 		Absence of Commitment Level/Attitude of 		Management L: 		Understands value & supports project Unlikely  Frequently seek 		feedback to ensure continued support 		Absence of Commitment Level/Attitude of 		Users L: 		Understands value & supports project Unlikely  Frequently seek 		feedback to ensure continued support 		Absence of Mid-Management Commitment L: 		Most understand value & support project Unlikely Frequently seek 		feedback to ensure continued support  Project 		Staffing     		  		Project Team Availability M: 		Distributed team makes availability questionable Somewhat likely Continuous review 		of project momentum by all levels. Consultant to identify any impacts 		caused by unavailability. If necessary, increase committmment by 		participants to full time status 		Physical Location of Team prevents 		effective management M: 		Team is dispersed among several sites Likely Use of Intranet 		project website, comprehensive Communications Plan 		Project Team’s Shared Work Experience 		creates poor working relationship M: 		Some have worked together before Somewhat likely Comprehensive 		Communications Plan 		Weak User Participation on Project Team L: 		Users are part-time team members Unlikely User Group 		Participants coordinated by full time employee Project 		Management     		  		Procurement 		Methodology Used foreign to team L: 		Procurement Methodology familiar to team Unlikely N/A  		Change Management Procedures undefined L: 		Well-defined Unlikely N/A  		Quality Management Procedures unclear L: 		Well-defined and accepted Unlikely N/A  Software Vendor 		 		    		  		Number of Times Team Has Done Prior 		Work with Vendor Creates Foreign Relationship H: 		Never Certainty A comprehensive 		vendor evaluation and selection process (incorporated into Project Plan) 		will be employed to predict and define the relationship between the 		department and the vendor 		Team’s Lack of Knowledge of Package M: 		Conceptual understanding Somewhat likely Comprehensive 		vendor evaluation and selection process incorporated into Project Plan 		will assist the team in better understanding the package offering(s)     		Poor Functional Match of Package to 		Initial System Requirements L: 		Minimal customization required Unlikely  Although a package 		has not yet been selected, the Consultant has compared the initial 		requirements with available functionality and determined that a 		functional match to the initial requirements is very likely. Vendor 		selection will be based, in part, on how well the proposed application 		matches defined functional specifications. 		Team’s Involvement in Package Selection 		Impacts Success of Implementation L: 		High involvement in selection Unlikely Comprehensive 		vendor evaluation and selection process incorporated into Project Plan Credit:ivythesis.typepad.com

Improving Quality in Health care Services in PHCs: Task and Risk Management

George Foundation: PHC Project Improving Quality in Health care Services in PHCs Task and Risk Management Quality has been a topic of a...

