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Risk Management Handbook for Health Care Organizations, Student Edition

ISBN: 978-0-470-30017-6
672 pages
April 2009, ©2009, Jossey-Bass
Risk Management Handbook for Health Care Organizations, Student Edition (0470300175) cover image

This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for students and those new to the topic, each chapter highlights key points and learning objectives, lists key terms, and offers questions for discussion. An instructor's supplement with cases and other material is also available.

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Exhibits, Figures, Tables, Photographs, and Appendixes.

The Contributors.

Preface.

About This Book.

ONE: Development of a Risk Management Program (Jane J. McCaffrey, and Sheila Hagg-Rickert).

Risk Management Program Development.

Key Structural Elements of the Risk Management Program.

Scope of the Risk Management Program.

The Risk Management Process.

Evolution of the Risk Management Program.

Selecting an Appropriate Risk Management Program Structure.

Assessing Areas of the Organization That Need Risk Management.

Key Components for Getting Started.

Writing a Risk Management Program Plan.

Achieving Program Acceptance.

TWO: The Health Care Risk Management Professional (Jeannie Sedwick).

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

Health Care Risk Management Across a Spectrum of Settings.

Required Skills for the Successful Health Care Risk Management Professional.

Risk Management Ethics.

A Profile of the Health Care Risk Management Professional.

Education and Professional Recognition Programs.

THREE: Patient Safety and the Risk Management Professional: New Challenges and Opportunities (Denise M. Murphy, Katrina Shannon, and Gina Pugliese).

The Scope of Medical Errors.

Seeking Solutions: What Are the Causes of Medical Errors?

FOUR: Health Care Legal Concepts.

Peter Hoffman.

Legal Issues Common to All Health Care Providers.

Legal Issues Related to Specific Health Care Providers.

FIVE: Governance of the Health Care Organization (John Horty, and Monica Hansolvan).

Essential Responsibilities of the Hospital Board.

Basic Legal Duties of Health Care Trustees.

Lessons from the Panel on the Nonprofit Sector.

Federal Sentencing Guidelines for Organizations.

The Sarbanes-Oxley Act of 2002.

The Volunteer Protection Act of 1997.

Risk Management and the Board.

The Medical Staff, Risk Management, and the Board.

SIX: Early Warning Systems for the Identification of Organizational Risks (Roberta L. Carroll).

Early Identification of Exposure to Loss.

Food and Drug Administration.

Institute for Safe Medication Practices, United States Pharmacopeia, and National Coordinating Council for Medication Error Reporting and Prevention.

Medical Event Reporting System--Transfusion Medicine.

Intensive Care Unit Safety Reporting System.

Pittsburgh Regional Healthcare Initiative.

Other Voluntary Programs.

Standardizing a Patient Safety Taxonomy: The National Quality Forum.

Protecting Sensitive Information.

SEVEN: The Risk Management Professional and Medication Safety (Hedy Cohen, and Nancy Tuohy).

Latent and Active Failures.

Systems Thinking.

Risk Management: A Prioritizing Approach.

EIGHT: Ethics in Patient Care (Sheila Cohen Zimmet).

Ethical Principles and Moral Obligations.

Research.

Institutional Review Boards.

Patient Self-Determination Act.

"Do Not Resuscitate": Withholding or Withdrawing Treatment.

NINE: Documentation and the Medical Record (Sandra K. Johnson, Leilani Kicklighter, and Pamela Para).

Documentation.

Record Retention.

Release of Records.

Ownership of Medical Records.

Medical Record Audits.

Documentation and Risk Management.

Emerging Risk Exposures.

The Risk Management Professional’s Role.

TEN: Statutes, Standards, and Regulations (Mark Cohen).

Patient Care.

Medicare Modernization Act.

Medical Staff.

Life Safety Code.

Federal Health Insurance Laws and Regulations.

Tort Reform.

Policy and Procedure Manuals.

Case Law.

ELEVEN: Basic Claims Administration (Ellen L. Barton).

The Claims Environment.

The Claims Process.

The Risk Management Professional’s Responsibilities.

Regulatory Reporting of Claims.

TWELVE: Introduction to Risk Financing (Dominic A. Colaizzo).

Risk Financing in the Context of the Risk Management Process.

Risk Retention.

THIRTEEN: Insurance: Basic Principles and Coverages (Kimberly Willis, and Judy Hart).

Definition of Insurance.

Specific Types of Insurance for the Health Care Industry.

FOURTEEN: Information Technologies and Risk Management (Ronni P. Solomon, and Madelyn S. Quattrone).

Risk Management Information Needs.

Risk Management Information Systems.

Using Information Systems to Generate Reports.

Integrating Risk Management, Quality Assurance, and Patient Safety.

Electronic Mail.

Internet- and Web-Based Technology.

Personal Health Record.

Electronic Health Records and Systems.

Clinical Information Systems and "Smart" Technologies.

Infrastructure Technology.

Point-of-Care Technology.

Telemedicine.

Appendix 14.1: IT Glossary for Risk Managers.

FIFTEEN: Risk Management Metrics (Judith Napier, and Trista Johnson).

Benchmarking Defined.

Claims.

Measuring Change.

Developing New Metrics.

Conclusion.

Key Terms.

Acronyms.

Notes.

Suggested Reading.

SIXTEEN: Accreditation, Licensure, Certification, and Surveying Bodies (Frederick Robinson).

The Consumer Era of Health Care.

What the Health Care Risk Management Professional Needs to Know.

Mandatory Surveying Bodies.

Voluntary Surveying Bodies.

URAC.

Appendix 16.1 Accreditation Organizations and Government Agencies.

SEVENTEEN: Emergency Management (Michael L. Rawson, and Harlan Y. Hammond).

The Steps of Emergency Management.

Prevention.

Planning and Preparation.

Implementation and Response.

Recovery.

EIGHTEEN: Occupational Safety, Health, and Environmental Impairment: A Brief Overview (John C. West).

Administrative Procedure Act.

Administrative Enforcement.

Specific Occupational Safety and Health Issues.

Appendix: A Guide to Medical Terminology.

Glossary.

Index.

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Roberta Carroll, ARM, MBA, CPCU, CPHRM, is senior vice president of Aon Healthcare based in Tampa, Florida.

American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association with more than 5,000 members representing health care, insurance, law, and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking, and interactions with leading health care organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, preserving financial resources, and maintaining safe working environments.

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