For this assignment, you will research risk management programs for health care

Question

For this assignment, you will research risk management programs for health care facilities or organizations. Review the criteria below in order to select an exemplar that applies to your current or anticipated professional arena. (Note: Select an example plan with sufficient data to be able to complete the assignment successfully.)

In a 1,000-1,250 word paper, provide an analysis that includes the following:

Brief summary description of the type of risk management plan you selected (new employee, specific audience, community-focused, etc.) and your rationale for selecting that example.

Description of the recommended administrative steps and processes in a typical health care organization risk management program contrasted with the administrative steps and processes you can identify in your selected example plan. (Note: Select an example plan with sufficient data to be able to complete the assignment successfully.)

Analyze the key agencies and organizations that regulate the administration of safe health care and the roles each play in the risk management oversight process.

Evaluation of the selected exemplar risk management plan regarding compliance with the American Society of Healthcare Risk Management (ASHRM) standards relevant to privacy, health care worker safety, and patient safety.

Proposed recommendations or changes you would make to your selected risk management program example to enhance, improve, or to secure compliance standards.

Explanation / Answer

Introduction to Risk Management Program for Healthcare Facilities:

Elements of Risk Management Program:

Risk Management is a research programme. The focus of this programme is manifold and address the following issues: fostering the use of the tools of risk assessment and risk management in new fields of application such as policy making; providing a platform between the insurance community, the engineering and academic communities and policymakers to discuss risk issues; promoting the concept of the insurability of risks as the natural borderline between State legislation and the market economy; identifying new opportunities for insurers in the emerging sustainability concept in order to enlarge the field of insurable risks. The essential elements of an effective risk management program are:

Techniques for maintaining a successful risk management Program

The risk management in any organization plays a vital role or maintaining the successful risk management program the person should be aware & educated of the risk involved in any organization. There are steps are as follows:

Steps for Presenting a Risk Management Program to New Employees:

The first step in the presentation of a risk management program to new employees will be taking them through the organizational structure. A thorough understanding of the hierarchies in the organization, the communication channels and escalation policies and other characteristics will be a necessary pre-requisite to new employees understanding the risk management program of a healthcare organization.

The functions of every position will be explained to the new employees. This will enable the new employees to have an understanding of the role that each function plays in the risk management program. An understanding of the functions of all positions in the organization will give the new employees knowledge of risk exposure of various departments and the policies in place that the organization has in place to reduce risk exposure.

The risk management program of the organization will then be explained to the new employees. This will involve an in-depth analysis of the program and a discussion of the efforts that the organization is taking to identify risk, manage risk, mitigate risk and transfer risk. Hypothetical situations will be used to discuss the policy of the organization as regards risk management, and through such hypothesis, the presentation should give the employees and a good understanding of the risk management program of the health institution. The risk management program of our organization involves four major categories. It seeks to ensure that the organization avoids risk by having in place policies geared towards ensuring that chances of losses are prevented. Mitigation of risk seeks to ensure that in case of occurrence, the impact of the risks on the organization and other parties are reduced through implementation of set out policies. Acceptance of risks is another part of risk management plan of the organization, and it seeks to reduce the adverse impact that the organization would suffer through policies of budgeting and insurance. Transfer of risks is the last part of the risk management program. It seeks to transfer the liability in case of occurrence of risky events through the transfer of such risks to third parties, especially through insurance.

The roles and functions that the new employees will be playing will then be brought under discussion. This will be in relation to the role that they will need to play in the risk management program of the organization. It is important that before the new employees take up their positions in the organization, they have a thorough understanding of the risk management plan of the organization so that it guides their day to day functions.

Compliance with the American Society for Healthcare Risk Management:

The risk management program of the organization is compliant with the requirements of the American Society of Healthcare Risk management. It has instituted policies that are in accordance with the proposals that are set out and has in place the human resources that are necessary to ensure that risk is well managed in the organization. The organization has also made patient safety the cornerstone of its risk management program, and this is in compliance with the American Society of Healthcare Risk Management proposals. The organization has made efforts to identify risks and transfer them so that it limits its exposure by taking up insurance covers. Policies in the organization regarding patient safety are also in compliance. The organization has a well-trained risk manager and conducts periodic training for staff to capacity build them on new policies regarding the risk management program of the organization. This is also in compliance with the proposals set out by the American Society of Healthcare Risk Management.