Sample Research Study on RISK MANAGEMENT FOR HOSPITALS

RISK MANAGEMENT FOR HOSPITALS   INTRODUCTION               Increasingly, with the advent of new technology which provides individuals with vast information, patients have developed an increasing bulk of expectations regarding their care at hospitals. Along with this increase in patient’s expectations is also the increase in responsibilities, legal disputes, costs of risk transfers, and the attention of public opinion regarding hospitals, patient care and health care in general. This also paves way for the increasing need for risk management within health care organizations. But it has to be noted that risk management in hospitals is very complex. Take for example, when faced with events like the birth of a baby whose life is in danger or the abrupt awakening of a confused elderly person in a hospital bed, health care professionals in hospitals are more likely to deal directly with human suffering than their colleagues in other organizations. The risks faced by health care organizations are therefore numerous, intricate, and inter-linked. Because of this, risk management must be rational, systematic, and integrated. The aim of this paper is to discuss risk management in hospitals in the United States.     BODY   Risk management is defined as a planned and systematic process to reduce and/or eliminate the probability that losses will occur in a specific setting. It consists of three distinct, yet interrelated areas: 1) risk identification and loss prevention; 2) loss reduction; and 3) risk financing. To be most effective in the hospital setting, risk management involves a multidisciplinary and proactive approach (Yale School of Medicine, 2006). Risk is one of today’s hottest topics. Shareholders, for instance, have organized round company crises and forced a more strategic approach to their causes. The result was risk management, which is a mating of identity politics and corporate social responsibility, and has dramatically reduced many risks: excellent examples are transport and workplaces that are now an order of magnitude safer than twenty years ago (Coleman, 2006). However, risk management is no longer confined to business organizations, as one would probably think. Risk management has also become a hot topic in health care organizations. The business of healthcare is becoming riskier. Capitation is increasing the risk providers must assume; expansion of the populations they cover makes health-related events (and the cost) more difficult to predict: and competition among providers is eroding operating margins, making the effect of risk on profitability more pronounced. At the same time, the management of risk is becoming more complex as the delivery of healthcare becomes ever more fragmented. Knowing up front what medical conditions and treatment situations are most likely to result in medical errors or problems–and consequent lawsuits–is helping hospitals improve quality of care and save lots of money. Gone are the years when tax-exempt hospitals and health systems could obtain lowest-cost capital simply by issuing “plain vanilla,” fixed-rate 30-year bonds and essentially forget about the bonds until they matured. To optimize the opportunities created by changing interest rates, yield curves, financial products, and increasingly complex organizational financial structures, today’s healthcare financial executives must manage, with equal attentiveness, both the investment/asset and debt/liability sides of their balance sheet (McKeown, 2006). Emerging risks’ are usually understood to include anything unexpected that can cause losses. Old technologies can create new liabilities, as is the case with silica and mixed dust, the “new asbestos.” Known drugs that have been widely used, such as Vioxx and Celebrex, are now being questioned or recalled, triggering multiple lawsuits. Likewise, new technologies bring new areas of risk-for instance, genetically modified organisms or nanotechnology, the consequences of which have yet to be fully understood (Verhaegen, 2005). The goals of the overall risk management program are to identify areas of actual or potential risk, prevent, as much as possible, injuries to patients, visitors and employees, and to prevent or limit financial loss to the hospital and its staff. Financial loss can occur in a number of ways. From a risk management perspective, the primary concerns are those financial losses associated with the inherent risks that exist in providing health care services, which can result in a patient instituting a medical malpractice claim or lawsuit against the hospital and/or a health care provider (Yale School of Medicine, 2006). Risk management in practice typically involves some mixture of anticipation-“looking forwards”, and resilience-“bouncing back” (Hood & Jones, 1996). Misjudging risk can be very costly to business. Human