In the broadest sense, a medical malpractice insurance crisis was the dawn of what is now the American Society for Healthcare Risk Management (ASHRM).
In the early- to mid-1970s, insurance rates for physicians and hospitals escalated until coverage was either unavailable or unaffordable. Legislators created Joint Underwriting Associations (JUAs)-state government-sponsored insurance companies-to provide professional and general liability coverage for physicians and hospitals.
The American Hospital Association (AHA), aware of members' concerns, formed the Hospital Association Risk Managers (HARM) in 1973. Members of HARM were designees of the AHA's Allied and State Hospital Associations groups; they met in Chicago several times to discuss the insurance crisis. That same year, Jim Groves, risk manager for the AHA, developed Hospital Providers Insurance Co. (HPIC) and Hospital Providers Service Corp. (HPSC) to write and service the insurance needs of member organizations.
Finding Like Minds
About this time, Steven Salman of the Health and Hospital Corp.'s Marion County General Hospital in Indianapolis developed a self-insurance program for his institution. In 1976, he met with attendees from across the country at an AHA-sponsored program on insurance and risk financing to discuss the lack of availability of reasonably priced malpractice insurance. The following year, Salman moved to Columbus, Ohio to became the risk manager at Riverside Methodist Hospital.
Meanwhile, Glenn T. Troyer was serving as a board member of the Ohio Hospital Association's Risk Assessment Program and as an assistant professor in Ohio State University's Graduate Program in Health Services Administration, teaching health law and related management classes. When he invited Salman to serve as a guest lecturer for a risk management topic, they realized that they shared an interest in helping hospitals develop risk management programs.
Salman and Troyer met Layton C. "Butch" Severson, claims manager and later operations manager at the Ohio JUA, which was the state's only insurer for physicians and hospitals. In 1978, Severson, Salman and handful of other hospital risk managers created the Ohio Society of Healthcare Risk Managers-the first state hospital risk management society in the country; Severson served as its first president and Salman as its second.
The state-level enthusiasm led a group of risk managers including Troyer, Salman, David Dodge (representing the South Carolina Hospital Association), Keith Calvert (administrator of Logan County Health Center, Guthrie, Oklahoma), and Groves and Arline Sax from the AHA to explore the feasibility of creating a national society to represent the interests of hospital risk managers.
Mounting financial pressure prompted hospitals to explore the need for risk management programs. The state of Florida passed legislation in 1976 that required hospitals, ambulatory surgery centers and HMO and other facilities to develop internal risk management programs. By 1978, several state hospital associations and risk managers were weighing the benefits of organizing the profession at a national level.
In the summer of 1978, Salman conducted a survey by mail of 2,000 hospitals to gauge whether there was large-scale interest in hospital risk management, and he concluded that support existed for the formation of a national group.
A year later, the AHA appointed a task force to validate the survey's finding. Task force members included Salman, Troyer, Dodge, Calvert, Stanton Parker (Loma Linda University Medical Center, Loma Linda, Calif.), Ernie McCollum (Samaritan Health Services, Phoenix) and Janine Fiesta (Allentown & Sacred Heart Hospital Center, Allentown, Pennsylvania). The members were unanimous in their recommendation to form a society within the AHA, and the association approved its formation in May 1979. The governing board-comprising the task force members and appointed by the AHA-held its first meeting in January 1980. Sax was appointed as the first staff director, and Salman became the first president.
Launching the Society
Some 300 people attended the first meeting and educational seminar of the American Society of Hospital Risk Managers in New Orleans from March 17-19, 1980. Session topics included organizing a risk management program, techniques for risk identification and treatment, and gaining physician involvement in risk management programs.
In November that same year, a second educational session in Phoenix drew 600 participants, and the first ASHRM officers were elected. Ernie McCollum was elected to succeed Salman as president, with Troyer as president-elect. Other elected board members included Calvert, Pamela Collins (director of Risk Management and Quality Assurance for St. Joseph's Hospital in Chicago) and William Ryan (insurance and risk manager at the University of Michigan in Ann Arbor). They joined Fiesta, Parker, McCollum and Salman to compose the ASHRM board for 1981.
Over the years, ASHRM presidents have brought a wide range of skills, expertise and experience to the task of leading the society, as illustrated in the following pages. We asked them to answer a few questions, including:
How did you enter the profession, and what were the most significant accomplishments of your term?
STEVEN L. SALMAN, 1st president (1980)
Profession : I was selling life and health insurance but didn't want to do that for the rest of my life. I answered an ad in the local paper for a hospital risk manager that read "insurance experience required." I was hired as the risk manager for the county hospital and the parent municipal corporation.
Accomplishments: Forming the society, setting up the structure and holding two successful annual meetings in the first year of the society's existence.