Healthcare Risk Management: Safeguarding Patient Care
The healthcare industry is marked by constant evolution. Despite what changes occur, however, safeguarding patient care remains at the heart of every healthcare organization’s mission. Healthcare professionals in risk management roles are responsible for protecting patients even as business operations, reimbursement models, provider shortages, care philosophies and other aspects of the industry rapidly evolve.
With June 15-19 being National Healthcare Risk Management Week, now is a good time to look at the role of risk managers, the work they do and the challenges they’re facing.
More Changes, More Challenges
Change itself is the biggest challenge most healthcare organizations currently face, and at times it approaches chaos levels, says Cora Butler, CEO and Founder of HealthCore Values, which focuses on healthcare risk management. These changes include adjustments to the public payer model that are reshaping Medicare and Medicaid reimbursements, corresponding changes to private insurers’ reimbursement schemes, a renewed focus on value-based purchasing and provider shortages.
The rapid pace of mergers and acquisitions in 2015 is also a challenge to thorough risk management. According to PwC, deal volume in healthcare M&As was up 19 percent in the first quarter, with disclosed value up 92 percent, compared with the first quarter of 2014. Now, says Butler, “instead of a slow and measured hiring process, you’re suddenly moving a whole lot of people around.” As organizations combine their operations, facilities and personnel, old policies and procedures may not address new working environments, leading some people to simply make things up as they go along, thereby increasing risk.
On top of these issues, the risk manager's role itself is changing. People in risk management traditionally looked only at claims and liabilities, says Jaque Mitchell, Risk Manager at Sentara Norfolk General Hospital and Past President of the American Society for Healthcare Risk Management. Now, they are tasked with looking at risk across the entire enterprise: operational, clinical and patient safety, employee safety, strategic risk, human resources, legal and regulatory, a vast increase in the scope of their responsibilities.
Risk Managers Must Change Their Approach
As the healthcare industry navigates these rapid changes, experts say risk managers will need to change their approach to the job. Butler recommends organizations change the way they think about risk management and compliance, and apply it in a broader context. They need to understand levels of risk will vary by organization, department and duties, but no matter the level, risk is something the entire organization needs to address. And healthcare organizations’ boards need to get involved, too, Butler says. “As an enterprise issue, it’s a board issue.”
In addition to addressing risk across the entire organization, healthcare risk managers should also consider the following changes in their approach to risk mitigation.
Risk management will need to be involved in all of a healthcare organization’s different domains, Mitchell says. Risk managers should be incorporated into teams across the organization so they can provide valuable expertise in different departments.
As risk managers take this enterprise-wide approach, they’ll need to be sensitive to different operations and aware of how changes they make may affect other stakeholders, Mitchell says. Working respectfully, but confidently, with other departments establishes the value of risk management for all aspects of healthcare. “Risk managers are not going to know everything about human resources, strategic plans or initiatives, but we’re going to have our experts that can provide a valuable perspective to those operations.”
Take Advantage of Outsourcing Opportunities
Outsourcing some standard risk-management procedures has become a popular way to address a variety of risk management challenges, Butler says. For example, after a merger, if one of the organizations involved didn’t do a good job maintaining background check information or confirming training or accreditations, it can put patients and the organization at risk.
Rigorous background checks can ensure lapsed accreditations, criminal records and other disqualifying events don’t fall through the cracks. Old procedures may have been sufficient for other organizations, but when an acquiring organization brings on a large number of new people who haven’t been screened to its standards, a strong background check policy can help protect patients and the organization.
Educate Other Employees to Think Like Risk Managers
Mitchell recommends healthcare risk management professionals encourage others in their organizations to think like risk managers. Empowering others to address risk management on their own can mean a major culture shift for the organization and will need buy-in from the C-suite, but Mitchell says showing the value risk managers bring to any department can help establish the importance of the role and encourage others to look for risk as they go about their work.
Risk management is essential to all aspects of a healthcare organization’s day-to-day operations. As organizations face a wide variety of challenges in the rapidly changing healthcare environment, risk managers will continue to safeguard organizations’ patients, operations and reputations with their important work.
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