CONCURRENT SESSIONS
Friday, Oct. 3 | Saturday, Oct. 4 | Sunday, Oct. 5

SATURDAY, OCT. 4

10:30-11:30 A.M.

SA-01

Aortic Dissection at Any Age: The Tyler Kahle Story

Hear the case study of a unique lawsuit settlement that yielded procedural changes in the hospital’s ED, the production of an educational video, and a partnership between the family and hospital to educate others about a rare life-threatening condition.

Objectives: Understand how mediation can allow providers to settle claims in positive ways. Recognize the power of collaborating with communications and public relations staff and the media to stimulate improvements in medical care.

Sara Juster, JD, CPHRM

Nebraska Methodist Health System, Omaha, NE

SA-02

Assessing Ambulatory Care Risk, Improving Safety in Physician Practices

This session shares results of proactive risk assessment surveys of physician offices and presents strategies for controlling risks and improving patient safety. A case study shows how an integrated health system with owned group practices participated in risk assessment surveys and used results to improve ambulatory care.

Objectives: Use benchmark data from risk assessment surveys to assess office practices. Identify strategies and tools for controlling risks and increasing patient safety. Select strategies appropriate for particular offices and needs.

Kathleen Shostek, RN, ARM, BBA, FASHRM

ECRI Institute, Plymouth Meeting, PA

SA-03

Negativity in the Workplace: A Symptom or a Job Duty Problem?

Gossip, negativity, passive-aggressive behavior. … they can occur daily in any organization. These behaviors affect the ability to function safely, efficiently and effectively. How do risk managers identify and address these behaviors in all ranks of an organization? This presentation addresses the etiology of negative behavior and suggests guidelines for addressing these in supervisory relationships.

Objectives: Analyze and discuss the etiology of negative behaviors in the workplace. Discuss their risk management implications and the role of risk management to intervene at all levels of the organization. Discuss a model for leadership intervention that addresses both the etiology and ramifications of negative behavior.

Cindy Siders, RN, MSN, DFASHRM

Geri Amori, Ph.D., ARM, DFASHRM, CPHRM

Karol Wareck, RN, CPHRM

The Risk Management and Patient Safety Institute, Lansing, MI

SA-04

Safety Risk Alert: Hazardous Drug Exposure Identification and Prevention

Although OSHA addressed safe handling of hazardous drugs in 1986, safe handling practices still are lacking, placing patients and healthcare staff at risk. An expert panel presents issues, evaluation strategies and interventions for a compliance plan.

Objectives: Identify safety and potential exposures. Discuss liability, claims and federal compliance guidelines. List barriers to prevention strategies. Conduct risk assessment and rate facility exposure potential. Identify hazardous drugs. Describe health risks in handling hazardous drugs. Discuss safe handling practices and recommendations to implement risk prevention program criteria to measure compliance.

Rachel Behrendt, RN, MSN, OCN

Robert Wood Johnson University Hospital, New Brunswick, NJ

Donna Tarulli, RN, MSN, CPHQ

Kenneth Doskocil, MS, CPHQ

The Paris Group LLC, Los Angeles

James Jorgenson, R.Ph., MS, FASHP

University of Utah, Salt Lake City

SA-05
Tools for Learning from Infant Injury Cases

There is a need for maintenance of individual competence and open and direct communication among obstetric team members, as well as for effective teamwork when faced with an OB emergency. After a review of almost 500 OB malpractice claims, the speakers developed a template for other OB departments to use in identifying weaknesses in processes and systems without the emotion and defensiveness that can impede analysis of their own cases.

Objectives:Identify the three most damaging system failures that result in infant injuries and death. Utilize a template to analyze potential OB system failures. Describe two methods for preparing OB teams for life-threatening events.

Darrell Ranum, JD

The Doctors Company, Columbus, OH

Paul Greve, JD, RPLU

Willis Healthcare Practice, Fort Wayne, IN

SA-06

Keeping Our Babies Safe

While infant abductions are generally considered to be unlikely, statistics contradict that notion. This presentation reviews surprising abduction data, describes prevention techniques, discusses infant security systems and flaws, advocates specific safety policies, identifies access barriers to the physical environment, and suggests education for staff and parents. This presentation also includes a risk manager’s 2007 abduction story.

