Inside This Issue
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‘Disclosure’ education outreach expands with Pearls booklet
The disclosure of adverse events, or unanticipated outcomes, is an evolving process in health care. Difficult issues center on when, how and what to say during disclosure.
ASHRM’s thought-leadership on disclosure pre-dates the Joint Commission on Accreditation of Healthcare Organizations Patient Safety Standard on the topic. In early 2001, ASHRM released a monograph titled “Disclosure of Unanticipated Outcome Information” and followed up in 2003 with a three-part monograph series focusing on the communication of disclosure. (The complete monographs are posted at www.ashrm.org, Resources section)
Now, ASHRM is broadening the reach of its expertise with the mid-July release of Risk Management Pearls on Disclosure of Adverse Events.
The 44-page, easily shared pocket-sized booklet describes organizational scenarios and strategies for implementing and enhancing the practice of disclosure. Portions have been incorporated in other works, including the March 2006 consensus statement of the Harvard Hospitals, “When Things Go Wrong: Responding to Adverse Events.”
While it can help a wide audience of health care providers understand the legal and regulatory aspects of disclosure, it also focuses on the human aspects. As ASHRM President Peggy Martin and Institute for Healthcare Improvement Senior Fellow Jim Conway note in the foreword to the booklet, “it is important to ground ourselves in the expectations of the patients.”
Risk Management Pearls on Disclosure of Adverse Events points out that “disclosure” has been part of health care for many years. Physicians and other health care providers disclose daily. They share information about diagnoses, prognoses or complications of treatment.
However, physicians have long debated the extent to which devastating prognostic information should be revealed. Once malpractice liability first became a particular concern in the late 1970s, the decision whether to disclose, especially when there was possible error and therefore litigation potential, was pre-empted by legal considerations and emphasis on evidentiary protection.
In 2001, Standard RI.1.2.2 of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) required accredited facilities to establish a process for the disclosure of unanticipated outcomes of care. This new standard amplified the debate about the roles of patients and providers in a new, patient- and family-focused health care world. Accredited health care organizations were now required to be forthcoming about information often viewed as potentially damaging.
Compelled to disclose, health care providers are learning that the practice may be less detrimental to malpractice outcomes than predicted and that it may be beneficial to reasonable claim management efforts. Risk Management Pearls on Disclosure of Adverse Events notes that disclosure actually may be viewed favorably by jurors and the community.
Unfortunately, the infrastructures that respond to such honesty are not changing so quickly. The legal system still functions in a punitive mindset. Licensure and professional boards still hold individuals, not systems, accountable for error. The availability of emotional support for those involved in treatment gone awry has lagged the need. Insurance companies and claims committees may respond slowly with the financial follow-up to a smooth disclosure.
Concerns remain about the legal damage that can result from a poorly conducted disclosure discussion. Providers (and their attorneys) fear that hearsay may become “fact” by virtue of thoughtless comment or patient misunderstanding. Apology may be misinterpreted as culpability. Discloser discomfort may be interpreted as dishonesty. Fortunately, careful education, process development and training can overcome these concerns. Risk Management Pearls on Disclosure of Adverse Events can assist in that education.
Health care providers must focus on the overriding purpose of disclosure: to provide patients and families complete information about their care. Appropriate treatment decisions and planning require this level of honest communication. The decision to disclose shouldn’t revolve around efforts to avert litigation, but rather around the shared goal of providing patients and families information needed to make decisions about next actions.
To that end, Risk Management Pearls on Disclosure of Adverse Events is intended to help providers disclose in ways that may provide the most effective communication with the least risk.
Risk Management Pearls on Disclosure of Adverse Events will be available for purchase in mid-July at www.ashrm.org (Resources section, ASHRM Store page). They will be sold in 5-packs ($45 for members, $55 for non-members) and as single copies ($15 for members, $20 for non-members). Formal announcement of availability will be announced to all members via e-mail and in e-News.
Special event to support future of the profession
“Sometimes it is a single light that pierces the darkness . . .” The ASHRM Foundation affirms this belief by facilitating the advancement of health care risk management professionals. Now, individuals who want to support the work of the foundation and the future of their profession have the opportunity to do so.
The ASHRM Foundation is inviting ASHRM members to attend a social and informational event this fall in San Diego with ASHRM Past-President Pamela Popp, who will recap the foundation’s accomplishments and outline its plans. Proceeds will help fund scholarships and education programs and future research projects.
Contribution levels range from $100 to $500. Contributions are tax deductible within the limitations of the Internal Revenue Code.
