Published on May 25, 2009
Hospital Risk Management : Hospital Risk Management Md. Kamal Hussain BIT, MBA/MHA, DTQM, AMAHA, PhD (Due) Consultant- Hospital Planning & Quality Accreditation Speciality : Speciality Joint Commission International Canadian Accreditation ACHS NABH India CIBAHI, KSA NABL CAP ISO 9000:2008 What is risk management? : What is risk management? Identifying and analyzing situations or practices that create financial risk for the hospital and medical staff. Develop strategies to elimintae,avoid or minimize the risks. Slide 5: To manage risks to the quality of services provided & the safety of patients, their carers & visitors. To manage risks to staff & subsequent risks to service quality. To manage risk of failing to meet national & local priority targets To manage risks to the efficiency of services. To manage risks to the reputation of the hospital Risk management aims Slide 6: To identify the major sources of risks to hospital, staff & visitors. Develop regular statistical & qualitative risk management reports Establish mechanisms to maintain & develop structures & processes for a cohesive approach to the management of clinical & non clinical risk. Conduct operational reviews of departments to identify deficiencies & potential areas for improvement. Risk management plan aims Slide 7: Recognition & acknowledgement of risks to patient safety & medical/health errors with a focus on improving processes & systems. Initiation of actions that reduce these risks Reporting the findings & action taken to improve processes & systems. Minimizing of individual blame or retribution for involvement in a medical health care errors. Organizational learning about medical health care errors. Sharing of acknowledgment to effect behavioral changes to minimize risk to patients. Risk management objectives Slide 8: Slide 9: Access to care & continuity of care Patient & family rights Assessment of patient Care of patients Patients & family education Quality improvement & patients safety Prevention & control of infection Governance, leadership & direction Facility management & safety Staff qualifications & education Management of information The scope of risk management Slide 10: Root cause analysis External assessments Incident reports Complaints Claims Clinical audit Performance monitoring Risk management analysis tools Slide 11: Hospital mortality Early neonatal mortality Inpatients peri operative mortality Inpatient intra operative mortality Cesarean sections Readmissions Unscheduled inpatients admission occurring the same day following ambulatory surgery Unscheduled returns to special care units within 48 hrs (ICU,CCU,NICU) Registered patient's time in emergency room- discharge disposition (time >4 hrs) Patients who leave he emergency room prior to completion of treatment Tacking / monitoring system Slide 12: Adult code blue outcomes Patient satisfaction surveys Patient complains Use of blood & blood components Departmental peer review from sampling of discharges Other data management sources Slide 13: Identify patients correctly. Improve effective communications. Improve the safety of high alert medications Eliminate wrong site, wrong patients, wrong procedure surgery. reduce the risk of health care associated infections. Reduce the risk of patient harm resulting from falls. 2006 International patients safety goals Slide 15: Roles & Responsibilities Chairperson, quality management system committee : Chairperson, quality management system committee He approves (with the committee) the integrated risk management plan. He carries out risk management activities through communication with all medical committees. Clinic, departmental heads & directors : Clinic, departmental heads & directors They are responsible for risk management within the scope of heir departments. Ensure that all staff within their departments are provided education regarding policies procedures, any new processes. Ensure that staff support & comply with the integrated risk management plan. Medical & hospital staff members : Medical & hospital staff members They are responsible to acquire & maintain the knowledge & skills they need to care for patients. Staff educated patients & their families on their responsibilities regarding safety. Staff are required to report errors & perceived risks once identified. Patients & families : Patients & families They have the responsibility to provide accurate & complete information about present complains,hospitilization, medications & other matters relating to their health. They are responsible for reporting perceived risks in their care & unexpected changes. The patient & family are responsible for asking questions when they don not understand what the have told about the patient's care. How are physicians involved in risk management : How are physicians involved in risk management Early reporting and investigations of incidents that have the potential for liability exposure. Collaborating with risk management on strategies to reduce risks Reducing risks in your clinical practice : Reducing risks in your clinical practice Maintain good communications with your patient. Maintain good communication with other members of the health care team. Appropriate documentation. Adverse outcomes. Clinical service policies and protocols Slide 22: ‘’clear, two- way conversation is a key element in preventing malpractice claims’’’’ What is Hospital