Risk and Quality Management Assessment Summary

University Hospitals is a health care systems providing high-quality patient-centered medical care with a network of specialty care physicians, skilled nursing, rehabilitation services, occupation health and wellness, and managed care and insurance programs. Collaboratively working as an integrated team to improve patient care and performance. University Hospital is a large organization with many systems working together to improve overall quality of patient care. University Hospital has a board of directors that have executives to see that their decisions are carried out and that the day-to-day operations of the hospital are performed successfully, and department managers that are responsible for one type of medical or operational service within a specific department. The department manager then relies on the patient care managers to ensure that staff members are giving quality care and are complying with rules and regulations. Lastly there are the service providers, such as hands on staff that ensure the safety and health of patients.

In larger organizations, such as University, various models are employed to assure that risk is adequately managed. According to Carroll, 2009 “An effective risk management program incorporates several building block, including key structural elements, sufficient scope to coverall organizational risks, appropriate risk strategies, and written policies and procedures” (p.3). With lives in their hands, hospitals have to function very precisely, executing high-quality services every hour of every day. Risk managers need to keep up with regulations and quality management has a responsibility for compliance. Essentially the relationship between risk management and quality management is to work hand and hand to create an environment that protects the company and the patient in two separate entities. Risk management evaluation involves not only the risk management professional but also senior management, medical staff and governing board, insurers, claims managers, and legal counsel (Carroll, 2009).

Medical errors and accidents can happen at any given time especially in a larger health care organization such as University, so it is necessary to have risk management professionals to help. According to Carroll (2009) “The patient safety movement has brought numerous challenges and opportunities to risk management professionals. By collaborating with other members of the management team, risk management professionals can use these strategies to solve the ongoing challenge of medical errors” (p. 110). Patient safety has become very important to heath care organizations, government, and others, so it is important to assess the prevalence and causes of different types of events that can occur in a hospital as well as the effectiveness of different approaches that can enhance safety and patient care. The key concepts is to help with the prevention and or reduction of adverse events or incidents involving patients, employees, or the facilities as a whole.

Relevant trends and patterns become overlooked because it is never enough communication and information shared between departments. Trending and analyzing incident data keeps the health care organization one step ahead of the issues they face. Key concept of quality management include improving quality along with patient safety with plans of preventing and controlling infections, managing private information, analyzing current processes, implementation of new processes for improvement, and providing training and education for the staff to stay accredited. Accreditation in hospitals help provide high quality care, treatment, safety, and services to patients. According to Aragwal (2010) “Overall it improves risk management and risk reduction and helps organize and strengthen patient safety efforts and creates a culture of patient safety.

Not only does it enhance recruitment and staff education and development, it also assesses all aspects of management and provides education on good practices to improve business operations” (para.4). Steps the organization may take to identify and manage their risks through incident reporting, education, accurate and complete documentation, departmental coordination, prevention, correction, and handling complaints in a timely manner. Bokar (2007) stated “Through chart audits, peer reviews and other formal techniques, quality management professionals seek out instances of suboptimal care or errors that can be remedied through process improvement” (p.4). Minimizing the financial loss to the hospital through risk detection, evaluation, and prevention. Quality and efficiency are maintained by keeping employees involved in the entire process (Grant, 2010).

Prevention can be improved thro proactive risk awareness and safety programs for employees and medical staff. Corrections can be made through post- incident remedial actions that will aim at minimizing the impact of events to prevent future and similar occurrences. Education through creative and meaningful service seminars to given at orientation and annual intervals. Departmental coordination that will create an overall framework that can help department mangers work together toward for the common goal of the company to improve staff and patient safety. When handling complaints and incidents in a timely manner which would include how the events are trended and analyzed with the follow up and resolutions of complaints. Some typical risk in the organization can include not being thoroughly familiar with the risk implications of federal Medicare, Medicaid, and Employee Retirement and Income Security Act regulations.

Carroll (2009) stated “Out-of-date policies or those that no longer comply with changes in the law serve little practical purpose from an operational standpoint and pose a significant risk to the organization. Another risk could include not identifying and disciplining physicians and other health care providers who after adequate, nondiscriminatory peer review, were found to have engaged in negligent or unprofessional conduct (Carroll, 2009). Not being familiar with risk implications of Medicare, Medicaid, Employee Retirement, and Income security act regulations can lead to many violations per EMTALA. Policies must be reviewed periodically to ensure that they reflect key regulatory and practice requirements must stay reviewed at all times because if not in compliance it can cause the organizations multiple fines.