The event will be held from 6-8 p.m. Oct. 31 at Manchester Grand Hyatt, San Diego (during ASHRM’s Annual Conference & Exhibition). Cocktails and appetizers will be served. Space is limited; reservations are required. For details, contact Diane Farina White at (312) 422-3980 or ashrmfoundation@aha.org.
Tool kit engages patients in safety efforts
Each ASHRM member is entitled to receive a copy of the ASHRM Foundation’s patient safety tool kit, “Communicating Your Commitment to Patient Safety.”
The kit contains a video to be shared with patients and their families via an in-house TV system or hospital Web site. The video engages patients in their care and provides tips for a safer health care stay, which are summarized on an accompanying tip card. The tool kit was developed with assistance from Emmi Solutions, creators of the Emmi interactive patient expectation management program.
Thousands of kits and have been distributed since last fall and have been well received. A limited number of copies are still available. Also, elements of the tool kit can be downloaded from the foundation’s Web site. For details, visit www.ashrmfoundation.org or call (312) 422-3980.
AHA certification – ‘a premier credential’
A majority of certificants holding credentials from the AHA Certification Center (AHA-CC) sees AHA Certification as the premier credential for their professions. Because of this perceived significance, an impressive majority of 92 percent plans to renew their AHA Certification.
Those statements are among the findings from two online surveys conducted in September 2005 by the AHA-CC. One survey involved contacting 2,048 AHA Certificants and generated 569 responses, which represents a 28 percent response rate – excellent for such a survey.
The survey crossed all four AHA Certification programs. Numbers of responses by program follow.
NUMBERS OF RESPONSES BY PROGRAM
CREDENTIAL PROGRAM RESPONSES
CPHRM Certified Professional in Healthcare Risk Management 220
CHESP Certified Healthcare Environmental Services Professional 97
CHFM Certified Healthcare Facility Manager 137
CMRP Certified Materials & Resource Professional 110
Not Identified 5
The second online survey involved contacting more than 3,000 potential candidates for AHA Certification programs and generated a usable response rate of slightly more than 8 percent –typical for online surveys.
This article, furnished by the AHA-CC, first addresses major findings applicable for all AHA Certification programs and then focuses on the CPHRM program.
Summary results – all programs
Most AHA Certificants were pleased with their credentials. Following are combined results from the four professions – including percentages of certificants that agreed or strongly agreed with selected statements.
* AHA Certification is an important standard/achievement in the profession – 92 percent.
* The AHA Certification examination is representative of the body of knowledge in my profession – 89 percent.
* If I were hiring for an open position, AHA Certification would be a deciding factor – 73 percent.
* AHA Certification has made a positive difference in my career – 62 percent.
* My facility/company encourages employees to obtain AHA Certification – 55 percent.
* The most important reason that I chose to become AHA- certified is because it is the premier certification – 52 percent.
* My local chapter or AHA personal membership group (such as ASHRM) encourages members to obtain AHA Certification – 52 percent.
Characteristics of AHA Certificants – all programs
The online survey provided some insight about the characteristics of certificants.
* The average age of an AHA Certificant is 50.
* Across programs, certificants are roughly evenly divided between male (46 percent) and female (40 percent) with others (14 percent) not identifying gender. The mix for specific programs differs; most CPHRMs are female, while CHFMs are typically male.
* Certificants tend to be highly experienced, averaging just over 23 years in health care and over 18 years in management, supervision and/or administration.
* Certificants tend to hold senior positions, with 25 percent responsible for multiple departments and 32 percent responsible for entire departments.
* Certificants tend to be highly educated with 5 percent holding doctorates, 30 percent holding master’s degrees and another 29 percent holding baccalaureates.
Benefits of AHA Certification – all programs
Benefits reported by AHA Certificants are identified in the chart below. Benefits related to market impact of AHA Certification may ultimately be the most significant. Selected written responses about such benefits follow.
“The CPHRM is a requirement of employment as a risk manager.”– CPHRM
[My] “job description now requires CMRP for all purchasing agents.” – CMRP
Because many current certificants were examined when programs were relatively new, they may actually have under-weighted the significance of AHA Certification. The executive director of the AHA-CC believes that AHA Certification is playing an important role in the job market and says that importance will grow.
“Many recent job listings identify AHA Certification as required or preferred. I believe reliance on AHA credentials will increase as more and more professionals become certified,” said AHA-CC Executive Director Maribeth Casey.
As additional evidence of the value management is placing on AHA Certification, slightly more than half of certificants responding to the online survey (51 percent) reported that their facility or company covered the cost of the certification examination.
Quality of AHA Certification examinations – all programs
To compile information about examination quality, certificants were asked to evaluate the statement: The AHA certification examination was representative of the body of knowledge of my profession.
