Healthcare Risk Management – Keeping Track of Multiple Complex Issues

I’m currently designing a healthcare risk management work-flow database which will be released through Simple Data Solutions.  It’s a fascinating project, and I believe the end result will prove to be a useful tool for many hospitals.  Risk Management is a complex, multi-faceted process which bears significant responsibility for patient safety, as well as for protecting the organization’s reputation and financial assets.

When care goes awry, and it does at times even in the best run hospital, Risk Management is often the first department contacted.  Although organizations have varying expectations, Risk Managers are usually responsible for:

  • Early intervention and investigation of events and surrounding circumstances
  • Participant and observer interviews
  • Meetings, and at times negotiation, with patients and families
  • Root cause analysis
  • Summary and trend reports for organization leadership
  • Staff education sessions regarding risk mitigation and disclosure
  • And of course, those infamous “other duties as assigned”

Add to that the likelihood that there are multiple events, of varying significance, at various points in the process, being investigated and followed at any given time, and you’ll realize it’s a lot to keep track of.  The consequences for losing sight of an important element at a crucial moment could be serious; thus, the need for an effective, user-friendly, tracking and trending risk management database. 

A while back I designed a similar system for a Clinical Risk Management department in the large teaching hospital where I worked.  Initially the risk managers weren’t so sure the time spent entering data would prove to be a worthwhile return on investment.  By the time I left the position however, if the system needed to be taken down temporarily for updates there was much gnashing of teeth until it was once again up and running.  

So if your Risk Management Department could use a better system for keeping track of its workload contact me. 

Update 8/2010  –  This project is currently on hold due to time constraints, but if you would like more information, please contact me.

Are You A Star Meeting Facilitator?

Fa⋅cil⋅i⋅tate – Verb

1.  To make easier…

If you’re in any kind of leadership role, you get to attend lots of meetings; and are no doubt responsible for facilitating some of them.  Let’s briefly consider the role of meeting facilitator, which we now know thanks to, is to make the meeting experience easier for attendees.

First a couple of thoughts on meeting facilitation from Mind Tools:

To facilitate an event well, you must first understand the group’s desired outcome, and the background and context of the meeting or event. The bulk of your responsibility is then to:

  • Design and plan the group process, and select the tools that best help the group progress toward that outcome.

Let’s further consider what that means in terms of effective meeting facilitation:

Designing and Planning the Group Process Includes: 

1.  Figuring out who the group is; getting the right people around the table.  This means including those argumentative, difficult folks when they happen to be key stakeholders in the outcome.  Either get them at your table, or expect them to work against everything that is decided there.

2.  Publishing time frames. Whether the goal is regular dates for ongoing meetings, or anticipated start/finish dates for project planning, publish the dates and times early and do your best to stick with them. If you don’t stick to the schedule your attendees will soon decide they have better things to do as well.

3.  Designating a Chair.  Select someone who cares about the issues to be considered, is willing to commit the required time, and who has or is willing to learn, the skills necessary to effectively manage meetings and processes.

4.  Designating an Assistant Chair.  Select someone willing to support the process, and grant them authority to manage the meeting and the group in the Chair’s absence.  That helps prevent meeting cancellation, which facilitates item number 2.

5.  Creating an agenda and putting the most important items first.  Start your meetings off with meat, not fluff, to motivate attendees to arrive on time.  Close the door when the meeting starts, late arrivers will just have to open it to get in.

6.  Establishing rules of meeting etiquette.  Let participants know up front how the meeting will be conducted.  Will discussions be informal and fast-paced, or must speakers wait to be recognized by the Chair?  Will Roberts Rules of Order be followed?  (If Roberts Rules are to be enforced, make sure participants understand them.)

Selecting the Best Tools Includes: 

1.  Recording meetings. Create a record of the committee’s work in a format that keeps track of action items and helps everyone know who is responsible for what, and when.

2.   Selecting the best format for sharing progress. Will you distribute meeting minutes ahead of time, at the meeting, or at all?  Instead of distributing minutes, would sharing a simple list of action items be more effective? 

3.  Deciding on use of technology during meetings. Will using Power Point or other forms of visual or audio media help keep the group focused and on track, or put them to sleep?