The objective of peer review is to promote patient safety through the continual monitoring of physician performance because if this is not done the organization and the physician can be held liable for any negligence. Internal factors that influence quality outcomes in the organization include leadership, lack of correct staffing levels, and no communication between departments. Ferguson, Calvert, Davie, and Fallon (2007) stated “In an era when patient safety and quality of care are a daily concern for health care professionals, it is important for nurse managers and other clinical leaders to have a repertoire of skills and interventions that can be used to motivate and engage clinical teams in risk assessment and continuous quality improvement at the level of patient care delivery” (para. 1). Without strong leadership there is no standard for the employees to look up to. Lack of staffing levels puts a strain on the quality of care that is given by the staff because they are burned out, and it also does not allow them to have the appropriate training and educational programs that will help with quality patient care.

Lack of staffing also can mean that the department may be doing certain task wrong which could cause injury to the patient or the employee. Lack of communication between departments such as risk management and quality management must learn to work together in some efforts to eliminate the possibility of an oversights in incorrect documentation that could have been prevented if both departments had more open communication with issues that occur in the organization. External factor that influence the organization’s quality outcome is patient surveys that inform the organization to analyze, review, and receive ideas on how to make improvements on its quality of care. Another external factor local market competition such as private or public health organizations impact of quality initiative and standards. Also improving the accreditation that also provides a competitive advantage in the organization that strengthens community confidence in the quality and safety of care, treatment, and services.

Three long-term goals are developing the right culture for the quality to grow in the University’s vision, gaining and retaining the correct employees to promote quality in the organization, and giving the staff the correct development tools to improve overall quality. Short-term goals improve patient quality surveys, improving departmental communications, and improving timeliness and efficiency of document recording. Three fundamental risk management policies would first include focusing on prevention, policy, and procedure. Secondly, help to assess the liability exposure to the organization and help mitigate any future loss that may arise. Lastly, reporting, identifying and implementing corrections that would help reduce risk. All of these policies would help provide great working conditions.

Three fundamental quality management policies would include having a mission statement that provides the quality values that the organizations wants to achieve. Implementing employee satisfaction surveys and leadership programs that will give the employees the right tools for the job and let the employer know what they must do to ensure employee happiness. Finally customer information feedback that would allow the organization to see if they need to improve on any services specifically. Risk management is concerned with many different issues and situations that hold the potential for liability or casualty losses for the organization. Quality management aim to design formal process improvement initiatives that target the underlying causes of events.

Risk management and quality management work together to improve performance by training the staff on quality and risk management which results in quality care and assurance that the patient is treated correctly. Risk management and quality management improvement focuses on the safety of the staff, quality of care the staff gives, and the safety of the patients to prevent financial losses to the company. Essentially the relationship between risk management and quality management is to work hand and hand to create an environment that protects the company and the patient in two separate entities.

Risk management and quality management programs and implementation are important in a hospital setting because without it the organization could suffer severely with fines, loss of revenue, and lack of growth. Large organizations such as University Hospital must have strong mission, vision, and values with the right leadership to enforce it goals. Focusing on maintaining and establishing safety and assurance of correct treatment for patients as well as staff members which are valuable to the success of the organizations growth. Collaboratively working as an integrated team to improve patient care and performance is the most important goal for the organization with the guidance of these programs.

References

Agarwal, R. (2010, May 19). A guideline for quality accreditation in hospitals. Quality Digest Bokar, Vicki. (2007). Different Roles, Same Goal:. Retrieved from http://www.ashrm.org/ashrm/education/development/monographs/Monograph.07RiskQuality.pdf Carroll, R. L. (Ed.). (2009). Risk management handbook for health care organizations (Student ed.). San Francisco, CA: Jossey-Bass.

Ferguson, L., Calvert, J., Davie, M., Fallon, M., & al, e. (2007). Clinical
leadership: Using observations of care to focus risk management and quality improvement activities in the clinical setting. Contemporary Nurse : A Journal for the Australian Nursing Profession, 24(2), 212-24. Retrieved from http://search.proquest.com/docview/203166638?accountid=35812 Grant, W. (2010, January 20). Employee involvement boosts quality. Quality Digest