Risk Management Policy and Procedure Discussion

  • Health care organizations have always searched for ways to identify and reduce risks. An organization’s ability to identify and analyze its risk exposure is a determining factor in the effectiveness of its risk management program (Hoarle, 2015). Early identification and analysis are essential. Current health care risk management practices developed in the mid-1970s as a result of a surge in malpractice suits. These suits caused rapid increases in claims costs for the industry and later in insurance premiums. Today, health care delivery systems and organizations realize the value of risk management and have developed formalized programs (Hoarle, 2015). In addition, organizations have established mechanisms to review potential incidents of risk and safety concerns (Pelletier & Beaudin, 2018). While risk management programs are responsible for daily management and risk operations, all health care stakeholders are responsible to participate in activities that will reduce unnecessary risks and improve safety and quality (Hoarle, 2015). This second course assessment consists of two parts. You are to assume the role of a new risk manager within your organization’s risk management department. According to your director, employees lack awareness of the organization’s risk management program. Likewise, departments inconsistently apply risk management principles. As a result of these deficiencies, your director has given you your first assignment.

    Part One: Risk Management Policy and Procedure

    Your director has asked you to write a formal risk management policy and procedure for the organization.

    Part Two: Application of Risk Management Principles to a Specific Incident

    In addition to the policy and procedure, your director has asked you to apply your knowledge of risk management principles to a specific organizational risk that has occurred. You will select one of the three incidents from the Vila Health: Patient Safety media piece from Assessment 1. These incidents included a patient identification error, a medication error, and a HIPAA/privacy violation. Select the risk that holds the most interest for you. Your director believes that the organization’s newly written risk management policy and procedure, coupled with your analysis from a risk management standpoint of a recent, specific incident that occurred, will help employees (and the organization) recognize how the hospital’s risk management program contributes to the overall organization’s safety and quality improvement efforts.

    References

    Hoarle, K. (2015). Risk management poised to grow as healthcare evolves. Biomedical Instrumentation & Technology, 49(6), 433–435.Pelletier, L. R., & Beaudin, C. L. (2018). HQ solutions: Resource for the healthcare quality professional (4th ed.). Philadelphia, PA: Wolters Kluwer.

    Demonstration of Proficiency

    By successfully completing this assessment, you will demonstrate your proficiency in the course competencies through the following assessment scoring guide criteria:

    • Competency 1: Analyze the quality and performance improvement activities within the health care organization.
      • Propose evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk.
    • Competency 2: Explain the risk management function in the health care organization.
      • Explain the importance of a risk management program to health care organizations.
      • Define key risk management terms.
      • Describe the major risk categories in a health care organization, along with their corresponding risk identification techniques.
    • Competency 4: Apply leadership strategies to quality improvement in a health care organization.
      • Analyze the risk manager’s role in effective management of the organization’s risk management program.
    • Competency 5: Communicate in a manner that is scholarly, professional, and respectful of the diversity, dignity, and integrity of others and is consistent with health care professionals.
      • Write a clear, organized risk management policy and procedure that is generally free of errors and is reflective of professional communication in the health care field.
      • Provide citations and title and reference pages that conform to APA style and format.

    Preparation

    To help prepare for successfully completing this assessment:

    • Conduct independent research on policy templates. You will find multiple policy templates from which to choose as you write your risk policy and procedure.
    • Select one of the organizational risks from the Vila Health: Patient Safety simulation from Assessment 1. These included a patient identification error, a medication error, and a HIPAA/privacy violation. For Part Two of your assessment you will conduct an in-depth analysis of the organizational risk you selected.

