risk-based thinking in healthcare: Getting startedBy: Ted Schmidt, RPh, CERM
8/25/15 |
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In a previous article, I revealed some very unfortunate statistics- hospitals are not as safe for patients as we might have thought. As a pharmacist on the inside looking out, it is often hard to accept the facts as they are presented. These facts, unfortunately, are true. We have to change the way we think and the way we perform our work to begin changing those statistics. We also have to bring our colleagues along with us on this journey.
As many of our healthcare colleagues can attest, the average out of court settlement for medical malpractice in 2012 was $360,000. The average judgment after going to court was pushing $800,000. The cost of the malpractice insurance, according to a 2011 study, stated that OB/GYN’s paid an average of $46,400/year. We are paying heavily for our errors, not to mention the impact to the patient and their family.
We’re also getting hit when we do not give the patients the best care with the new “pay for performance”. Insurance reimbursements are getting tighter every day. As we all know too well, our performance is now available with the click of a mouse. And as Malcolm Baldrige once said, “customers vote with marketplace dollars”.
As a result, we have some significant barriers to overcome just to do our jobs as professionals. We are smart people, so we have to figure out how to make this culture of safety sustainable and meaningful, because right now, it’s not working. Enter risk based thinking.
We first have to realize that everything that happens in our hospitals, clinical or not, is a process. We have business processes such as admission, insurance verification, etc. We have management processes such as strategic planning, budgeting, etc. We have clinical processes, such as nursing, surgery, etc., and we have support processes that help hold all of these together, such as environmental services, biomedical engineering, dietary, etc.
Each of our processes, no matter what type of process, has a basic anatomy. It has an input (a requirement such as a patient needs sutures), an activity (suturing a patient) and it has an output (sutured patient). We now need to deploy risk based thinking to begin the shift to a better position.
We need to identify our processes by type as a necessary baseline. Once we have this completed, we need to determine the level of risk that is associated with each of these processes. There are several tools available to help us create a risk ranking, such as a FMEA. A multi-disciplinary team composed of process owners should complete the process identification and risk determination activity. We are mostly risk-averse in healthcare. Because we cannot realistically manage all risk, we start with those processes that contain the most risk.
This is a going to be a huge project, so we should put these activities on a Gantt chart, assign responsibilities, deadlines, metrics, etc. If you work where you have the greatest need; you’ll likely get your greatest payback.
Managing our riskiest processes effectively is paramount. We cannot continue to have more than 400,000 preventable deaths per year. Just ask Chris Jerry. His beautiful two-year-old daughter, Emily, died as a result of a preventable medical error. Here is Chris’ quote: “There is no pain greater than losing a child. My beautiful Emily's death was senseless and preventable.”
In summary, we must focus on risk management to improve patient safety. We need to first start on our highest risk processes. Then we need to celebrate the wins and move to our next processes. Remember, this is a project and we work until the project is completed. Yet, while we may complete the activities on the Gantt chart, if we are doing risk management correctly, we are never really finished. Risk based thinking is now part of who we are, our genetic makeup. We will continually mitigate risk to create a sustainable patient safety environment. That’s what we signed up for….to first, do no harm.
Thank you for your interest and time to read all the way to here. I am passionate about what I do and I would welcome the opportunity to learn more about you and the journey your hospital is taking to create a safer patient environment. I can be reached by email at [email protected] or you can call 844-424-7825. Your comments are always welcome.
Let's stay in touch,
Ted
As many of our healthcare colleagues can attest, the average out of court settlement for medical malpractice in 2012 was $360,000. The average judgment after going to court was pushing $800,000. The cost of the malpractice insurance, according to a 2011 study, stated that OB/GYN’s paid an average of $46,400/year. We are paying heavily for our errors, not to mention the impact to the patient and their family.
We’re also getting hit when we do not give the patients the best care with the new “pay for performance”. Insurance reimbursements are getting tighter every day. As we all know too well, our performance is now available with the click of a mouse. And as Malcolm Baldrige once said, “customers vote with marketplace dollars”.
As a result, we have some significant barriers to overcome just to do our jobs as professionals. We are smart people, so we have to figure out how to make this culture of safety sustainable and meaningful, because right now, it’s not working. Enter risk based thinking.
We first have to realize that everything that happens in our hospitals, clinical or not, is a process. We have business processes such as admission, insurance verification, etc. We have management processes such as strategic planning, budgeting, etc. We have clinical processes, such as nursing, surgery, etc., and we have support processes that help hold all of these together, such as environmental services, biomedical engineering, dietary, etc.
Each of our processes, no matter what type of process, has a basic anatomy. It has an input (a requirement such as a patient needs sutures), an activity (suturing a patient) and it has an output (sutured patient). We now need to deploy risk based thinking to begin the shift to a better position.
We need to identify our processes by type as a necessary baseline. Once we have this completed, we need to determine the level of risk that is associated with each of these processes. There are several tools available to help us create a risk ranking, such as a FMEA. A multi-disciplinary team composed of process owners should complete the process identification and risk determination activity. We are mostly risk-averse in healthcare. Because we cannot realistically manage all risk, we start with those processes that contain the most risk.
This is a going to be a huge project, so we should put these activities on a Gantt chart, assign responsibilities, deadlines, metrics, etc. If you work where you have the greatest need; you’ll likely get your greatest payback.
Managing our riskiest processes effectively is paramount. We cannot continue to have more than 400,000 preventable deaths per year. Just ask Chris Jerry. His beautiful two-year-old daughter, Emily, died as a result of a preventable medical error. Here is Chris’ quote: “There is no pain greater than losing a child. My beautiful Emily's death was senseless and preventable.”
In summary, we must focus on risk management to improve patient safety. We need to first start on our highest risk processes. Then we need to celebrate the wins and move to our next processes. Remember, this is a project and we work until the project is completed. Yet, while we may complete the activities on the Gantt chart, if we are doing risk management correctly, we are never really finished. Risk based thinking is now part of who we are, our genetic makeup. We will continually mitigate risk to create a sustainable patient safety environment. That’s what we signed up for….to first, do no harm.
Thank you for your interest and time to read all the way to here. I am passionate about what I do and I would welcome the opportunity to learn more about you and the journey your hospital is taking to create a safer patient environment. I can be reached by email at [email protected] or you can call 844-424-7825. Your comments are always welcome.
Let's stay in touch,
Ted