The responses of the vast majority of AHA certificants (88 percent) agreed or strongly agreed with that statement – an overwhelming percentage given the variance among health care institutions; 1.6 percent disagreed or strongly disagreed. Further evidence of examination quality came in the form of written comments. Selected comments follow.
“It [CPHRM Certification] is the only certification that directly applies to health care risk management.” – CPHRM
“I promote the CHESP Certification above other certifications as it is based on not only knowledge but experience as well.” – CHESP
Focus on CPHRM responses
Coverage of the CPHRM credential is intended to serve three purposes:
* To identify significant differences from the group of all AHA Certificants, if any;
* To address contributions of ASHRM to the certification process; and
* To address barriers to AHA Certification identified by health care risk managers not yet certified.
Differences in responses from CPHRMs from other AHA Certificants were relatively minor in most respects. The largest difference was in gender, with a large majority of CPHRMs being female. Other findings included:
* CPHRMs tended to have more formal education than other certificants.
* Very few CPHRMs (under 2 percent) used online education to prepare for the certification examination.
* CPHRMs tended to consider other certifications slightly less frequently than other certificants.
In some respects, the most valuable information produced by the survey came from written comments. Themes covered in comments include:
* Support for certification, including the role that ASHRM plays in initiating and supporting AHA Certification;
* Importance of achieving recognition for AHA Certification from the “C suite” and human resources departments; and
* Suggestions for improving the certification process.
Selected examples of such comments from CPHRMs follow.
“In our group of risk managers, it is a certification that everyone is looking at and working toward.”
“The American Society for Healthcare Risk Management has been encouraging membership to reach for this goal for several years. It also offers a prep course that includes a helpful study guide, suggested readings, Web sites, etc.”
“I am proud of having the certification. I feel that it distinguishes me from others in my field and that it shows my commitment to the profession.”
“AHA needs to do some significant work to increase both the chatter about the certification and the knowledge level of the health care community as to its worth.”
“I regretted not being able to learn which questions I missed on the exam.”\ (Note: Providing the information suggested would impact security of the certificationexamination. The suggested approach is employed for the CPHRM Self-Assessment Examination.)
“I liked the fact that you could renew through continuing education and did not have to take the exam again.”
Risk managers who have yet to earn CPHRM status recognize the value of the credential. Of 89 such individuals who responded to the online survey, most were aware of AHA Certification and 81 percent planned to become certified. Further, 63 percent agreed or strongly agreed with the statement: AHA certification would have a positive effect on my career.
Percentages listed may actually understate support for AHA Certification among the target audience, because 14 percent of those who responded did not answer the specific question on the subject. Reasons selected for not yet being certified included:
* Being new to the field – 19 percent;
* Being unaware of AHA Certification – 12 percent;
* Not being encouraged by the facility to seek AHA Certification – 6 percent;
* Cost – 4 percent;
* Inconvenience of testing sites – 4 percent; and
* Difficulty of the certification examination – 3 percent.
For more information, visit the AHA Certification Center’s Web site at www.aha.org/certification.
The Certified Professional in Healthcare Risk Management designation provides a credential that verifies a broad-based knowledge of risk management. Certification elevates professionals in an increasingly competitive marketplace.
Congratulations to recent CPHRM achievers:
Nancy C. Argo, Arlington, TX
Wayne L. Atkinson, Lewisburg, WV
Donna Kay Atwater, Pinehurst, NC
Carolyn Pierce Bell, Los Angeles
Dalena Louise Berrett, Nashville, TN
James Benjamin Burke, Nashville, TN
Deborah Ann Caldwell, Aurora, OH
Marie L. Ekstrom, Redlands, CA
Sheila M. Frawley, North Port, FL
Ann D. Gaffey, Arlington, VA
Nancy C. Grenier, Lewiston, ME
David W. Kain, San Antonio, TX
Linda M. Keldsen, Ellicott City, MD
Mary Brigid Krizek, Rockville, MD
Ava Dean Lancaster, Nashville, TN
William Joseph McDonough, Boston
Randy Dean Perrin, Sarasota, FL
David Petrous, Danville, IN
Rebecca Pettit, Statesville, NC
Kimberli M. Poppe-Smart, Anchorage, AK
Theresa L. Ramey, Kalaheo, HI
Vince M. Rice, St. Louis
Carolyn Williams Robey, Pearland, TX
Stephanie A. Rogers, Pinehurst, NC
Laurette Anne Salzman, Madison, WI
Lisa T. Simm, Waterville, ME
Kelley Jeanne Smith, Whitestone, NY
Deborah S. Stephens, Grand Rapids, MI
Dorothy E. Thielman, Coeur d’Alene, ID
Brenda Sue Thompson, Ripley, WV
Margaret M. Towers, Mount Vernon, NY
Kathi B. Vestal, Pinnacle, NC
Torsten C. Waurig, Redding, CA
Robin Lynn Wessels, Columbia, MD
Inga von Witcher, Cabot, AR
Carol Yovin, North Merrick, NY
The CPHRM designation is awarded based on participants meeting eligibility requirements and passing an examination.