Objectives: Identify common behaviors of abductors and prevention tips. List steps to take in case of a suspected infant abduction. Review events of a recent hospital abduction with specific lessons learned.

Sharon Groves, BSN, MSA, ARM, FASHRM, CPHRM

Berkley Medical, Columbus, OH

Jacque Mitchell, FASHRM, BSN, ARM, CPHRM

Sentara Norfolk General Hospital, Norfolk, VA

SA-07

Best Practices for Alternative Risk Financing Programs

This “Captive 301”-level session identifies and reviews best practices in risk financing, actuarial modeling, legal and regulatory management and general program design for alternative risk finance program owners.

Objectives: Identify best in class performance in risk financing, financial and loss modeling and legal compliance with an alternative risk financing program. Measure an organization’s compliance using tools shared by the speakers. Utilize information and content process maps to assist in the design and rollout of services and practices for an alternative risk financing program.

William McDonough, MPAH, ARM, FASHRM

Integro Insurance Brokers, Boston

Tom Hermes, FAAS

Tillinghast Towers Perrin, Weatogue, CT

Julie Robertson

Honigman Miller Schwartz & Cohn, Boston

------------

SATURDAY, OCT. 4

1:15-2:15 P.M.

SA-08

Disclosure Gone Right, Disclosure Gone Wrong

This session provides insights into successful disclosure as well as disclosure that does not meet the needs of a family, patient or provider. A case study is utilized and claim outcomes are discussed.

Objectives: Recognize the top 10 reasons why disclosure works and the top 10 reasons it fails. Analyze the connection between disclosure processes and claim outcomes. Utilize guidelines to check a disclosure process for gaps and to educate staff.

Ruth Kilduf, RN, BS

Integro Insurance Brokers, Boston

Patricia Hughes, RN, MPH

UMass Memorial Health System, Worcester, MA

SA-09

Electronic Revolution: Strategic Planning To Avoid Defeat

Two parts compose this session: 1) an overview of both generally applicable and industry specific litigation and regulatory dangers healthcare providers face as a result of their growing use of and reliance on electronic information, and 2) recommendations for strategic planning to minimize those risks and their accompanying costs.

Objectives: Obtain an accurate understanding of the growing role of electronic information in healthcare. Obtain an understanding of the unique and new legal dangers created by healthcare’s increasing reliance on electronic information. Consider strategies for planning, managing and minimizing the legal risks and business expenses inherent in the use electronic information.

Kevin Yankowsky, JD

Fulbright & Jaworski LLP

Houston

SA-10

Keys To Becoming an Effective Risk Manager

What are some key concepts and basic information to help healthcare risk managers effectively perform their job? This session examines areas that cause anxiety to a new risk manager, such as facing disruptive physicians, handling a risk event, dealing with a lawsuit, addressing dissatisfied patients and conducting risk assessments. The goal of the session is to provide strategies to turn a negative perception of risk management to a positive view as a proactive resource.

Objectives: Understand the role of an effective clinical risk manager. Develop professional reports for the governing board or leadership. Understand the link between quality improvement, infection control, patient safety and risk management activities.

Brenda Wynkoop, CPHQ

BlueCross BlueShield of Tennessee, Chattanooga, TN

SA-11

Risk Management for Pressure Ulcers: Avoiding Litigation, Providing Quality Care

Pressure ulcers bring a significant litigation risk that will continue to grow because of new Medicare reimbursement guidelines that deny payment for preventable complications. Not all pressure ulcers, however, are preventable. This session gives an overview of this important quality indicator and shows how the healthcare system can minimize litigation for hospital- and nursing home-acquired pressure ulcers.

Objectives: Understand how a system can be re-engineered to reduce risk for residents, specifically regarding pressure ulcer prevention and management. Realize the importance of risk management strategies in addressing pressure ulcers into day-to-day practice. Appreciate the importance of communication and documentation in preventing litigation and providing quality care.

Jeffrey Levine, MD

Senior Health Consulting Inc., New York

SA-12

Partnering with Patients/Families on Performance Improvement Committees

While putting patients and families on a performance improvement committee after they have experienced adverse events can be an alluring concept, barriers often prevent it. This session gives an overview of the legal and psychological considerations and shares the experiences of a chief nursing officer who overcame barriers at her organization and brought a patient’s family member to her committee.