intuition and past experience are no longer adequate guideposts for handling new exposures. Risks are emerging at an increasing pace and across a broader spectrum-from global Internet liability and hidden construction defects to ever-present terrorism threats (Verhaegen, 2005). The active management of capital structure requires that financial executives determine the optimal mix of debt and equity financing, traditional versus nontraditional financing employed, and the appropriate levels of fixed rate and variable rate debt. Financing options available to tax-exempt healthcare organizations, including interest rate swaps and other derivatives, have increased dramatically in recent years. These mechanisms can significantly decrease an organization’s all-in cost of capital without requiring the issuance of additional debt (McKeown, 2006). A comprehensive policy that addresses the strategic issuance and management of debt and derivatives can provide a roadmap to guide a hospital or health system toward achieving increased capital access, added financial flexibility, and the lowest possible cost of capital, all within board-approved risk guidelines (McKeown, 2006). Measuring risk for a return to the organization is a revolutionary new approach. Risk managers, C-suite leaders and consultants agree: the business of risk management has changed radically in recent years. The days when the job simply meant buying a risk transfer policy for a competitive price are over. Every major aspect of an organization–its finances, its operations, its products and its human capital–either impacts or is impacted by risk, and risk management is becoming a key strategic line item on the balance sheets of organizations large and small (Morris, 2005). How well an organization handles today’s ever-increasing complexities of risk–especially compared to other organizations in its space–is about much more than the simple mitigation of loss. When risk is managed and reduced, the results are not only internal financial and operational advantages, but a measurable competitive advantage that affects every area of the company, from the costs of risk in the marketplace, to employee morale and retention, to the company’s position in the marketplace. Today’s complex challenges require a new approach. With the right system, process and tools, risk can be fundamentally turned around from its traditional role as a “necessary evil” of business to a positive center of opportunity and gain for organizations of every size (Morris, 2005). Organizations in every industry can also apply and benefit from a return-on-risk approach. For example, a hospital that improves risk management in clinical operations will be able to see measurable improvements in medical outcomes as a result of these enhancements. Better outcomes will, in turn, result in reductions in medical liability costs, improved nurse retention, enhanced patient safety and patient satisfaction, lower workers compensation costs and a stronger reputation in the community (Morris, 2005). A hypothetical example of a hospital that is especially vulnerable to adverse effects of risk can be used to illustrate how return on risk can deliver on its promise. Suppose that a medical error in the operating room results in a million malpractice case. When the verdict is handed down, the hospital can expect a huge malpractice insurance premium hike. But with a return-on-risk approach, that hospital has not just been waiting for the proverbial shoe to drop. Immediately after the incident, a systems-wide analysis of the risk drivers behind the incident would begin. A team including representatives of finance, clinical care, marketing and human resources would be assigned to evaluate both the potential causes of the incident and the risk implications for patient care, for finance, for marketing and for risk and retention of staff. Knowing the hazards of a certain situation is the starting point of every process of risk management. It is also the most important since every succeeding phase of the risk management program depend on it. Hazards must therefore first be detected; then possible risk scenarios analyzed and assessed in reference to past and present history. Once this identification and analysis is completed, the team would do three things. First, the data would be converted into benchmarks that could be measured against national and local standards. Key benchmarks for in this industry, which for this industry would include mortality rates, length of stay for various diagnoses and standards to prevent infections. Such data could be obtained through various organizations, including state and federal government, employer watchdog groups, insurers, regulators and consultants. Also, new resources such as clearing houses make public and private data resources more readily available for benchmarking, cost analysis and