      Instructions

      Part One: Risk Management Policy and Procedure (3–4 pages)

      As the new risk manager in your health care organization, your director has assigned you responsibility for drafting the organization’s risk management policy and procedure. This assignment stemmed from your director’s perception that employees lacked knowledge and awareness of risk management’s contribution to furthering the organization’s safety and quality improvement efforts. Likewise, your director also saw evidence that departments within the organization were inconsistently applying risk management principles to their daily work practices.The guidance you have received from your director about writing this policy and procedure is that it needs to include all of the following headings. It also needs to answer all of the questions underneath each heading:

      • Purpose Statement:
        • How can a risk management program help this organization advance its strategic safety and quality goals?
      • Key Risk Management Terms:
        • What is the definition for each of these risk management terms?
          • Risk prevention.
          • Risk reduction.
          • Regulatory compliance.
          • Patient safety.
          • Adverse event.
          • Near miss.
      • Risk Categories and Risk Identification Techniques:
        • What are the major risk categories in health care? In your answer, be sure to explain each risk category and to provide relevant examples from the literature to illustrate your points.
        • What risk management strategies will the organization use to identify potential organizational risks? Be sure your narrative identifies and describes such risk identification techniques as concurrent, retrospective, incident reporting, and previous trends. ‹Note: These are only a few of the risk identification techniques to address in your policy and procedure. Be sure to include other examples you are aware of from your professional experience or from reviewing your suggested resources.
        • What are examples of risk categories and their appropriate corresponding risk identification techniques? For example, coding errors are a type of financial risk. Retrospective auditing is the risk identification technique used to identify this risk type.
      • Risk Manager’s Role in Program Implementation and Compliance:
        • What is the risk manager’s role in risk management program implementation and compliance?
        • How can a risk manager impact effective management of the organization’s risk management program?
        • What is one example from the literature that shows how the risk manager role can positively impact a health care organization’s management of its risk management program?
      Part Two: Application of Risk Management Principles to a Specific Incident (3–4 pages)

      To further help employees and the organization at large see risk management’s contribution to helping the organization achieve its safety and quality goals, your director has asked you to analyze and apply risk management principles to a recent incident that occurred in the organization. Your director has asked you to include all of the following headings in your analysis and to address all of the questions underneath each heading.

      • Risk Description:
        • Which potential risk to your organization from the Vila Health: Patient Safety simulation are you analyzing? These included patient identification error, medication error, and a HIPAA/privacy violation.
      • Risk Implications:
        • What are the risks to patients, employees, and to the organization if this particular risk is not addressed? In other words, what could happen if the organization chooses to do nothing?
      • Risk Identification:
        • What risk management strategies and techniques will the organization employ to identify this type of risk in the future? For example, will the organization identify this type of risk by analyzing incident report data? What other strategies might the organization employ to identify the risk? Be sure to include your rationale for choosing the particular strategy(ies).
      • Risk Reduction/Elimination:
        • What risk management best practices could the organization employ to eliminate or reduce the risk in the future? For example, if you plan to identify the risk by analyzing incident report data, would you conduct a drill down to determine what is causing the risk? What other best practices might you employ? Consult your suggested resources for guidance on best practices for eliminating and reducing risk.
        • What steps would you take to implement your plan to eliminate or reduce your selected risk?

      Additional Requirements

      • Length: Your risk management policy and procedure assessment will be 6–8 double-spaced pages, not including title and reference pages.
      • Font: Times New Roman, 12-point.
      • APA Format: In the health care environment, typically a policy and procedure and analysis document would not be written according to APA style and format. To make this assessment as authentic as possible to what you might actually encounter in the workplace, the body of your assessment does not need to conform to APA guidelines. Do make sure that it is clear, persuasive, organized, and well written without grammatical, punctuation, or spelling errors. At the same time, health care is an evidence-based field. As such, your title and reference pages need to conform to APA format and style guidelines. Likewise, you also must cite your sources according to APA guidelines. Your leaders may question you about the sources of the information you are providing them.
      • Scoring Guide: Please review this assessment’s scoring guide to ensure you understand how your faculty member will evaluate your work.
    • SCORING GUIDE

      Use the scoring guide to understand how your assessment will be evaluated.VIEW SCORING GUIDE

    • CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
      Propose evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk. Does not propose evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk. Attempts to propose evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk, but recommendations are not always evidence based or appropriate for the particular risk. Omissions and/or errors exist. Proposes evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk. Proposes multiple evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk. Includes multiple examples, specifics, and references to the professional literature.
      Explain the importance of a risk management program to health care organizations. Does not explain the importance of a risk management program to health care organizations. Attempts to explain the importance of a risk management program to health care organizations; however, omissions and/or errors exist. Explains the importance of a risk management program to health care organizations. Provides a comprehensive explanation of the importance of a risk management program to health care organizations. Includes multiple examples, specifics, and references to the professional literature.
      Define key risk management terms. Does not define key risk management terms. Attempts to define key risk management terms; however, omissions and/or errors exist. Defines key risk management terms. Provides comprehensive definitions of key risk management terms. Definitions include multiple examples, specifics, and references to the professional literature.
      Describe the major risk categories in a health care organization, along with their corresponding risk identification techniques. Does not describe the major risk categories in a health care organization, along with their corresponding risk identification techniques. Attempts to describe the major risk categories in a health care organization, along with their corresponding risk identification techniques; however, omissions and/or errors exist. Describes the major risk categories in a health care organization, along with their corresponding risk identification techniques. Describes the major risk categories in a health care organization, along with their corresponding risk identification techniques. Includes multiple examples, specifics, and references to the professional literature.
      Analyze the risk manager’s role in effective management of the organization’s risk management program. Does not analyze the risk manager’s role in effective management of the organization’s risk management program. Attempts to analyze the risk manager’s role in effective management of the organization’s risk management program; however, omissions and/or errors exist. Analyzes the risk manager’s role in effective management of the organization’s risk management program. Provides a comprehensive, accurate analysis of the risk manager’s role in effective management of the organization’s risk management program. Includes multiple examples, specifics, and references to the professional literature.
      Write a clear, organized risk management policy and procedure that is generally free of errors and is reflective of professional communication in the health care field. Does not write a clear, organized, risk management policy and procedure that is generally free of errors and is reflective of professional communication in the health care field. Attempts to write a clear, organized, risk management policy and procedure that is generally free of errors and is reflective of professional communication in the health care field; however, significant omissions and/or errors exist. Writes a clear, organized risk management policy and procedure that is generally free of errors and is reflective of professional communication in the health care field. Writes a clear, organized, and error-free risk management policy and procedure that is reflective of professional communication in the health care field.
      Provide citations and title and reference pages that conform to APA style and format. Does not provide citations and title and reference pages that conform to APA style and format. Attempts to provide citations and title and reference pages that conform to APA style and format; however, omissions and/ errors exist. Provides citations and title and reference pages that conform to APA style and format. Provides citations and title and reference pages that conform to APA style and format, without errors.

    Expert Solution Preview

    Introduction:
    As a medical professor in charge of designing college assignments and answers for medical college students, the topic of risk management is of critical importance. In this assessment, we will examine the importance of early identification and analysis of risk exposure within health care organizations. Additionally, we will propose evidence-based risk management strategies and techniques to identify and eliminate or reduce a particular risk.

    Part One: Risk Management Policy and Procedure
    Risk management is a critical factor for the success of any health care organization. In order to address the lack of awareness and inconsistent application of risk management principles within our organization, a formal risk management policy and procedure is required.

    Purpose Statement:
    The purpose of our risk management program is to advance the organization’s strategic safety and quality goals by identifying, assessing, and controlling risks to patients, employees, and the organization.

    Key Risk Management Terms:
    In order to clearly communicate the policy and procedure, key risk management terms must be defined:
    – Risk prevention: actions taken to prevent a risk from occurring.
    – Risk reduction: actions taken to decrease the severity or impact of a risk if it occurs.
    – Regulatory compliance: adherence to laws, regulations, and standards relevant to the organization.
    – Patient safety: actions taken to protect patients from harm.
    – Adverse event: a harmful or negative outcome for a patient, employee, or the organization.
    – Near miss: an event or situation that could have resulted in harm but did not.