For details about the designation, download the newly updated (June 2006) CPHRM Candidate Handbook from the AHA Certification Center via www.aha.org/certification or call (312) 422-3715.
Preparing for the CPHRM Exam
The CPHRM Examination Study Guide (3rd Edition) covers exam content in a flexible format to meet the needs of anyone who has not yet purchased a study guide or does not plan to take a CPHRM Examination Preparation Course. Content was adapted from the Risk Management Handbook for Health Care Organizations (4th Edition). The study guide is available for purchase at (800) 242-2626; request item 178836.
Barton Modules provide solid professional foundation in July
All three sessions of the Barton Certificate in Healthcare Risk Management Program are set for July in Chicago. The Essentials in Healthcare Risk Management Module (July 24-26) is the educational foundation for major functions needed for effective health care risk management. The Applications in Healthcare Risk Management Module (July 26-28) provides in-depth discussions for professionals with 1 to 5 years of experience, and the Advanced Forum Module (July 24-26) facilitates critical thinking and analysis of current issues for risk management professionals with more than 5 years of experience. Updated Modules registration information, including space availability and agendas, is available on the ASHRM Web site (www.ashrm.org, Education section, Barton Modules page).
Interest Networks deliver specialized information
ASHRM’s Patient Safety Interest Network and Risk Financing & Claims Administration Interest Network deliver timely content and resources tailored according to risk managers’ primary needs, whether they are focused on patient safety efforts or on traditional risk management issues of risk financing and claims administration. ASHRM members may choose to supplement their regular ASHRM membership with either or both of the ASHRM Interest Networks for an annual membership fee of $25 for each Interest Network. Join by using the ASHRM membership form and selecting the Interest Network options near the bottom. For details, visit www.ashrm.org, e-mail ashrm@aha.org or call (312) 422-3980.
Learners set their own pace with online risk financing program
Learners can work at their own pace with ASHRM’s online education program, “Risk Financing for Risk Managers.” The program’s first course, “Fundamentals of Health Care Risk Financing,” addresses basic elements of risk financing. It explains how risk financing fits into the risk management process in an easy-to-navigate online environment with pre- and post-tests, examples of real-world risk financing situations, definition of terms, sample documents and more. The fee is $99. For program details, visit www.carelearning.com. Click on “Courses,” then select the Risk Management category. Payments must be made by credit card to CareLearning, not to ASHRM. Call ASHRM with questions at (312) 422-3980. This program is qualified for 1.2 contact hours of continuing education credit toward ASHRM designations of FASHRM (Fellow) and DFASHRM (Distinguished Fellow) and CPHRM renewal (Type Code: 3; Content Code: 3).
Adjustments help ensure delivery of e-News
ASHRM’s weekly e-News is a popular benefit of membership and the easiest way to stay up-to-date on risk management news, members-only products and program discounts, information on educational offerings, and more. As long as ASHRM has a current e-mail address (which members can confirm by checking the online Member Directory at www.ashrm.org), e-News is delivered to the e-mail server for that address every Friday. Increased e-mail security, however, may prevent some members from receiving this service. Members who are not receiving e-News may contact ashrm@aha.org or (312) 422-3985 for assistance.
Chapters can earn $25 rebates for new ASHRM members
ASHRM is offering its affiliated chapters a chance to help ASHRM grow and to earn valuable incentives for their chapters with the 2006 Chapter Rebate Program. For each local chapter member who joins the national organization from August 2005-July 2006, the chapter will receive a $25 rebate. Participation is easy: To qualify, a chapter must submit its membership roster electronically to ASHRM by Aug. 11. For details, visit the ASHRM Web site (www.ashrm.org, "Chapters" logo).
ON THE MOVE
William J. McDonough, CPHRM, to managing principal, Integro Insurance Brokers,
Boston
Vivian B. Miller, CPHQ, CPHRM, LHRM, to research project manager,
Maryland Patient Safety Center, Elkridge, MD
Make sure your peers know where to find you now. Send notices for On the Move to ashrm@aha.org Member contact details may be found in the ASHRM member directory at www.ashrm.org (login required).