Malpractice? : What is Hospital Malpractice? Hospital acquired infection Improper use of anaesthesia Failure to treat an illness Improper administration of drugs Failure to order proper tests Incorrect treatment of a diagnosed illness What is Hospital Malpractice? : What is Hospital Malpractice? Failure to consult with a specialist Failure to monitor a patient Failure to stabilize a patient Improper use of a medical device Birth injury or birth trauma due to physician, nursing or hospital negligence Surgical procedures that are not necessary, or that are done without patient consent Slide 26: ‘’40 - 60% of all medical malpractice claims are avoidable with systemic risk management’’ Slide 27: Introduce yourself to all patients and pay attention to non-verbal cues. Provide sufficient time to personally care for each patient. Avoid medical jargon and be punctual for meetings with patients and families. Avoid criticizing other physicians or another physician's management of your patients. NEVER guarantee the outcome of a treatment. The physician-patient relationship Slide 28: Personalize your treatment of patients Treat all patients with courtesy and consideration. Arrange for physician coverage for your patients while you are off. Prescribing medications over the phone is not advisable. Request consultations when indicated and appropriate. ‘’Document it. If you haven’t document it, you didn’t do it’’ : ‘’Document it. If you haven’t document it, you didn’t do it’’ Tips on documentation : Tips on documentation Clear and unambiguous Complete Errors Alteration and late entries Limit the records to patient care Document consent discussion Document instructions to the patient Adverse out comes Slide 31: Discussions Discharge instructions Telephone calls Any and all findings Patient's refusal of care Changes in the physical exam or clinical course Carefully Document all: Slide 33: Considerate and respectful care Effective pain management Privacy Receive care in a safe environment Be informed about your condition Informed consent Privacy regarding disclosure of health information Know the physician responsible for coordinating your care Know how the hospital is connected professionally with other hospitals or health care agencies Refuse to be examined, observed or treated by students or other hospital staff Be advised of experimentation affecting your care Be informed of the alternative treatments Expect reasonable continuity of care Pastoral care and spiritual services Make an advanced directive Prompt life saving treatment Patients rights Cont. Patients Right : Cont. Patients Right Have pain adequately assessed and treated Refuse treatment Have reasonable requests responded to promptly Interpreters at no cost Request a different physician Confidentiality View and receive copies of your medical records in accordance with state law and hospital policy Receive copies of bills What rules apply to your conduct as a patient Of a disabled person to receive equal care Receive information relative to financial assistance and free health care Receive medical services without discrimination Be free of restraints except in circumstances defined by hospital policy Be informed of unanticipated outcomes Patients Responsibilities : Patients Responsibilities Be considerate of the rights of other patients and hospital personnel Refrain from the use of tobacco products while hospitalized. Smoking is not allowed on the hospital campus Be respectful of the property of other people and the hospital Cooperate with all caregivers, ask questions if you do not understand the course of treatment and what is expected of you Keep appointments and notify the hospital if you must cancel or reschedule Provide accurate and complete information about past illnesses, hospitalizations and medications Report unexpected changes and perceived risks in your care to your health care team Accept the consequences if you refuse treatment or do not follow doctors' orders Recognize that the hospital will not tolerate weapons, threats to staff and substance abuse issues Pay hospital bills promptly, provide necessary information for insurance processing and seek answers to any questions you have about your bill Complete the patient satisfaction survey so we can improve service and maintain high standards of patient care . Informed consent : Informed consent Diagnosis; Nature of proposed treatment; Name of the procedure; Description in layman's terms; Risks associated with that treatment; Alternatives and associated risks; and Risk of no treatment. The big A & the 25 Cs : The big A & the 25 Cs Competence Communication Consent Compassion Consultation Chaperone Confirmation Completion Correction Caution Contract Common sense complaints 14. Check list 15. Coordination 16. Collections 17. Calls 18. Customer 19. Courage 20. Credential 21. Confidentiality 22. Comments 23. Counsel 24. Current 25. Calm RISK MANAGEMENT IN A CAPSULE The big A is: Anticipate What to expect during your hospital stay? : What to expect during your hospital stay? High quality hospital care Clean & safe environment Involvement in your care Protection of your privacy Help when leaving the hospital Help with your billing claims An easy way to prevent infection : An easy way to prevent infection Hand washing is a simple habit that can help keep you healthy. Hand Washing Slide 41: The First Line of Defense Against Germs Slide 42: Thank You...