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The evolution of risk managers
By Laura Averette, RN, MSN, CPHRM,
and George Struzynski, BS, MBA, MHA, LHRM, LCA
Nothing is safe if safe means free from risk, and yet as the theme of this year’s National Health Care Risk Management Week declares, patient safety is the quest in health care. As specialists in “what could go wrong,” risk management professionals are focusing on the quality of health care. They are developing their traditional role by measuring and assessing exposures in their organizations.
Today’s risk management professional continues to tackle some of the principal tasks that yesterday’s risk managers faced:
* Loss prevention efforts such as development of procedural and educational strategies to decrease the frequency and severity of adverse health care events.
* Loss reduction efforts including management of events that make it through loss prevention defenses.
What’s new? These tasks are growing in scope. Risk managers are looking beyond their traditional roles and forward to the development of safer systems in the new “age of safety.”
Increases in the frequency of claims and damage judgments have added new importance to the claims management part of the risk managers’ job. While there always has been involvement with those in the insurance industry, the increase in claims has led to many more routine contacts with insurance industry representatives as well as defense and plaintiff’s attorneys and judges. Mediations, trials and negotiations have become increasingly common.
The risk managers’ claim responsibility in the past did not focus on patients’ concerns. Instead, it aimed to give organizations a greater sensitivity to law and an ability to recognize liability. This highly focused responsibility, however, yielded a wealth of data on daily patient care activities – data to be mined to recognize potential claims earlier. Armed with these data, risk managers are now becoming experts about what
could go wrong and the cost of
potential liability. They can attain greater accuracy in anticipating the response of the insurer and the community, which in turn can lead to improved patient care.
Providing the backbone
Studying medical and clinical occurrences can help risk managers devise non-punitive reporting and surveillance systems that warn of events and help assess risk before actions lead to harm. Risk management reporting and surveillance protocols, policies, procedures and technology all help form the statistical “backbone” for their health care organizations’ quality, patient satisfaction and management operations programs.
In addition, new laws and regulations are defining the quality of health care. With this elaboration of the definition of quality, risk managers have gained responsibility to determine new risks. They deliver the information that directs accrediting agencies in the development of goals and standards. Meanwhile, the federal government is wielding fraud and abuse directives that affect the relationship of physicians to hospitals. State reporting laws also are bringing organizational risk processes under public scrutiny. Case and statutory law are changing the type of medical information hospitals collect and how it is distributed. Insurance companies have added contractual requirements in reporting that affect the way risk managers handle their work and the way patient safety information is collected and recorded.
All of these factors and opinions have created new definitions of diagnosis, treatment, care and follow-up activities that expand risk managers’ role in health care.
Compliance professionals
Many health care risk managers serve as their organizations’ regulatory adviser. They are involved in educating staff in the critical areas of sexual harassment and discrimination, setting up auditing processes to prevent Medicare and Medicaid billing fraud, reviewing hospital contracts to assure compliance with Department of Health and Human Services’ Office of Inspector General guidelines and cautions, and making certain that those in a position to do so are not taking advantage of the hospital for personal gain.
While those in charge of the overall management of a health care enterprise integrate the various organizational parts with the single objective of bringing a patient to the highest level of health, risk managers find ways to keep the enterprise from deviating from the standard of care as much as is scientifically and humanly possible.
Risk managers don’t design or deliver health care; they minimize the risks in the delivery system. They don’t provide the clinical care; they make it safer by training the providers to recognize where the care process could fail.
The ‘standard of care’
While technology and pharmaceutical advances have altered how physicians and nurses practice medicine and clinical care, all of the public and private entities that make rules and reporting demands on the hospitals and providers have consistently challenged the basis of the risk management profession, the “standard of care.”
This standard (composed of standards, actually) is defined by a collection of information relating to the practice of medicine. Traditional legal considerations, benchmarks set by accrediting organizations and evidence-based research outcomes all have added ingredients to the recipes for medical conduct as well as patient diagnosis, care and treatment.
Propelled by new technology and evidence-based clinical management strategies, the standard of care now
defines what is acceptable care and treatment. Because these standards are dynamic, risk managers have been called upon to connect the volume and frequency of standards updates with health care’s ability to provide safe patient care.
Caught in these dynamics, medical care has been facing certain foregone levels of failure. As health policy consultant William Lowrance observed, “[a] thing is safe if its risks are judged to be acceptable”
(Of Acceptable Risk, Science and the Determination of Safety, 1976).
But health care consumers – and risk managers, as well as insurers they deal with – are increasingly reluctant to accept the growing number of failures as the price for modern health care. Organizations can tap risk management’s expertise as adverse event investigators and advocates for change when failures in the standards of care arise. That is how progress can be seen in certain areas of risk over time.
The age of patient safety
Risk management has progressed from a reactive role to a proactive one. The focus has shifted from identifying potential error and addressing it through loss control education and risk transfer to a focus on facilitating organization-wide, multidisciplinary process analysis. The quest: imbedding an environment of safety into the health care system.
To accomplish this, progressive risk managers are utilizing sophisticated investigation and assessment tools to model and predict risk such as failure mode and effect analysis and root cause analysis.