4.  Making use of analytical tools that work. Well-designed charts, graphs, time lines, etc. can help busy people quickly grasp complex ideas.  Analytics can help the group understand barriers to progress and explore new ways to work through them.  One word of caution however, it is essential that the data being displayed is solid, unbiased and trustworthy.  

5.  Providing access to policies, bylaws, etc. If there are organizational guidelines within which the committee must work, make sure those reference materials are readily available to the group.

If you are an effective meeting facilitator people may actually look forward to participating in committees that you manage, and in today’s over-meeting’d world, that’s high praise indeed.


75 Million Dollar Malpractice Award Overturned by New Jersey Supreme Court

Child injury cases which result in devastating harm and the need for life-long care tug at the hearts of jurors and are known to be high risk cases for the defense in a jury trial.  In an exceptional example of that, the New Jersey Star Ledger reports that the state supreme court recently overturned a 75 million dollar malpractice verdict, which included 50 million for pain and suffering, and remanded the case for a new trial.

The case, which represents the largest medical malpractice verdict ever delivered in New Jersey, involved a 4 month old boy who went without oxygen for several minutes while recuperating from surgery, causing significant brain injury.    

The jury held that a nurse and  a physician failed to take appropriate action when an endotracheal tube giving the infant oxygen, dislodged. It also assigned culpability to two other physicians who were not in the room when the baby was deprived of sufficient oxygen, but were accused of poorly training the physician involved in the incident.


Health Wonk Review is up at The New Health Dialogue Blog

Paul Testa is the host for the current edition of Health Wonk Review, a collection of the best health policy posts on the web, over at The New Health Dialogue Blog.  Paul escorts us through the rather serious topic of healthcare policy with a decidedly light-hearted carnival theme.

Stop over for a sampling of the best of the week’s discussion on the web about healthcare policy and reform.

Grand Rounds 5.44 is up at Doc Gurley’s

Doc Gurley, who writes posts from an insane healthcare system, is the host of this week’s Mystery Themed Grand Rounds.   She explains the theme choice by revealing that she was a faculty member at a mystery writer’s conference last week, where she spoke about medical facts for writers, as well as the nitty-gritty of the urban human landscape. 

Stop by Doc Gurley’s for a peek at some mysteries of modern medicine.

Grand Rounds

How To Respond to an Angry Patient Complaint

by Susan Keane Baker

An angry complaint can ruin your day. You have to spend extra time dealing with the patient. Extra time spent listening to your colleague’s side of the story. Extra time spent thinking about the situation and how you could have responded differently. Here are some steps for handling angry complaints so that they don’t consume more time and energy than necessary.

  • Take the patient to a quiet area. In a low, calm tone of voice, say to the person, “Let’s step over here to talk. That way, we won’t be interrupted.” The angry patient with an audience will be less likely to accept your point of view.
  • Let the patient speak his mind without interruption. Otherwise, you may fix the problem, but not fix the relationship. You may be encouraging the patient to embellish and repeat his story to others, as he hasn’t been heard by you.
  • Avoid rationalizing.There are usually a few oft-repeated rationalizations that come immediately to mind when a patient has a complaint. “It’s the insurance company’s fault.” Or, “this is the way we’ve always done it.” Put yourself in the patient’s shoes for just a moment and consider whether your rationalization is an explanation or an excuse.
  • Respectfully use the patient’s name in your reply. When a person is very angry, using his or her name in a respectful way can ease the situation. Using the person’s name in a condescending way fuels anger.
  • Demonstrate your understanding. If sincere, use the “feel, felt, found” technique. For example: “I understand how you feel. I’ve felt that way too when I’ve received a bill that didn’t seem to make any sense. What I’ve found is that writing down my questions for the billing specialist helps us both understand where the misunderstandings are and resolve the problem without anyone’s feelings being hurt.”

Using these strategies will help you resolve conflict more positively, and give you peace of mind that you handled the situation in a professional, dignified manner. And that’s what frees up your mind and your time for more positive, productive activities.

Copied with permission of the author: Susan K. Baker
Speaker on Patient Satisfaction and Handling Patient Complaints


Editors Note:  Keep in mind that CMS (Centers for Medicare and Medicaid Services) has issued specific requirements for US healthcare organizations and their representatives which must be followed when responding to patient complaints and grievances that cannot be immediately resolved.

