Risk Management Applications in Hospitals

Risk Management

Applications in Hospitals

The concept, usage and learning of risk management phenomenon are important for all institutions in healthcare industry. The most important purpose of risk management in healthcare industry is learning from errors, it is these human errors that pave the way for us to learn prepare and not repeat these errors again. These errors can lead to a medical incident and the learning from them occurs when these incidents are discussed within teams. Most of these incidents are not discussed as individuals and teams tend to suppress these incidents mainly due to the seriousness it carries for the patient and their loved ones, for medical staff and for the hospital. The medical practice demands perfection in analysis and cure, admitting and dealing with human errors becomes difficult for the medical staff. In order to build confidence in staff to come forth and discuss these incidents there is a need to change internal culture so learning can occur (Allnutt, 1987).

One of the main purposes of risk management in healthcare industry is to deal with the increased cost of insurance premium by creating and adopting risk management practices, systems and techniques. Although a third party liability but if an incident or a complication occurs it results in to a high cost. There are legal requirements that are enforced on hospitals for providing good quality of care and management of patient.

Our operating hospitals have upon them the moral duty for developing an approach that can deal with issues when they arise and for providing quality in patient management by using best practices of risk management. A proactive approach to risk management and dealing with the issue before it occurs is still at infancy in our hospitals (Duckers, 2009).

Taking in to consideration, the purpose, importance and role risk management plays in a hospital we can define it as, ‘ a systematic and on-going controlling process and set of activities that can result in reducing risk for patients to a minimum level’.

A very important step for catering to such risks is predicting possible risk to patients which means that experienced staff remains aware of the adopted model in the wards and designs a process that takes place in these wards. For instance an emergency procedure if defined as a process can indentify certain loopholes that can be catered preemptively. One can also consider the effects of failure of such an adopted process and design alternatives for example if a doctor is not available to look after a patient that is rushed in an emergency nurses can calm down the situation by providing basic medical treatment. Another approach for identifying and managing such risks in a hospital is an active inventory of real risks to patients. First a voluntary incident reporting system can be utilized as a tool for reporting and managing risks based on the theory of Near Miss Management System. Secondly training should be provided to the medical staff on risk management and usability of incident reporting system giving the awareness about the consequences that can result for individual medical staff, patient and the hospital. The crucial step is to encourage medical staff for identifying quality issues without worrying about the consequences beforehand and finally a reporting system on which a dedicated team can deliberate and provide solutions to potential threats and possible incidents. For proactively minimizing occurrence of incidents a set of minimum norms can be developed that each ward shall follow these set of norms include process control and steps for safety of patients. This set of norm should be discussed and agreed upon by doctors and nurses and should also decide responsibility and decision making power to the medical staff.

Once these steps are being adopted, an audit and feedback system is necessary for measuring effectiveness; this audit system should include, Feedback on performance to individual medical staff followed up by counseling session where change to an adopted practice can be suggested to the individual or a particular ward. In identifying and minimizing such risks certain interventions besides a reporting system should also be introduced; these interventions are based on questionnaires filled by a focus group resulting in a manual of knowledge, education sessions, addressing individual concerns and recognition given to those who suggest improvements and participate well in such sessions. (Baram, 2000)

Risk can also be mitigated by using computerized physician order entry instead of hand written entries and prescriptions, adopting bar-code technology and a clinical decision support system provided to doctors can also reduce the risk of unsafe prescriptions. Organization wide safety programs for controlling adverse drug effects, smart pump technology for controlling drug amount and combination before infusion can begin and structured order sheet for preventing medication errors.

In the subject hospital three risks identified were;

1. Medication error, in this instance it was observed that doctors were prescribing drugs to patients by using their own handwritings which can lead to a severe effect. It is said that missing a single decimal point in writing a prescription can result in life-threatening situations an allergic reaction or an adverse effect of multiple drugs can result in medication error and danger to the patient.

2. Another risk identified was related to overall hygiene and cleanliness of the hospital. Hospitals are loaded with bugs themselves, it is becoming common that patients or families going to the hospital pickup various diseases. According to CDC (center for disease control) it was reported that 1.7 million healthcare associated infections occur every year; 22% are by surgical wounds others include infections to urinary tract, lungs and blood diseases that are acquired from the hospital. It is vital to maintain a clean and safe environment for the patients and families as well as maintaining individual hygiene of doctors and nurses. (Wallace, 2009)

3. It was also observed that the patients checking in to the hospital were passive in sharing their medical history or the drug they were using, in such a situation it is the duty of the doctor to assert and provide comfort to the patient and know the history before giving prescription. Patients tend to feel intimidated by the hospital they are also concerned with their own conditions and are emotionally vulnerable. In such situations a patient should always remember that it’s their own life at risk and hence should ask questions and respond to the queries of the doctor. It is also the duty of the doctor to initiate a conversation in a manner where patient feels easy and can respond to general queries from the doctor, using medical jargons by doctors is not ideal in such circumstances.

In mitigating risks hospitals can adopt best practices prevailing in the healthcare industry, consider suggestions from the staff and patients, compile policies / quality standard manuals and code of conduct for its staff. It is vital to educate and train the medical staff and sometimes the patients as well. In providing education and training, it should be made compulsory that every new employee and each interning batch should take a course on safety, hygiene and patient management. Effective communication and management is very important for the medical staff, in this relation hospitals should learn from the corporate business culture and organize trainings on interpersonal and people management skills. Every task should be given importance and hence the staff responsible for maintaining cleanliness and hygiene of the hospital should also be trained and monitored effectively by supervisors and continuous / periodic cleaning activities are recommended.

References

Allnutt, M.F. (1987). Human factors in accidents. British Journal of Anaesthesia, 59:856 — 864.

Baram, M. (2000). “Medical Error And Responsibility In Managed Healthcare,” Safety In Medicine, pp. 231-245

Duckers et al. (2009). Safety and risk management in hospitals. Retrieved 3rd September, 2012 from http://www.health.org.uk/public/cms/75/76/313/578/Safety%20and%20risk%20management%20in%20hospitals.pdf?realName=a1pE7U.pdf

Wallace L. et al. (2009). “Feedback from incident reporting: Information and action to improve patient safety,” Quality and Safety in Healthcare, 18, pp 11 — 21.

Risk Management in Hospitals Page 2


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