Risk Management:
Patient Safety-Driven Risk Management
Third article in a series
by: James B. Couch, M.D., J.D., FACPE
Phyllis DeCola, Manager of Healthcare Risk Services, Princeton Insurance
Tom Snyder, Vice President of Healthcare Risk Services, Princeton Insurance
Printable Version of this Article
This article, the third and final article in a series, highlights a process Princeton will follow to provide focus in the often mind-numbing torrent of patient safety initiatives in which to engage. This process is intended to provide a way for all participants to achieve the greatest return on investment in their patient safety risk management efforts and “do well by doing good.”
A Dizzying Array of Patient Safety Initiatives
Like so many movements in health care, patient safety has fallen prey to a seemingly endless stream of initiatives. Hospitals, physicians and others in health care are being bombarded with the “latest” from a wide spectrum of well meaning groups, each jockeying for attention by already overworked healthcare executives and clinicians. A non-exhaustive list of these groups with their safety initiatives include, but are not limited to:
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The Leapfrog Group and its four “leaps” (including computerized physician order entry, full time critical care physicians in intensive care units, volume based referrals for seven procedures and conditions and 27 best evidence-based measures from the National Quality Forum as its “fourth leap”);
- The National Quality Measures (previously called the “Core Measures” from CMS and other sponsoring organizations) concerning best evidence-based measures for treating patients with myocardial infarctions, heart failure and pneumonia;
- The National Patient Safety Goals issued annually now (2003 through 2007) from the JCAHO;
- Best practices to minimize the risks of medication errors from the Institute for Safe Medication Practices (ISMP);
- Best evidence-based practices to minimize the risks of infections and suboptimal surgical results (among other things) from the Evidence Based Practice Centers of the Agency for Healthcare Research and Quality (AHRQ);
- The six measures to improve patient safety and clinical results promoted by the Institute for Healthcare Improvement (IHI) and its 100,000 Lives Campaign (now well into its second phase with its 3100 hospital participants);
- The 26 safety and quality improvement “starter kit” measures from the Ambulatory Quality Alliance (AQA);
- The best practices to be monitored through the Hospital Quality Alliance (HQA);
- The measures from the Surgical Care Improvement Program (SCIP); and
- Aviation Crew Resource Management, Failure Modes and Effects Analyses, Six Sigma Process Improvement and a host of other methodologies.
Given increasingly limited time and resources, even the most capable Chief Medical & Patient Safety Officers and Risk Managers could benefit from some way of focusing their efforts in those areas which have the greatest opportunity for improving clinical outcomes and avoiding the types of medical errors with the greatest potential for litigation.
Princeton’s Safety Initiative Focusing Process
With so many patient safety initiatives out there, the last thing that Princeton Insurance wanted to do was to add one more project to the list. Rather, Princeton’s senior executives believe that helping its policyholders to focus on those patient safety initiatives (or on certain parts of various initiatives), which may also benefit their risk management efforts the most, is a service which was long overdue. To achieve this end, Princeton has already begun what will ultimately be a five step process. These five steps (depicted in a graphic at the end of this section) are the following:
- Identify the current “universe” of patient safety initiatives, standards and best practices
Princeton, in conjunction with Patient Safety Solutions, LLC, has identified hundreds of best safety, medical and preventive practices and standards associated with dozens of sponsoring organizations and associations. These represent practices and standards, which, if adhered to, at least have the potential to minimize the risks and actuality of errors, suboptimal clinical outcomes and adverse events which could provide the medical basis for successful litigation.
- Determine the subset of this universe in which Princeton policyholders are engaged or planning to become engaged
By now, your Chief Medical Officers, Patient Safety Officers and/or Risk Managers should have received (and, hopefully have completed and submitted back to Princeton) a survey intended to determine your current or planned involvement in various patient safety initiatives. The valuable information which we obtain from this survey will permit us to establish a consensus picture among all policyholders of the extent to which you are or are planning to engage in this area.
- Establish what patient safety practices likely would impact the incidence and severity of potentially compensable events most favorably if followed
Simultaneously with determining the subset of the universe of patient safety initiatives in which you are or are planning to be engaged, Princeton will be working with its new strategic allies, RMF Strategies of the Harvard Risk Management Foundation and Patient Safety Solutions, LLC, to identify those patient safety practices and standards, which, if adhered to, would likely have the greatest impact on reducing the incidence and severity of potentially compensable (adverse) events. Although this information is not intended to depreciate in any way those practices and standards not so associated, it will provide an unprecedented focus to help institutions to concentrate efforts in those areas demonstrably correlated with reducing the risk of litigation and financial loss.
- Determine to what extent Princeton’s policyholders are engaged or planning to be engaged in those safety areas most associated with minimizing the risk of potentially compensable (adverse) events
The next step will be to determine the degree of overlap of the patient safety initiatives in which Princeton’s policyholders are, or are planning, to become engaged and those practices, which if adhered to, have the greatest probability of decreasing the incidence and severity of potentially compensable (adverse) events. In those areas of overlap, Princeton will provide ongoing support to ensure the successful execution of those strategies already being or planned to be undertaken. In so doing Princeton seeks to help its policyholders to achieve not only risk management, but also other important improvement goals such as cost reduction, regulatory compliance and positioning for Pay for Performance.
- Enter into pilot projects with interested policyholders to expand into new safety areas associated with the greatest potential to decrease the incidence and severity of potentially compensable (adverse) events
Through the survey process and follow up meetings with Chief Medical, Safety and Risk Officers, Princeton will identify those policyholder institutions which are most ready, willing and able to engage in pilot projects to expand into and focus on improving those safety processes, practices and methods associated with decreasing the incidence and severity of potentially compensable (adverse) events. For the most part, these pilots will involve working with policyholder institutions to focus on those areas which they hadn’t necessarily been engaged, or planned to be engaged in patient safety.
Princeton may enlist the aid of additional strategic allies in supporting the design and ultimate execution of these pilot projects. Princeton will monitor closely their impact in decreasing the incidence and severity of potentially compensable (adverse) events. Princeton will also collaborate with these institutions to help them to monitor the favorable impact on other improvement goals such as cost reduction, regulatory compliance and positioning for pay for performance.
The graphic below depicts the five steps of this focusing process.
Dr. Couch is the Managing Partner & Chief Medical Officer for Patient Safety Solutions, LLC, as well as a Patient Safety Risk Management Consultant to Princeton Insurance.
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