Risk Management Handbook for Health Care Organizations, Student Edition

Exhibits, Figures, Tables, and, Photos ix

The Contributors xiii

Preface xxvii

About the Book xxix

ONE Development of a Risk Management Program 1

Learning Objectives 1

Risk Management Program Development 3

Key Structural Elements of the Risk Management Program 4

Scope of the Risk Management Program 8

The Risk Management Process 13

Evolution of the Risk Management Program 21

Selecting an Appropriate Risk Management Program Structure 22

Assessing Areas of the Organization That Need Risk Management 23

Key Components for Getting Started 26

Writing a Risk Management Program Plan 27

Achieving Program Acceptance 27

TWO The Health Care Risk Management Professional 31

Learning Objectives 31

The Risk Manager’s Job: Functional Areas of Responsibility 33

Health Care Risk Management across a Spectrum of Settings 53

Required Skills for the Successful Health Care Risk Management Professional 76

Risk Management Ethics 77

A Profile of the Health Care Risk Management Professional 78

Education and Professional Recognition Programs 78

THREE Patient Safety and the Risk Management Professional 87

Learning Objectives 87

The Scope of Medical Errors 89

Seeking Solutions: What Are the Causes of Medical Errors? 91

FOUR Health Care Legal Concepts 115

Learning Objectives 115

Legal Issues Common to All Health Care Providers 116

Legal Issues Related to Specific Health Care Providers 134

FIVE Governance of the Health Care Organization 157

Learning Objectives 157

Essential Responsibilities of the Hospital Board 159

Basic Legal Duties of Health Care Trustees 160

Lessons from the Panel on the Nonprofit Sector 162

Federal Sentencing Guidelines for Organizations 165

The Sarbanes-Oxley Act of 2002 167

The Volunteer Protection Act of 1997 169

Risk Management and the Board 170

The Medical Staff, Risk Management, and the Board 175

SIX Early Warning Systems for the Identification of Organizational Risks 181

Learning Objectives 181

Early Identification of Exposure to Loss 182

Food and Drug Administration 206

Institute for Safe Medication Practices, United States

Pharmacopeia, and National Coordinating Council for Medication Error Reporting and Prevention 208

Medical Event Reporting System—Transfusion Medicine 212

Intensive Care Unit Safety Reporting System 212

Pittsburgh Regional Healthcare Initiative 212

Other Voluntary Programs 212

Standardizing a Patient Safety Taxonomy:

The National Quality Forum 213

Protecting Sensitive Information 213

SEVEN the Risk Management Professional and Medication Safety 219

Learning Objectives 219

Latent and Active Failures 220

Systems Thinking 221

Risk Management: A Prioritizing Approach 252

Eight Ethics in Patient Care 261

Learning Objectives 261

Ethical Principles and Moral Obligations 263

Research 263

Institutional Review Boards 266

Patient Self-Determination Act 275

“Do Not Resuscitate”: Withholding or Withdrawing Treatment 277

NINE Documentation and The Medical Record 287

Learning Objectives 287

Documentation 291

Record Retention 310

Release of Records 310

Ownership of Medical Records 311

Medical Record Audits 312

Documentation and Risk Management 313

Emerging Risk Exposures 320

The Risk Management Professional’s Role 321

TEN Statutes, Standards, and Regulations 327

Learning Objectives 327

Patient Care 328

Medicare Modernization Act 331

Medical Staff 332

Life Safety Code 350

Federal Health Insurance Laws and Regulations 354

Tort Reform 357

Policy and Procedure Manuals 359

Case Law 360

ELEVEN Basic Claims Administration 367

Learning Objectives 367

The Claims Environment 368

The Claims Process 369

The Risk Management Professional’s Responsibilities 371

Regulatory Reporting of Claims 378

TWELVE Introduction to Risk Financing 381

Learning Objectives 381

Risk Financing in the Context of the Risk Management Process 384

Risk Retention 384

THIRTEEN Insurance: Basic Principles and Coverages 395

Learning Objectives 395

Definition of Insurance 396

Specific Types of Insurance for the Health Care Industry 408

FOURTEEN Information Technologies and Risk Management 427

Learning Objectives 427

Risk Management Information Needs 430

Risk Management Information Systems 431

Using Information Systems to Generate Reports 432

Integrating Risk Management, Quality Assurance, and Patient Safety 433

Electronic Mail 434

Internet- and Web-Based Technology 435

Personal Health Record 435

Electronic Health Records and Systems 436

Clinical Information Systems and “Smart” Technologies 437

Infrastructure Technology 440

Point-of-Care Technology 442

Telemedicine 442

Appendix 14.1: IT Glossary for Risk Managers 447

FIFTEEN Risk Management Metrics 451

Learning Objectives 451

Benchmarking Defined 453

Claims 456

Measuring Change 459

Developing New Metrics 461

SIXTEEN Acreditation, Licensure, Certification, and Surveying Bodies 467

Learning Objectives 467

The Consumer Era of Health Care 468

What the Health Care Risk Management Professional Needs to Know 469

Mandatory Surveying Bodies 471

Voluntary Surveying Bodies 475

URAC 489

Appendix 16.1: Accreditation and Licensure Organizations, Surveying Bodies, and Government Agencies 501

SEVENTEEN Emergency Management 503

Learning Objectives 503

The Steps of Emergency Management 505

Prevention 506

Planning and Preparation 511

Implementation and Response 525

Recovery 526

Recommended Web Sites 528

EIGHTEEN Occupational Safety, Health, and Environmental Impairment 529

Learning Objectives 529

Administrative Procedure Act 530

Administrative Enforcement 532

Specific Occupational Safety and Health Issues 535

APPENDIX A A RISK MANAGEMENT PROGRAM (EXAMPLE) 543

APPENDIX B REQUEST FOR RECORDS form (EXAMPLE) 549

APPENDIX C A GUIDE TO MEDICAL TERMINOLOGY 551

GLOSSARY 565

INDEX 623