Objectives: Discuss risk management issues that need to be considered before opening performance improvement committees to outside members. Understand the psychological concerns of all involved parties and discuss ways to provide a safe environment for active participation. Identify approaches to integrate patients and families onto committees.

Theresa Zimmerman, RN, BSN, JD, ARM, FASHRM, CPHRM

Catholic Healthcare Partners, Norton, OH

Catherine Tolbert, RN, MSN, CNA, FACHE

Anne Gardner

Humility of Mary Health Partners, Youngstown, OH

SA-13

Condition Help (H): Making the Hospital Safe for Patients

The purpose of this presentation is to heighten awareness of the significance of the patient-centered, patient-activated rapid response team (RRT) at the University of Pittsburgh Medical Center. This session introduces the background and current state of Condition Help (H) and its importance to safety and patient-centered care.

Objectives: Understand what it takes to build a patient/family-activated RRT. Prepare a plan and conduct a small test of change involving patients initiating a RRT. Receive resource contact information for help in developing tests involving patient/family RRTs.

Cindy Liberi, BS-Sc.

Kathleen Hale, RN, BSN, MHSA

University of Pittsburgh Medical Center, Pittsburgh

SA-14

Be Your Own Boss in the Alternative Risk Market

This session describes the who, what, when, why and how of entering the alternative risk market with solutions such as risk retention groups and captives.

Objectives: Define the alternative risk market and why is it becoming the norm in healthcare. Describe key methodologies for implementing an alternative risk program and determining whether an onshore or offshore option is better. Describe methods for selling the idea to organizational decision-makers.

Nancy Gray, CPA

Aon Global Consulting, Chicago

Mark Dame, MHA, FACHE, CPHRM

Unity Physician Group, Bloomington, IN

------------

SATURDAY, OCT. 4
2:30-3:30 P.M.

SA-15

The Rest of the Story: The University of Michigan Experience

The University of Michigan has received national attention for its innovative approach to handling medical errors and potential claims. What has not been described in detail is how the university achieved this success. The speakers’ share facets of the program, including the evolution of the Risk Management Department from a traditional claims-based approach to a proactive and transparent focus on early claims resolution with strong ties to patient safety.

Objectives: Describe the University of Michigan approach to handling medical errors and potential claims. Explain the infrastructure necessary to support the University of Michigan Claims Management Model. Identify key factors contributing to its success.

Susan Anderson, MSN, MBA, CPHRM

Ellen McKeown, BSN

University of Michigan Health System, Ann Arbor, MI

SA-16

Risks Outside the Walls: Home Care, Hospice and Community Care

This session addresses risk exposures when healthcare is delivered in the home and community settings such as home health, hospice and medical adult day care. The discussion focuses on professional, general and auto liability. Information is based on loss control data, incident report trends and claims data. Emphasis is on presentation of risk management strategies for areas with frequency and/or severity, such as medication events, falls, pressure sores and auto accidents. The format includes case scenarios and group discussion.

Objectives: Implement positive risk management techniques to limit losses and improve patient safety in a community care-based organization. Identify at least three care-related risk exposures in the community care setting. Identify at least two effective risk management techniques related to driver safety.

Elizabeth Norman, BSN, MBA, CPHRM

Glatfelter Insurance Group, York, PA

SA-17

Long Day’s Journey from Staff RN to Risk Manager: Hiring from Within

This session addresses hiring a clinical risk manager from within the organization. The speaker reviews steps to take prior to the posting of the position, such as defining responsibilities and determining necessary skill sets. Barriers that can arise during orientation are addressed along with tips for moving past them with patience, humor and common sense. Interview questions, orientation checklists and other documents are shared.

Objectives: Define necessary steps prior to posting a position. Create an orientation plan and timeline to ensure successful transition from staff RN to clinical risk manager. Discuss barriers and strategies to retaining a new employee.

