Risk Management and Patient Safety

Focusing on Patient Safety Benefits Both Patients and Physicians

No one, least of all physicians, wants patients to be harmed by the care that is meant to help them. Despite national attention to patient safety, patients continue to be harmed during the course of treatment. The drive to improve patient safety has prompted much discussion and the development of initiatives by national and local stakeholders seeking to reduce preventable adverse medical events.

The goal of patient safety is to prevent problems by identifying adverse events, analyzing the causes of preventable adverse events, and then developing or modifying processes and systems to prevent reoccurrences. Not surprisingly, this description is also applicable to the risk management process. Risk management has always supported quality improvement and the prevention of adverse events—key factors in patient safety. Promoting patient safety also reduces professional liability risk, a secondary goal of risk management.

Where does one start? While it is impossible to implement every piece of risk management advice promoted by well-meaning risk managers, using the risk management process can help guide decisions about where to begin and where and how to expend finite resources.

There are five steps to the risk management process:
  • Step 1: Identify current and potential risks
    Think about the potential patient safety risks where you practice. Make a list.
  • Step 2: Evaluate risks (frequency and severity)
    Although numerous current or potential risks to patient safety can be identified in any practice setting, it makes sense to focus on those risks found to be of high frequency and/or high severity and concentrate on those first.
  • Step 3: Choose a risk management strategy
    After identifying which patient safety risks to address, research and explore possible solutions to the problem. Plans to improve patient safety and reduce professional liability risk can take many forms depending on the type of practice, amount of resources, the treatment team available, and so on.
  • Step 4: Implement the strategy
    Begin with strategies that have the most potential to impact the most significant patient safety issues. Focus on improving systems and processes that support patient safety. Do not try to change everything at once; small changes are more likely to be sustained and can be built upon over time.
  • Step 5: Evaluate the strategy
    After a reasonable trial, evaluate how well the chosen strategy works for you and those in the treatment setting where you practice. Modify the existing strategy or implement another one as needed.

 

Sometimes, clinicians approach risk management with an air of paranoia, convinced that they must adopt a siege mentality and practice "defensive medicine" in order to reduce professional liability risk. This is a mistaken impression. When used appropriately, the application of risk management principles and strategies helps a practice run more smoothly and reduces anxiety by supporting the quality of care provided to patients—all of which contributes to improved patient safety.

PATIENT SAFETY RESOURCES

The following are useful online resources for a variety of patient safety topics:

  • The American Academy of Neurology (AAN) website has a wealth of information and resources about patient safety and related issues. The Patient Safety page is a good place to start. The website provides an opportunity to get involved in patient safety initiatives in a number of ways including reading, using, and sharing patient safety tips online. There are links to numerous internal and external links. Be sure to look at “AAN Clinical Practice Guidelines" and information from the 2007 and 2008 “Patient Safety Colloquiums," among the many resources.
  • The Joint Commission's Patient Safety Practices (PSP) website is designed for healthcare professionals and the public. On this website “[o]ver 800 links to trusted patient safety websites are provided, with tips, tools and resources for addressing patient safety problems. The problem categories and topics have been culled from the Joint Commission's Sentinel Event Database."
  • Within the Department of Health and Human Services (HHS), the Agency for Healthcare Research and Quality (AHRQ) “supports health services research initiatives that seek to improve the quality of health care in America. AHRQ's mission is to improve the quality, safety, efficiency, effectiveness, and cost-effectiveness of health care for all Americans." The “Quality and Patient Safety" page on this website provides links to many resources. Do not miss all the information at the “Medical Errors and Patient Safety" page.
  • Professional liability risks associated with delayed diagnosis or misdiagnosis of neurological condition/disorder
  • Professional liability risks associated with documentation
  • Informed consent
  • Enhancing effective communication with patients
  • Medication adverse events/errors
  • HIPAA Privacy Rule requirements
  • Reporting impaired drivers
  • Supervision, consultations, covering for colleagues or liability for the acts of others
  • Communicating and managing patient expectations
  • Professional liability risks associated with pain management

We encourage TNP insureds to contact us whenever a request or situation is troubling them, or raising questions or concerns. No question is insignificant or frivolous, but there are significant questions that are not asked. These unasked questions may increase risk. In fact, the greatest risk may lie in not asking.

If you are currently insured with TNP and have a risk management question, please visit My Program for contact information.

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