Risk managers’ traditional study of adverse events has led them to two realizations: First, specific information directs attention to individual events that threaten the safety of patients. Second, looked at over extended periods of time, these data form patterns. It is the second realization that is revolutionizing the risk management role in the quest for safe and trusted health care. Health care organizations now realize that studying an adverse event is not simply making note of an interesting detour, but discovering patterns – paths that lead to outcomes. These paths are all part of a system of interconnected activities in the health care environment that are understood and can be more effectively managed.
A unique instrument
The day-to-day proactive role is one where the risk manager can take the position of managerial consultant to all parts and processes of the organization. They can interact with board members, the president and vice presidents; with physicians, surgeons and clinical directors; with front-line nurses and mid-level managers; with non-clinical staff and administration; and, yes, with patients and their families. This is unprecedented access for a single corporate manager … and critical. Unencumbered access can assure leadership that a corporate information and reporting system exists and is providing appropriate, timely information so action can be decisive and effective.
In many ways, the ability of the risk manager to weave throughout the organization makes the position itself a unique instrument of communication. The message is reflected in ASHRM’s mission statement: “To advance safe and trusted patient-centered health care delivery, ASHRM promotes proactive and innovative management of organization-wide risk.”
CPHRM self-assessment program launches July 1
A new online tool is available for preparing for the Certified Professional in Healthcare Risk Management (CPHRM) Certification Exam.
Created by the AHA Certification Center (the people who created the certification exam itself), the new Self-Assessment Exam (SAE) simulates the certification exam in format and content.
The SAE can be an affordable way to become familiar with the online format and the types of questions, as well as identify areas for review before taking the CPHRM Certification Exam. It is aimed primarily at individuals unable to take advantage of CPHRM exam prep sessions that are offered by ASHRM and its affiliated chapters during the course of the year.
The extra value of the SAE comes in the form of pragmatic feedback to test-takers. The test offers rationales for correct and incorrect options, as well as several score reports that highlight the exam topics that they scored well in and those that need improvement.
The 100-question SAE can be an excellent study tool for exam candidates, credentialed practitioners, students and anyone interested in measuring and sharpening their individual knowledge. Also, for those who have earned their CPHRM, taking the SAE earns 5 hours of Continuing Professional Education credit toward the three-year requirement of 45 hours to renew certification.
As a member benefit, ASHRM members save $85 on the SAE assessment fee, paying only $115 (non-members pay $200). For details about the SAE, contact the AHA Certification Center at (312) 422-3713.
Study session and exam offered at conference
The CPHRM exam will be administered Wednesday, Oct. 20, at the ASHRM Annual Conference site in Orlando. The conference administration can be the perfect opportunity to take the CPHRM exam because:
* The exam is a “paper-and-pencil” format, as opposed to online, for those more comfortable with a pencil than a keyboard.
* ASHRM is offering a CPHRM exam prep session on Sunday, Oct. 17. This enables participants to take the exam while the review session information is still fresh in their minds.
Visit www.ashrm.org for details.
To take the CPHRM exam at the ASHRM Annual Conference, participants must submit applications by Sept. 8. The application is included in the Annual Conference advance program mailed to all members in May as well as in the CPHRM Candidate Handbook, found at www.aha.org/certification. Applicants must be sure to indicate that they will be taking the “paper-and-pencil” exam on Oct. 20, 2004. Credit card, company check, cashier’s check or money orders are welcomed (no personal checks, please).
With questions about applying for the CPHRM exam, contact the Certification Center at (312) 422-3713.
NEW CPHRMS
The Certified Professional in Healthcare Risk Management designation provides a credential based on a solid assessment that verifies a broad-based knowledge of risk management. Certification elevates professionals in an increasingly competitive marketplace. For details, call the AHA Certification Center at (312) 422-3715.
Congratulations to recent CPHRM achievers:
Laura M. Averette, Birmingham, AL
Carol M. Block, Marengo, IL
Vicki Rae Bokar , Strongsville, OH
Lori J. Davis , Portland, OR
Carol J. Doyle , Louisville, KY
Pamela Jahn-Derian , Woodland Hills, CA
Janna S. Jones , Elberton, GA
Cheryl Louise Long , Bangor, ME
Scott D. Monahan , Brownsville, VT
Dawn G. Pfohl , Oxford, OH
Jay J. Purcell , Bangor, ME
Diane Raczykowski , Flossmoor, IL
Mary Patrice Tevlin , Grand Rapids, MI
Heath A. Thompson , Ocean Springs, MS
Karen S. Uyeda , Honolulu
Marcia Ruth Vixie , Wenatchee, WA
Rosemary Waitkus , Madison, WI
The CPHRM is a professional designation that is awarded based on participants meeting eligibility requirements and passing an examination. For details about the CPHRM designation, download the CPHRM Candidate Handbook from the AHA Certification Center via www.aha.org/certification or call (312) 422-3715.
Updated CPHRM Exam Study Guide available
The newly released 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 Session.
Much of the content was adapted from the new Risk Management Handbook for Health Care Organizations (4th Edition). Also, practice tests in the study guide correspond with the CPHRM content outline. Study guide users generally review the material in the study guide, take the practice exams, and determine which areas they should review further by using the handbook.