Elizabeth Kirschling, RN, BA, MPH, JD, CPHRM

Southeastern Regional Medical Center, Lumberton, NC

SA-18

Risk Management Tool Box for Legal and Regulatory Inquiries

What legal and regulatory concerns does the risk manager face on a daily basis? Sharing examples, situations and resources to assist the risk manager in addressing these situations, the speakers cover topics such as release of medical records, HIPAA privacy, EMTALA (patient transfers), psychiatric patients (restraint & seclusion), informed consent, refusal of treatment, organ donations, treatment of minors, healthcare decision making, brain death, IRBs, and reporting obligations to accrediting and/or licensing agencies.

Objectives: Put together a risk management tool box to meet the specific needs of an organization. Identify resources to assist in responding to regulatory and legal inquiries. Develop a checklist for obtaining information to develop an informed response and approach to handling risk situations.

Laura P. Martinez, BSN, RN, MS, CPHRM

Pauline M. Barry, BSN, MPS, CPHRM

Darwin Professional Underwriters Inc., Coppell, TX

SA-19

Wrong Site Surgery: A National Study

This presentation looks at findings from two national surveys. One focused on evaluation of the effect of the AORN Correct Site Surgery Tool Kit on implementation of the Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. The other survey was designed to identify the number of wrong site surgery incidents occurring Jan. 1, 2000-July 31, 2006.

(Note: Research for this presentation was funded by a grant from the ASHRM Foundation.)

Objectives: Identify evidence-based strategies to promote implementation (or adoption) of the Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery. Identify methods to engage perioperative team members in supporting the Universal Protocol. Explain how the Universal Protocol can reduce wrong site surgery events using national data.

Deborah Mulloy, Ph.D.(c). MSN, RN, CNOR

ASHRM Foundation grant recipient

Massachusetts General Hospital, Boston

SA-20

How Event Data Can Determine Risk Management Activities

This program describes the Maryland Patient Safety Center’s (MPSC’s) 2-year-old Near Miss/Adverse Event Reporting Tool, now being used to identify an improvement in trend percentages over time as opposed to specific numbers. Data are compared biannually to assess progress after implementation of generally accepted fall and medication error prevention techniques.

Objectives: Describe the MPSC’s Adverse Event Reporting Tool and how Maryland hospitals submit requested data. See opportunities for initiating collaboration between risk managers and patient safety officers to develop and implement standardized techniques to promote patient safety. Demonstrate how data can help risk managers and patient safety officers determine future risk management initiatives for an organization.

Vivian Miller, BA, FASHRM, CPHQ, LHRM, CPHRM

Maryland Patient Safety Center, Elkridge, MD

SA-21

Protecting Your Hospital’s Assets

U.S. healthcare operations are expected to spend more than $50 billion on new facilities in 2008. And considering a construction inflation rate of 30-35 percent during the past four years, plus the dynamics of an industry where the equipment turns over every five to seven years, the speakers are prompted to ask: How can you be sure your hospital’s assets are fully protected?

Objectives: Recognize the options available to control and quantify physical assets. Identify ways to improve the marketability of a hospital property insurance program. Apply this knowledge to refine risk transfer strategies.

Mark Bobber

American Appraisal, Milwaukee

Mary Breighner, CPCU, DRM

FM Global, Cincinnati

----------------

SATURDAY, OCT. 4
3:45-4:45 P.M.

SA-22

Assessment Tools That Create Legal Risks

This session examines the role assessment tools play in litigation. Examples of documentation help explain how plaintiff’s lawyers piece together theories of cases using assessment tools/documentation. Forms that are used to assess residents’ risks, and how the documentation can later support a claim, are analyzed. Lastly, innovative ideas for intervening with residents that score high on risk assessment tools are shared.

Objectives: Identify three risk assessment tools utilized by plaintiff’s lawyers to establish that the defendant was “on notice.” Identify five common documentation errors that plaintiff’s lawyers use to establish a breach in the standard of care. Identify methods to address common assessment tools problems, especially as they relate to the documentation of high-risk residents.

Sheila Nicholson

Quintairos, Prieto, Wood & Boyer PA, Tampa, FL

SA-23

Clinical Trials and the Enterprising Risk Manager: Human Research Risk

Clinical trials and research are conducted in large and small healthcare facilities every day. This session introduces the concept of “Research Risk Management” as an important subset of any ERM program. Speakers describe an applied methodology for understanding research exposures and controlling risks associated with experimentation involving humans in the clinical setting.