    Risk Categories and Risk Identification Techniques:
    There are several major risk categories in health care, including clinical, financial, legal, and reputational risks. For each category, the policy and procedure should provide relevant examples from the literature to illustrate each risk category.

    To identify potential organizational risks, several techniques can be used, such as:
    – Concurrent: identifying risks in real-time during care delivery.
    – Retrospective: reviewing past events to identify risks and opportunities for improvement.
    – Incident reporting: capturing and analyzing data related to reported incidents.
    – Previous trends: analyzing data to identify trends and patterns in risk exposure.

    Furthermore, in the policy and procedure, examples of risk categories and their appropriate corresponding risk identification techniques should be outlined. For example, coding errors are a financial risk, and retrospective auditing is the risk identification technique used to identify this type of risk.

    Risk Manager’s Role in Program Implementation and Compliance:
    The risk manager plays a critical role in the implementation and compliance of the risk management program. They are responsible for monitoring regulatory changes, identifying potential risks, and developing and implementing risk management strategies.

    A risk manager can impact effective management of the organization’s risk management program by collaborating with other department leaders, establishing a culture of safety, and ensuring all staff members receive education and training on risk management principles.

    An example of a risk manager positive impact on a healthcare organization’s management of its risk management program is through the development of a patient safety committee. This committee can provide a platform for open communication, collaboration, and sharing of best practices related to risk management.

    Part Two: Application of Risk Management Principles to a Specific Incident
    To apply risk management principles to a specific incident, we will select one of the three incidents from the Vila Health: Patient Safety simulation from Assessment 1. We will analyze the incident from a risk management standpoint and provide recommendations to eliminate or reduce the risk.

    Risk Description:
    We will analyze the patient identification error from the Vila Health: Patient Safety simulation.

    Risk Implications:
    The risks to patients, employees, and the organization are significant if this risk is not addressed. The patient can receive the wrong treatment, and the employee can lose their license or face legal action. Moreover, the organization can face reputational damage, increased expenses, and loss of revenue.

    Risk Identification:
    To identify this type of risk in the future, the organization needs to implement a multi-step identification approach. The approach includes concurrent identification, incident reporting, and retrospective analysis. Furthermore, the organization can implement mandatory patient identification protocols and ensure staff members are trained and educated on best practices.

    Risk Reduction/Elimination:
    In order to eliminate or reduce the risk of patient identification errors, the organization should implement a comprehensive plan. The plan should include regular auditing of patient identification protocols, the creation of a patient identification task force, and mandatory education and training for all staff members.

    In conclusion, a formalized risk management program led by a competent risk manager is essential for health care organizations to identify, assess, and control risk exposure. Through the implementation of a formalized risk management policy and procedure, coupled with knowledge and application of risk management principles for specific incidents, health care organizations can improve safety and quality outcomes for patients, employees, and the organization as a whole.

    References:
    Hoarle, K. (2015). Risk management poised to grow as healthcare evolves. Biomedical Instrumentation & Technology, 49(6), 433–435.

    Pelletier, L. R., & Beaudin, C. L. (2018). HQ solutions: Resource for the healthcare quality professional (4th ed.). Philadelphia, PA: Wolters Kluwer.

    Expert Solution Preview

    Introduction:

    Healthcare organizations face various risks, from financial losses to patient safety mishaps. Effective risk management programs enable such organizations to identify, analyze, and mitigate potential risks that may impact the organization’s performance. This assessment requires the design of a formal risk management policy and procedure for an organization and the application of risk management principles to a specific incident. This paper describes the policy and procedure for managing risk and applies the same principles to one of the identified risks.

    Part One: Risk Management Policy and Procedure

    Purpose Statement:

    The risk management program of our organization aims to promote patient safety, minimize potential financial losses, and ensure regulatory compliance in healthcare delivery. This policy facilitates the implementation of the risk management program to advance the organization’s strategic safety and quality goals.