operations improvement, and compile and integrate current medical outcomes data with traditional historical claims data and professional liability studies. These major data resources provide a multi-dimensional window on risk and improvement tracking that has never been available to organizations of any size but is now available to all. Much of this data is available through a wide array of online, self-service and pre-packaged tools. Second, the team takes this benchmarked data and compares it to other hospitals nationwide. This comparison is converted into an index that measures the organization’s relative risk compared to its peers. An index greater than one, for example, indicates a less-than-average risk compared to its peers. An index less than one means a greater-than-average risk. Third, the team develops a plan to address those areas where the hospital is vulnerable and where improvement can occur. Among the areas that may be identified for remediation are: education and training of staff; the use of technology during the operation to reduce risk; the use of hospitalists (physicians who specialize in hospital care) to manage the patients pre- and post-surgery to standardize and enhance the level of care these patients receive; and automated systems to manage medication dosage. After implementation of that plan, the measurement process occurs again. This time, the hospital’s ranking should indicate substantial improvement due to the enhanced ability to manage risk. The facility’s ability to better manage risk is measured in the hospital’s ability to produce superior medical outcomes–to produce a superior product. Effective risk management does not happen automatically. Managers who aspire to enable their organizations to be good at managing risk must recognize that the road to effective risk management is long, twisting, and occasionally hazardous. Beginning the journey is not difficult. It may be triggered by a one-page directive issued by the chief operating officer following a small disaster, exhorting the organization to implement good risk management practices. But after the initial hoopla, when the confetti has settled and the noisemakers have been thrown away, the journey toward effective risk management grows difficult (Frame, 2003). An important rationale behind risk analysis is to avoid surprises. You may not be able to stop the hurricane that is rushing toward your home, but if you know that it is on its way and will reach your area in six hours, you can prepare to deal with it. If you are unaware of its impending arrival, you will be caught unprepared, and this may have serious consequences for your home and personal safety. The key element in the success of the risk management program in preventing and reducing these particular claims and associated financial losses, is the participation of physicians, nurses, other health care providers and hospital employees in implementing effective risk management strategies. Each individual must be committed to reducing risks (Yale School of Medicine, 2006). Risk management should become the central point to gather information in the hospital and provide feedback to the hospital’s safety committee on compliance with state and federal regulations. Risk management should not just be a department in a hospital, it is an understanding throughout the organization from the top of the organizational structure to the bottom (Bradford, 1997). To foster that understanding, emphasis is placed on educating employees about risk management and their role in helping control losses. The education starts when an employee comes to work at the facility. On a monthly basis, nurses new to the facility and those who want a risk management update on issues such as claims and legal issues are brought together for a meeting. The concept here has been to involve all employees in the risk management program. It doesn’t get done by itself. Everyone within the hospital should help set direction, coordinate and plan.   CONCLUSION   Ironically, today’s risk-filled world demands that organizations develop good capabilities to handle risk, even as chaos and complexity make it difficult to implement effective risk management policies. At a minimum, they need to implement a structured approach to managing risk. Efforts to identify risk, assess its impacts, prepare to handle it, and control it must be carried out explicitly. While the employment of formal risk management processes may not allow you to estimate the likelihood of specific risk events accurately, it will increase the risk sensitivity of managers and employees and reduce the number and impact of the surprises the organization is likely to encounter. Leaders within organizations must act ethically while working to resolve legal dilemmas in ways that are beneficial to the organization’s finances and public image. Credit:ivythesis.typepad.com