Objectives: Identify and evaluate clinical trials and research exposures through a mechanized risk assessment process including risk mapping. Differentiate between what is and is not insurable relative to human research activities. Develop strategies to manage insurable and non-insurable exposures.

Lyn Rossano, MPH

Navigators Life Sciences, New York

Robin Maley, MPH, RN

RobinMaley Healthcare Strategies, New York

SA-24

Avoiding Perils in Physician Peer Review

While most quality issues are the result of systemic factors, physician peer review continues to be necessary. Physician performance is often a continuum, and competency issues arise without warning. Well-designed peer review programs allow for early recognition and resolution of individual competency issues. However, ineffective peer review programs can bring disastrous consequences. This session explores barriers to an effective physician peer review program and the factors necessary for success.

Objectives: Describe the impact of ineffective physician peer review programs. Formulate strategies for overcoming barriers and perils. Identify key elements of a successful program.

Becki Kanjirathinkal, MS, RN, CPHQ, CMQOE, CPHRM

CNA HealthPro, St. Joseph, MO

SA-25

Transformational Leadership: Achieving a Culture of Safety

Understanding transformational leadership can help risk managers merge cutting-edge science with a commitment to compassion, creating a safer practice/organization culture With examples from the acute care and aging care industry segments, this session differentiates traditional/transactional leadership from transformational leadership and demonstrates why organizations must address the universal human needs of respect, dignity and connection to become organizations of choice.

Objectives: Discuss the challenges in the traditional culture of healthcare institutions and practices. Emphasize the important leadership role of risk managers in transforming an organization’s culture and creating an environment of patient/resident safety. Differentiate between traditional leadership and transformational leadership.

Bruce Dymtrow, BS, MBA, CPHRM

CNA HealthPro, Chicago

SA-26

How Hospitals Can Survive the New CMS Rules

This presentation recaps the history and rationale for the new regulations that no longer allow reimbursement for hospital-acquired conditions. All categories of conditions are evaluated. Additionally, the concept of “present on admission” is discussed to develop an understanding of ways in which reimbursement can be maximized. The new diagnosis-related groups codes are reviewed also to attain the highest level of reimbursement. Finally, proposals and questions are raised regarding the impact of the new regulations on patient care, risk management and liability.

Objectives: Understand the CMS rules on reimbursement regarding hospital-acquired conditions. Evaluate benefits and risks for developing methods to obtain reimbursement for hospital-acquired conditions.

Dale Burrus Frisby, JD, LLM

Melanie Rubinsky, JD, LLM

Kroger, Myers, Frisby & Hirsch, Houston

SA-27

Translating Effective Communication and Documentation into MRSA Reduction

Strategies for leadership engagement, clinicians at the bedside and system-wide process design to improve identification, communication and care of patients with colonization or infection with Methicillin-resistant Staphylococcus aureus (MRSA) are considered in this session. The speaker draws on adverse event and near miss data that hospitals file with the Pennsylvania Patient Safety Reporting System (PA-PSRS). The presentation covers problems identified in PA-PSRS reports related to healthcare-associated MRSA and describes strategies for risk managers to reduce harm to patients.

Objectives: Identify at least three process failure modes that promote transmission of MRSA. Identify at least three risk reduction strategies to prevent the spread of MRSA and at least one strategy for implementation at a facility.

Mary Blanco, RN

ECRI Institute, Plymouth Meeting, PA

SA-28

Request for Proposal: Evaluating and Choosing an Insurance Broker

Drafting a request for proposal (RFP) to select an insurance broker can be intimidating. This session provides a process for evaluating a broker partner, including solicitation of an RFP, evaluation of responses and face-to-face interviews with candidates. Selection criteria are based on factors including financial considerations, scope of services, access to insurance markets, and cultural and personal fit between the broker and the client. While focusing on broker selection, this process can be adapted to any key vendor-partner relationship.

Objectives: Identify situations where an RFP might be appropriate. Create an RFP that is customized to the needs of the organization using a template provided. Evaluate responses in a fair and objective manner and select a partner that is aligned with the organization’s goals and objectives.

Hala Helm, MBA, FACHE, CPHRM

John Muir Health System, Walnut Creek, CA

EDUCATION