Risk is inherent in healthcare, so as leaders, what can we do to minimize risk, improve safety, and ensure quality outcomes for our patients? Identification of your organization’s specific risks, trending those risks by multiple factors including your vulnerabilities, and then planning mitigation strategies is the core of risk mitigation and injury prevention.
Identification of Risks
Healthcare organizations are required to provide a way for staff to report unanticipated events, errors, and variances. This can be accomplished using an electronic event reporting system or through paper reporting. Systematic reporting that uses a consistent taxonomy and format is an important foundation and sets the framework for grouping events. Ensuring that staff are educated in the use of your reporting system, the types of events to report, and why reporting is important is the backbone of risk identification. Other methods of risk identification include peer review, claims data, and complaint information. Leaders should routinely review all available sources in order to have a clear picture of their organizational risks. Many organizations identify these trends through a patient safety committee. This allows for a legally protected and multidisciplinary review and leads the way for trending and planning.
Establishing Trends
When establishing risk trends there are multiple factors to consider. First, who are the involved parties: inpatients, outpatients, emergency patients, or visitors? Knowing the patient types can help focus your efforts during the prevention planning stage. What types of events are occurring? Establishing broad and consistent categories such as medication related, lab, falls, treatment related, and medical device related help to group the variances. Differentiating between safety events, those that reached and impacted the individual; near misses, events that reached the individual but had no impact; and unsafe conditions, events that never reached the patient but would have impacted the patient is an important trending mechanism and allows you to plan your focus for the events reaching the patients first.
Where events occur is another important trend. Organizations can look at location by department, ambulatory practice, specific units within a department, or specific locations within a unit. Identifying the days, shifts, or holidays during which an event occurs is another important aspect of risk trending. Last, but certainly not least, is the HOW of the event.
How did the injury occur and how did it affect the person(s) involved? Narrative sections of reports can provide a great outline of the event and the actions leading up to the event. Severity ranking using a consistent and defined scale can provide you with trends harm. For example, death, severe harm, moderate harm, mild harm, no harm in conjunction with whether the harm is temporary or permanent.
Planning for prevention
The first step in successful mitigation planning is determining the focus. There are methods by which this can be accomplished. Using the trends you have established in the above steps and then weighting them by the probability that the event will occur again and the impact to the organization allows you to assign a score to each grouping. The scores and the events they correlate with can then be placed in order from highest to the lowest. This is the first step of your risk management plan, identifying the priorities. The next steps are to plan specific strategies to prevent occurrences, implement these strategies, evaluate for desired effect, and roll out successful interventions. The goal is improvement of quality of care and outcomes that results in decreased injury, liability, and losses.
If your organization has risk management related questions or needs, contact Antum Risk at [email protected]