The study guide is available for purchase via the AHA Online Store at an ASHRM member price of $50. Visit www.ashrm.org (Members Services, Tools & Products) or call (800) AHA-2626 and ask about item 178836.
Chapter News
Kentucky slates CPHRM study session
The Kentucky Society for Healthcare Risk Management (KSHRM) will host a CPHRM examination preparation session from 8:30 a.m.-4:30 p.m. June 16 at Kentucky Hospital Association/Coverage Options Associates in Louisville. Joyce Benton and Robert Bunting will review topics covered on the exam. The cost is $50 for KSHRM members, $75 for non-members. Participants can also purchase the CPHRM Examination Study Guide (3rd edition) at a discounted price of $35. To register, contact David Hester at (502) 339-5703 or dhester@apassurance.com.
Rebate program offers big rewards
Through its Chapter Rebate Program, ASHRM offers $10 for each chapter member who becomes a new member of the national organization. Local chapter members who join ASHRM will enjoy benefits such as networking, professional development, educational opportunities and discounts, to name a few, and bring their chapter extra revenue. Any local chapter member who has joined ASHRM between July 1, 2003, and June 30, 2004, is eligible for the rebate. To request a rebate, chapters should provide a current chapter membership list, including contact information, to Nancy Neff at nneff@aha.org.
Leadership workshop Oct. 16 in Orlando
Save the date for this year’s Chapter Leadership Workshop. ASHRM will host the workshop from 1-3 p.m. Saturday, Oct. 16, prior to the start of the Annual Conference & Exhibition, Oct. 17-20 in Orlando. The meeting is an excellent opportunity for chapter leaders to exchange ideas and network with other leaders. All current presidents and presidents-elect are invited; an agenda will be announced soon.
CALENDAR
The Greater Houston Society for Healthcare Risk Management will hold a general meeting at 11:30 a.m. Tuesday, June 1, at Trevisio’s Restaurant. Shauna Clark, attorney at Fulbright & Jaworski, will give an employment law update. The cost is $25 for members, $30 for non-members. To register, contact Kurt Nelson by fax at (713) 297-0710 or e-mail at lrasco@mhn-law.com.
The Connecticut Society for Healthcare Risk Management will meet at 10 a.m. Tuesday, June 15, at the Yankee Silversmith in Wallingford. For details, contact Lynda Nemeth at (203) 852-2732 or lynda.nemeth@norwalkhealth.org.
ELECTIONS
The California Society for Healthcare Risk Management (CSHRM) recently announced its 2004-2005 chapter officers: Brandy Gass, president; Regina Vukson, president-elect; Debbie Aspling, secretary; and Victoria Rollins, treasurer.
The Chicagoland Healthcare Risk Management Society (CHRMS) recently elected officers for 2004-2005: Rae Hibner, Loyola University Medical Center, president-elect; Mary O’Grady, Advocate Illinois Masonic Medical Center, secretary; and Pauline Jakubiec, The Cunningham Group, Pam Para, ASHRM, and Bob Tarver, Ingalls Health System, executive board members.
Updated news, resources online
The Chapters Services section of the ASHRM Web site features special announcements, an updated calendar, a chapter Web sites listing, chapter finder, information on sponsoring a local CPHRM examination preparation session and helpful resources such as links to the chapter handbook and chapter affiliation guide.
Visit the section at www.ashrm.org.
Publicize chapter events here and let other ASHRM members in your state know what your chapter is doing. Submit chapter news and updates to Nancy Neff, Project Specialist, at nneff@aha.org.
ASHRM UPDATE
All 3 Barton Modules offered in June
Risk managers, insurance and claims professionals, quality managers, safety managers, patient safety officers, administrators, financial/compliance officers, clinicians, attorneys, consultants and other professionals from a wide variety of health care settings can benefit from the Barton Certificate in Healthcare Risk Management Modules. All three modules levels are being offered in Chicago, providing one of the best educational programs of the year. Essentials and Advanced Forum are set for June 28-30 (final offerings for this year); Applications is set for June 30-July 2.
The host hotel is the historic Palmer House Hilton in Chicago’s Loop, located within walking distance of the city’s free Country Music Festival June 26-27 and Taste of Chicago food festival June 25-July 4.
Agendas (including updated start and end times for Applications) and other details are available at www.ashrm.org (Education, Barton Modules).
New resource covers accreditation issues
ASHRM has collaborated with Joint Commission Resources (JCR), an affiliate of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), on a new reference book titled Accreditation Issues for Risk Managers. The 174-page resource is designed to help risk managers in a variety of health care settings better understand the JCAHO accreditation process and integrate it with common risk management practices. It focuses on key accreditation issues, including the National Patient Safety Goals, infection control, medication management, emergency preparedness, pain management and patient rights. It also shares useful examples of risk reduction for a variety of settings.
ASHRM members may purchase Accreditation Issues for Risk Managers at a special price of $58.50 when it is ordered through the AHA online store. Visit www.ashrm.org (Tools & Products) or call (800) AHA-2626 and request item 178851.