Recommendations for Inclusion in the Program:

Changes need to be carried out in the processing of claims against the organization. More resources, financial and human, need to be allocated to the risk manager’s department so that claims can be resolved in the shortest time possible. This is very important since for a health care facility, reputation is a key aspect of the business, and any delays in the process of handling claims may cause an irreparable dent on the reputation of the organization.

The change also needs to be instituted in the evaluation of the risks that are facing the healthcare organization. Though this falls under the responsibility of the risk manager, it is important to ensure that the healthcare organization has in its workforce actuaries who can evaluate the risk exposure of the organization in the most accurate manner. This will go a long way in ensuring that the resources of the organization are well protected and used in the most optimal manner.

The administrative process:

The administrative process is the actual policies that an organization has in place for mitigating risk. The first administrative process for any healthcare facility is the employment of a risk manager. A risk manager will be responsible for developing policies, in consultation with other stakeholders in the organization, for loss prevention and reduction. A risk manager will also be responsible for handling other administrative issues that are related to risk management such as risk financing, patient safety and seeking and ensuring regulatory and accreditation compliance of the healthcare institution. A risk manager will, also in consultation with other stakeholders, develop policies for risk management program, lead the institution of changes in practice and policy of other departs to align with the risk management plans. In the environment of a health institution, the risk manager will guide medical staff behavior and conduct so as to mitigate any risk that may arise from such. A risk manager in a health organization is not involved directly with patient care but plays an active role in providing support to patients to ensure their safety. In case of emergencies or when the risk management plan has been breached, or a risk occurs, the risk manager usually the point of contact to explain the events and the efforts that the healthcare organization is taking to limit the effect of such an occurrence. The risk manager is also responsible for handling claims that are made against the organization, and he has a duty to ensure that these claims are true.

In the administrative process is the management of the healthcare facility, particularly, the directors of the facility to whom the risk manager report to. These individual have an important role to play in the development of the risk policies of the organization. Medical staff and other employees also participate in the administrative process of risk management. This is because these are the people who directly interact with patients and provide patient care. These are the individuals who are most exposed to risk and therefore need to be well appraised of the administrative procedures that need to be followed in case of an occurrence of a risky event.

Two major categories of risk in Healthcare organization:

Quality of care:

In recent years, CMS, OIG, and DoJ have stated very clearly that they consider the quality of care to be a top priority item for evaluation, investigation, and enforcement.  OIG may exclude health care entities from participation in federal health care programs if the entity provides unnecessary or substandard items or services.

Hospitals must develop and implement a quality assessment and performance improvement program that will identify patient safety issues and reduce medical errors in hospitals. Sub categories may include medical necessity, deficient care, practitioner qualifications, and accuracy of quality-reporting data.

Research:

Medicare covers the routine costs of qualified clinical trials as well as reasonable and necessary items, tools, and services used to diagnose and treat complications arising from participation in clinical trials.

Hospitals that participate in clinical trials should review the requirements for submitting claims for patients who participate in clinical trials. In addition, informed consent regulations require clinical investigators to obtain legally effective informed consent in an appropriate manner from the subject or the subject’s legally authorized representative before initiating a clinical trial using human research subjects. Time and effort reporting, financial conflict of interest, researcher misconduct, and proper cost allocation are some of the other risk areas in research activities.

Sub categories may include time and effort reporting; financial support from other sources; principal investigator conflict of interests; patent, trademark, and copyright under federal funds; human subjects research; and animal subjects research.

Application of 3 elements of Risk Management from Elements of Risk Management Program:

1) Identify the assets to be protected. What are you protecting (i.e. customer/patient information, critical business/healthcare processes, etc.), and why (privacy, security, etc.)

Explanation: The first preference should be given to the Identification of assets that should be protected, the reports, patients personal information, operation procedures, the systems, the equipment all should be protected so that there is no risk involved in the life of the patient. There should be privacy maintained and proper security should be there so that there are no errors & risk.

2) Apply controls in a layered, overlapping way until the risks are reduced to an acceptable level.

Explanation: There should be the proper control on each and every task so that nothing is overlapping. There should be proper time schedule for each and every activity from giving medicines to the patients to operation timings etc and each small things and activity should be considered as the organization cannot play with the health of the patients.

3) Test the adequacy and effectiveness of the controls/reports.

Explanation: There should be a proper study of the effectiveness of each task & there should be proper control to all what is going to be. There should be no complaints and smoothly all work should go on. There should be a proper protection to be taken to all task.

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