Sample Research Study on RISK MANAGEMENT FOR HOSPITALS

RISK MANAGEMENT FOR HOSPITALS INTRODUCTION Increasingly, with the advent of new technology which provides individuals ...

Action Plan on Health Care Providers

Action Plan on Health Care Providers

Credit:ivythesis.typepad.com

Contribute to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies

GIBBS’ REFLECTION CYCLE A. Description Paida is 50 years old lives alone and has a history of bipolar disorder. Paida when she is not well pulls herself at risk by inviting male strangers into her home whom she then entices into sexual relations. Paida also tends to withdraw large amounts of money that she gives away to those hosting her at home; this of course puts Paida at high risk of abuse.  and  (2004) state that common symptoms of maniac are usually sexually inappropriateness, pressured speech and flight of ideas. A further behavioural manifestation is termed significant indulgence in sensual activities that can be related with painful results; for instance, sexual immorality ( 2000). This unexplainable negligence of planning with regards to sexual behaviour puts the sexual health of individuals afflicted with mental disorders in peril, with possibly catastrophic outcomes (. 1997). These outcomes include the possibility of contracting STDs and unwanted pregnancy. The author thinks that it is not enough to cite a particular experience in order to gain significant learning. If the process of reflection is neglected in this experience it might easily be forgotten or the lessons that can be derived from it can be lost (. 1996). It is from the observation and perceptions that comes from this reflection that evaluations or ideas can be acquired. And it is evaluations which make it possible for new instances to be discussed properly. Likewise, if it is a purpose or an objective that learning be used to alter behaviour, it is not enough to understand new ideas and formulate fresh evaluations. This understanding must be further evaluated in fresh instances (, 1994). One must learn to integrate theory and action through the process of preparing for that action, executing it, and then having a process of reflection, examining what transpires back to the theory. It is not sufficient only to perform something, and neither is it sufficient only by thinking. Doing both at the same time is also not enough. Gaining significant learning from experience must include the integration between the performance and the analysis. The six-stage model of learning by doing and thinking is discussed in detail in that of  (1993). Some experts have established various models in order to provide pertinent explanations regarding how individuals learn from experience, but all of them possess the critical factors of  model which is itself like  derived from . Learning from experience includes six stages, which follow each other in a cycle. According to  (1997), reflective practice is ‘Potentially both a way of learning and a mode of survival and development once formal education ceases’.  (1997) refers to reflective practice as ‘thoughtful practice’, performing actions that are based on the known theory and monitoring consciously these actions, questions why the outcome occur and so identifying a widening legitimate knowledge base for the individual. If those involved in the heath acre arena are to gain knowledge and move their practice forward then it is suggested that reflective practice must play an active role in the development of their practice. The development of reflection assists the individual to gain self-awareness, insight, ability to express emotion and problem solving skills, which are all desirable for professional growth according to  (1995) The reflective module I chose to use as a tool to reflect on my experience of a hospital placement was  (1998) I found this more appropriate and uncomplicated to follow. It also follows six stopping points that I will use as a guide to fully reflect on this incident. A potential negative point with utilizing the experiential cycle in this manner is that learners are not able to establish a solid basis for evaluations to fresh dilemmas, but have to discuss every new event as if it were unique (, 1992). The following step of development of this course will include finding and using a standard model of the communication process to create a solid foundation for the evaluation of reflections based on experience. This would make the learning cycle process a complete success and also supports to integrate the experience to theory, which established a comprehensive learning of the communication process as well as enhancing competence in particular events involving communication skills (, 1995). B. Feelings Communication in this incident was paramount. Upon hearing the situation I could only feel empathy for Paida as she was clearly becoming a maniac. The male strangers were acting in a non-professional manner and I felt angry at the fact that they were abusing Paida’s position. Contrary to this, there was also a feeling of gratification on my part. Reflecting in action, I knew that if I could make a dialogue with Paida, this would put me in a position where I could approach her properly and have the opportunity to examine her. I felt that this situation was not instigated by myself, but I could turn this to my advantage. I issued my feelings like these because I believed that I had to: A)   Remain in control of the situation. Being in control of that particular situation would enable me to command the respect and confidence of the public, especially my superiors. Thus, I would be able to expand my responsibilities through continuous improvement in other aspects of my profession (, 2000). B)   Gain more confidence and experience. The actions that I laid down in trying to pacify the condition of Paida were able to somehow increase my confidence and experience handling unexpected situations like that. C)   Thrive and learn in emergency cases; and D)   Answer my call of duty. Being a nurse care practitioner myself, I realized that I must not fail to help others especially in cases of emergencies. I realized that I had to be ready always. While it may be true that experiences are necessary for learning to occur, I firmly believe that learning brought about by experiences cannot make me a complete Nurse Care practitioner. I am fully aware that it is through reflecting on experiences that certain concepts and ideas can be created. And it is generalizations, which enable new situations to be tackled effectively. Similarly, if it is intended that learning should change behavior, it is not sufficient simply to learn new concepts and develop new generalizations (. 2000). This learning must be tested out in new situations. One must make the link between theory and action by planning for that action, carrying it out, and then reflecting upon it, relating what happens back to the theory. It is not sufficient only to perform something, and neither is it sufficient only by thinking. Doing both at the same time is also not enough. Gaining significant learning from experience must include the integration between the performance and the analysis. The six-stage model of learning by doing and thinking is discussed in detail in that of  (1993). Some experts have established various models in order to provide pertinent explanations regarding how individuals learn from experience, but all of them possess the critical factors of  model which is itself like  derived from . Learning from experience includes six stages, which follow each other in a cycle. Current thinking in nursing advocates the need for some nurses to be educated in ways that develop their autonomy, critical thing, sensitivity to others and their open-mindedness (, 1991). There have been many books written on this subject and each author expresses their variations in different ways. Once we have decided what reflection is we can then look at reflective practice.     