    Key Risk Management Terms:

    Risk prevention refers to the proactive approach taken by healthcare organizations to mitigate potential risks that may threaten the safety and wellbeing of patients, employees, and visitors. Risk reduction implies reducing the likelihood or severity of an adverse event or risk. Regulatory compliance refers to the organization’s adherence to federal, state, and local regulations that govern healthcare delivery. Patient safety refers to the measure taken by healthcare organizations to prevent harm, injury, or death to patients. Adverse event refers to any deviation from the expected, including adverse drug reactions, medical errors, or patient falls. The near-miss refers to any potential adverse event that was detected and corrected before causing harm.

    Risk Categories and Risk Identification Techniques:

    Healthcare risks cut across various categories, including clinical, financial, legal, operational, and strategic risks. Clinical risks may include falls, infections, medication errors, and wrong-site surgeries. Financial risks may include fraud, billing and coding errors, and inadequate revenue. Legal risks may include malpractice suits, HIPAA violations, and labor disputes. Operational risks may involve inadequate staffing, supply chain disruptions, or equipment failure. Strategic risks may include market competition, changing regulations, and changes in reimbursement policies. The organization will identify potential organizational risks using various techniques, including retrospective, concurrent, and prospective risk identification. Incident reporting and analysis, an investigation of near-miss events and trends, and risk assessments are additional techniques.

    Risk Manager’s Role in Program Implementation and Compliance:

    The risk manager is responsible for developing, implementing, and monitoring the organization’s risk management program. The risk manager’s role involves identifying potential organizational risks, developing policies, and procedures to manage identified risks and conducting risk assessments, investigations, and corrective actions. The risk manager also collaborates with other healthcare personnel to promote compliance with federal, state, and local regulations that govern healthcare delivery. The risk manager plays an essential role in effective management of the organization’s risk management program by facilitating strategic risk management that aligns with the organization’s objectives, collaborating with other departments to manage risks, and promoting compliance with regulatory requirements.

    Part Two: Application of Risk Management Principles to a Specific Incident

    Risk Description:

    The incident chosen from the Vila Health: Patient Safety simulation is a medication error. This error occurred when a patient was mistakenly given insulin instead of heparin.

    Risk Implications:

    The risk implications of a medication error include potential harm or injury to the patient, negative impact on the reputation of healthcare organizations, legal and financial liabilities, and decreased confidence in the healthcare system.

    Risk Identification:

    The organization can identify medication errors by analyzing incident report data, conducting root cause analysis, and reviewing best practices. By analyzing event report data, recurring medication errors are identified. Interventions are identified, and the impact evaluated. Root cause analysis helps identify the factors contributing to medication errors. Reviewing best practices identifies the reasons behind successful risk management efforts in other organizations.

    Risk Reduction/Elimination:

    The organization can eliminate or reduce medication errors by design of computerized physician order entry (CPOE) systems that support safe medication order entry, coordinate medication administration, and link with electronic medication administration record (EMAR) that meet the “five rights.” End-user training and education provide end-users with the knowledge and skills necessary to use CPOE systems effectively. Utilizing available technology for bar-code verification of correct patient and medication administration contributes to further reduction of medication errors.

    Implementation Plan:

    The implementation plan includes CPOE systems, end-user education, and bar-code verification system. The implementation plans must involve the collaboration of the IT department and other stakeholders, including physicians, nurses, and pharmacy personnel. Training and orientation sessions for end-users are carried out before the implementation. Monthly and annual reviews and amendments to this CPOE system implemented during the yearly reviews. Staff performance evaluations to ensure that this plan is being properly applied.

    Conclusion:

    Effective risk management programs facilitate an organization’s ability to identify, analyze, and mitigate potential risks that may impact the organization’s performance. Regular reviews, monitoring, and continuous improvement are integral to maintain and improve a risk management program. Healthcare providers should work towards preventing the occurrence of risks by integrating measures to mitigate and prevent them from materializing. These factors ensure better outcomes and safety of patients, workers, and visitors to the healthcare organization.

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