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Risk Management in Health Care Institutions: Limiting Liability and Enhancing Care, 3rd Edition.
This text serves as a primer for risk management professionals. It covers basic concepts of risk management, employment practices, and general risk management strategies. It also goes over specific risk areas including medical malpractice, strategies to reduce liability, managing positions and litigation alternatives. It includes an emphasis on outpatient medicine and the risks associated with electronic medical records. This new edition covers academic medical settings and the impact on healthcare delivery, ambulatory and outpatient surgery, and office-based surgery (OBS). Each and every chapter will be updated, and more emphasis will be placed on electronic medical records including security and encryption issues. New chapters cover Risk Management for Infection Control Programs, Telemedicine, Risk Management in Ambulatory Care Settings, and Risk Management in Office-Based Surgery.
Introduction to the Third Edition
It has been over a decade since the publication of the second edition of Risk Management in Healthcare Institutions. In this period of time, healthcare delivery has dramatically changed, creating new issues and challenges for healthcare professionals. The field of risk management has grown infinitely more complicated and complex, and problems that could not have been previously imagined are facing today’s professionals. Patient safety and quality have been elevated to the highest level, with executives with this title reporting directly to the CEO and to the Boards of Directors. The Institute of Medicine’s landmark report, “To Err is Human:
Building a Safer Health Care System,” and the more recent report, “Crossing the Quality Chasm,” brought the issues clearly into focus. Let us look at the dramatic changes that have occurred in the healthcare field and their impact on patient safety and quality. Certainly the passage of the Affordable Care Act will have wide ranging implications, particularly the focus on the electronic health record. The implementation of the electronic health record has made record keeping more efficient but has run into resistance from older physicians and caregivers who have not grown up with the technology, creating a “digital divide.”
Also, the expense of conversion from written medical records has slowed the migration into the new paradigm. Certainly, risk management professionals need to be conversant with the technology and its incumbent problems and employ it into the monitoring and reporting systems. Exposure to hackers poses a real threat. In Utah, some 780,000 records were breached, and in South Carolina, 228,000 records
were improperly transferred to an employee’s email account. The past 10 years have seen changes in the physician’s relationship with hospitals. Many more physicians are giving up practices with the attendant headaches and joining physician groups associated with hospitals. Along with this trend is the employment of Hospitalists to provide primary care to hospitalized patients. No longer do physicians in practice make rounds, but rather shift this burden to the Hospitalists. Orienting and sensitizing these groups to the safety and quality issues becomes an important challenge to today’s risk manager.
Along with the growth of hospital employed physicians is the trend of hospital mergers and acquisitions and the increasing move to corporate models for the healthcare system. Competition has led to business practices that were once the province of industry. Marketing and advertising have grown to be a significant budget item in an effort to attract patients who bypass physicians to gain access to prestigious centers. The smaller hospitals are less able to compete in the marketplace and as a result are not able to access the capital markets for growth and development. Merging cultures of different healthcare organizations is very difficult and fraught with problems. Clearly, patient safety and quality are at risk as new financial and organizational models are developed. The Affordable Care Act has the potential to equal, if not surpass, the creation of Medicare and Medicaid. Its implications on the delivery and financing of health care will affect every hospital and health system in the country. It has and will drive many institutions to formulate accountable care organizations (ACOs). As of this printing, there are some 40 ACOs in formation, involving many large medical centers with over 15,000 physicians. Setting standards and quality measures for
these organizations pose new and uncharted problems. As this movement spreads, the challenges to maintain quality and safety loom as new problems.