Evaluation of Feelings A. Good Points The good point about my feelings was that a good opportunity presented itself to me to determine my readiness to help somebody in case of emergency. Having been neglected by a nurse care practitioner, it would be really tough to regain the trust and confidence of the patient. But as long as an opportunity like these would come along, it’s always nice to take advantage of it. B. Bad Points             The bad point about my feelings is the fact that Paida might have developed a bad image on most nurse care practitioners. Therefore, the patient might have the tendency to refrain from cooperating with me. C. Analysis Biopsychosocial Issues A. Biological Issues The real cause of the maniac syndrome of Paida was yet to be determined. Apparently, it just occurred as an end result of Paida losing sanity. It is important first to determine the main health problem that’s been bothering Paida before any specific course of action can be done. This will prevent any further damage that might occur as a result of a wrong diagnosis. The maniac syndrome of Paida obviously was only a secondary issue. The underlying health problem of Paida can be determined by determining if she had any history of diseases or conditions that can somehow be related to her getting maniac. B. Social Issues It is alarming to know that there are people like Paida who in spite of their age are still exhibiting the maniac syndromes. These people need to be guided and apprehended since their attitude poses a great danger to the lives of innocent people.   C. Psychological Issues Definitely, it is Paida who’s the one that’s more psychologically shocked than anyone else, based on the treatment she got from those male strangers who took advantage of her. She will always remember the fact that once in her lifetime, there were people who caused her so much fear and pain at a time she badly needed help. She will also somehow develop a bad impression regarding most males as a result of this bad experience. On the other hand, we, the general public, would also worry that someday, this incident might also happen to us.                 Contribute to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies     Quality assurance provides a framework for a coherent, local program of quality improvement and an opportunity to share best practice. For nurses, quality assurance will be about building upon and linking together many of the activities that they are already involved in, which help to promote and improve standards of patient care. Quality assurance involves the development of a culture and ways of working that continually improve quality, allowing good practice to be shared, lessons to be learnt from mistakes, and encouraging patient participation. For many nurses, clinical governance will afford the opportunity to formally link together and enhance existing quality improvement activities such as implementing evidence-based practice and care pathway development. Quality assurance can be divided into four key components: clinical effectiveness, human resources, professional self-regulation and risk management. Quality assurance is about doing the right thing at the right time for the right patient. It enables nurses to reflect on why they do what they do for patients and to systematically find and implement better ways of providing care. The activities involved in clinical effectiveness include finding out what is best known practice, appraising the available evidence, changing practice if necessary, and confirming through clinical audit that actual practice is consistent with best practice. The human resources component of the quality assurance framework is about ensuring that healthcare professionals have the right education, adequate training and development, skills and competencies to provide quality patient care. It is also about workforce planning and lifelong learning. Professional self-regulation protects the public as it requires registered practitioners to practice within a code of conduct and is supported by the promotion of good practice, prevention of poor practice, and intervention when practice is poor. Professional self-regulation supports the clinical governance framework by setting professional standards and guidelines that contribute to the creation of an environment in which clinical excellence will flourish. In practice, many nurses have experienced real and substantial problems with regulation. Risk management is about identifying, measuring and controlling those risks that threaten quality or performance in the delivery of patient care. Every day, nurses help patients through education, empowerment and expertise to avoid the recognized complications associated with various illnesses. This is a proactive risk management strategy that involves the recognition and identification of things that can go wrong as part of a systematic approach to patient care. Patients are empowered to respond appropriately in a risky situation. Implementation of shared quality assurance initiatives or other structures that promote autonomy, control of practice, and empowerment of nurses have been identified as key strategies to continue to improve the work environment of nurses. This could in turn improve how the nurse delivers care to the clients. In a quality assurance model, each person has an obligation to ensure that his or her skills and knowledge make a positive contribution and to work efficiently and effectively. Quality assurance is a collaborative team process in which team members share key leadership roles. Shared leadership is empowering employees to act autonomously, be decisive at the point-of-service, and create a shared vision aligned with organizational goals. Shared leadership development and autonomously practicing nurses appear to be the equation for success in delivering quality patient outcomes in today’s organized health care delivery systems. For a quality assurance model to work, the nursing leaders must develop skills that go beyond facilitating team and group decision making and assume a transformational role of disrupting the status quo, particularly in situations where evidence-based practice clearly points to a need for rapid change and improvement. Nursing leaders must translate the demand for change into a clear, understandable plan, as well as help staff members handle the chaos and uncertainty that accompany rapid change.                 REFERENCES   Credit:ivythesis.typepad.com

Contribute to public protection by creating and maintaining a safe environment of care through the use of quality assurance and risk management strategies

GIBBS’ REFLECTION CYCLE A. Description Paida is 50 years old lives alone and has a history of bipolar disorder. Paida when she is not...