Institute for Continuing Education

Risk Management for the Health Provider

Course Objectives

Upon successful completion of this module, you will be able to:

• Describe the history of Risk Management and how it has evolved to be what it is today.
• Identify the Risk Management process.
• Define the basic definition of Quality.
• Describe Total Quality Improvement (T.Q.I.).
• Describe how to implement a Risk Management Program.
• Discuss the proper methods of medical record documentation.
• Describe the sequence of events in a legal process.
• Discuss the use of Advanced Directives and their differences.
• Identify requirements for Medical Record Keeping.
• Describe an Incident Report and what information it must contain.
• Identify the methods of Risk Treatment
• Describe the basic functions of the Risk Manager.
• Define the goals of the Risk Management process.
• Identify the Code
• Report requirement and its purpose.
• Describe the legal ramifications and individual concerns with regards to Sexual Harassment

Course Information

Imagine oneself fifty years ago, and needing a sudden surgical appendectomy. No high tech sophisticated electronics or wonder drugs such as antibiotics were available. You were simply at the mercy of the physician attending to you at that moment. Little, if any documentation was written, later available or even preserved. Frequently poor sanitary conditions caused many postoperative infections and many died as a result. And although medical malpractice did exist, it was generally not considered a consequence as it is today. The concept of Risk Management had not yet been developed or conceived.

The roots of Risk Management had its early beginnings during the post WW II era. Many medical advances were beginning to occur. The development of antibiotics including Penicillin probably caused the most dramatic changes in the medical industry during post war time period. With the ever-increasing number of hospitals during the forties and fifties, patient expectations began to change. Greater outcomes were now being expected from the healthcare provider by the patient population.

During the fifties, increased technology spawned the rise of increased risks and the advent of new Negligence acts. The patient with any adverse result could now question the provider to assure they were working within their scope of practice and that no adverse results were caused by acting outside that scope of their legal practice. Increased hospital liability now entered the scene causing many hospital administrators to reconsider their prior methods and concentrate on methods to reduce their risk of patient death and reduce their risk of financial loss as well.

In the sixties, dawned the era of consumer knowledge. New legal requirements demanded hospitals establish policies and procedures to assure compliance and patient satisfaction was delivered. The development of "Standards of Care" occurred placing a real responsibility on the healthcare provider to be accountable due to their scope of practice. No longer was bliss or ambivalence accepted because of these new Standards of practice now being in place.

In the seventies and eighties more advancements in technology and more potent and effective drugs became available, causing people to live longer and thereby having more chances of adverse problems. The cost of healthcare began to significantly rise. An increased number of malpractice lawsuits began to cause a major medical financial crisis. Companies now began to focus more on purchased outside corporate liability insurance as a major risk protection for their financial losses due to higher courts settlements. This trend caused all insurance premiums to begin to escalate very rapidly.

Today in the nineties, Risk Management has significantly developed. The scope of the Risk Manager is to: identify, evaluate and treat the risk of any financial loss. A formalized program is developed to reduce the frequency of loss as well as the severity of loss both to the patient and to the company. The Risk Manager attempts to minimize the losses caused by any unplanned or uncontrolled occurrences that result in loss of any type whether it be loss of life or health to a patient, to an employee, loss of certification or accreditation to the facility, or loss of a company¹s financial status.