Courageous Credentialing and Privileging Support Patient Safety

“For a long part of the history of modern medicine, the mention of credentialing and privileging a physician conjured images of paper stacks, rubber stamps, and file cabinets.  Every couple of years, someone would make sure the new stack of papers were in order, stamp them, and add them to the file cabinet.  The process often was perfunctory – frequently political – but infrequently rigorous.  Those in a position to authorize (or reauthorize) a physician’s appointment were reluctant to mount a challenge against a substandard candidate – a potential legal quagmire – and simply followed the path of least resistance.  Every so often, the newspapers would chronicle patient tragedies linked to a clinician who should never have been practicing medicine.  Hospital leaders would dismiss those as unavoidable circumstances: bad apples who cheated the system.”

“Competition and the burgeoning patient safety movement now demand a different response from the entities that credential and privilege physicians.”

So opens a document created by CRICO/RMF, the medical malpractice company owned by and serving the Harvard medical community, Credentialing, Privileging & Patient Safety.

The National Association Medical Staff Services, whose members are charged with verifying credentials and clinical competency for healthcare providers in hospitals, managed care panels, ambulatory surgery centers, nursing homes, etc.  has long stated that “Patient Safety Begins With Us.” Verifiers and administrators provide the foundation for a thorough credentialing and privileging program, but more is required.  The system only works as intended if that foundation supports strong medical staff and business leadership; individuals who may at times need courage to navigate a difficult and treacherous course.

kayakDuring the years that I worked in the field of medical staff administration in various organizations, more often than not I had reason to be proud of the leaders with whom I worked. They took their responsibilities seriously; they stood for the patient. On the few occasions when the path of least resistance was chosen over the safety of patients and the organization, I found it profoundly disappointing. 

If you are charged with the responsiblity of assuring that only safe, competent clinicians care for patients in your organization, please remember that at this most crucial time in healthcare we need courageous leaders.  Will you help guide us to safer waters? 


Ten Years After ‘To Err is Human’ Are We Any Safer?

Ten years after the Institute of Medicine’s To Err is Human report, which claimed that 98,000 lives are lost each year in the U.S. due to preventable medical errors, the Consumers Union’s Safe Patient Project gives the country a ” failing grade on progress.    

Consumers Union asserts that     

  • Few hospitals have adopted well-known systems to prevent medication errors and the FDA rarely intervenes.  
  • A national system of accountability through transparency as recommended by the IOM has not been created.  
  • No national entity has been empowered to coordinate and track patient safety improvements.  
  • Doctors and other health professionals are not expected to demonstrate competency (in patient safety practices).

Consumers Union believes that little or no progress has been made during the past decade.  I’m not so sure I agree.    

While no one would dispute the need for vast improvement, the very fact that I’m writing about patient safety and you’re reading about it shows that there is now discussion where little existed before.     

Thumbs Up:   

  • Ten years ago patient safety was an afterthought, today it holds a prominent position in discussions at nearly every level of healthcare.
  • Ten years ago the idea of disclosing a medical error was almost universally shunned by both clinical and administrative professionals.  Today cracks exist in that protective armor, and more openness is almost certain to follow. 
  • Ten years ago few patients felt comfortable asking tough questions, especially of their physicians, from “Did you wash your hands?” to “Did something go wrong with my care to bring about this result?”  Today patients are becoming increasingly knowledgeable and increasingly savvy about healthcare safety.

Thumbs Down:  

  • While considerable work and funding are being fed into patient safety initiatives, nearly every organization is pouring those precious resources into reinventing the wheel.  Informal networks are springing up that allow providers to share ideas and best practices, but the fear of “giving away too much” and possibly placing one’s organization (and job) in harm’s way stifles honest exchange, inevitably restricting the pace of improvement.
  • Old habits die hard, and the habit of protecting providers and organizations when an error occurs is deeply ingrained.  The events leading to an adverse patient outcome are rarely clear cut, and balancing the patient’s right to know with the organization’s legitimate right to protect its reputation and assets is often  enormously challenging.  The scales have yet to tip toward a default response of patients first.

The science of patient safety is in its infancy.   

So yes, we have a difficult journey ahead, but at least we’ve started the climb. Let’s see if we can help pull one another up along the way.