Risk management is defined as the systematic process of identifying, evaluating, and addressing potential and actual risk. Risk management according to the article is way more than just health care, it goes beyond clinical care. Risk management entails reducing the possibilities of error. Risk management in health care involves reducing costs on matters that may cause injury, disability and stress. Risk management is done. However, the risk management also enhance quality health care delivery. Risk management entails a process that detects, communicates and reports any detected deficiency in a system that would otherwise led to damage and a costly mistake. It basically entails running the day to day programs that is free of mistakes to achieve quality healthcare.
For instance before an operation, the anesthetist has to assess the patient by asking questions about their health. They need information such as their allergies, their health history and any recurring conditions. This is a form of risk management because the anesthetist aims at ensuring that once the patient is a sleep during the operation then all risks are eliminated for a successful surgery.
The definition of risk stands out to be the probability or threat of liability or loss maybe caused by vulnerabilities and solved. Risks can occur in when human interact with machines, the complex technology that might be involved in the hospital, negligence among others. For instance before surgery the scrub nurse is supposed to sterilise all the equipment that will be used for surgery. They need to make sure that all this equipment are 100 percent sterile to use on the patient and will not cause any risks to the patient. However, the predominant underlying causes of medical errors are as follows; communication problems, inadequate policies and procedures, technical failures and staffing patterns and work flow.
Risk management being involved in reducing risks and errors that is just one aspect of provision of quality clinical care. Clinical care is just more than just risk management, however together with other aspects and branch of hospital health care provision maximizes the quality of health care (Bagheriyan, Setareh, Nezhadnik and Niknam 2011).
After having an understanding of risk management, it is also crucial to have an in depth understanding of clinical care, but not just clinical care but quality of health care. Clinical care is much more than just the professional aspect but it is intertwined among many other level of performance. Patients too are involved as far as quality care is concerned. The patients’ freedom of choice and access to quality health care provision is also part and parcel of quality care. This therefore brings us to the question what exactly is meant by the term quality clinical care (Chourey 2015).
Clinical care has its standardized measure of operation as per the terminology it is related to the discrete elements of nursing practice. Therefore, this practice has to be done if fulfilment and to provide maximum care. Clinical care basically covers the essence of patient care, data elements, care needs that sums up to resources, the workload that sums up to productivity, costs of care and lastly the outcomes which sums up to quality. The nurses are the main persons involved in clinical care. They need to give clinical care during their stay in the hospital and also after their stay in the hospital. If the care was to end only at the time the patient was in hospital then it would really not be care given. The clinical care as used by nurses in health care giving facilities involve a sit step series processes
Assessment
Diagnosis
Outcome identification
Planning
Implementation
Evaluation
However, the stablished fact is that risk management does not in any way mean clinical acre, but it is just a broader aspect of clinical care that has to be implemented in many stages of health care. Without a risk management process then the clinical care given would be put at jeopardy as illustrated by Maxwell (1984).
When the need to assess quality comes in handy, Donabedians classification of health care is seen. He divides health care into its structure, process and outcomes. However, Maxwell classification is quality improvement based on the methodical assessment of the implemented programme. Maxwell bases his findings on these aspects of dimension of quality (Pandey and Sharma 2017).
Effectiveness, efficiency, Appropriateness, acceptability, Access, and Equity. Therefore, this process of evaluation can be applicable in the provision of health care to outpatients’ clinics. Outpatients’ clinics offers services to patients and they leave. Maxwell Classification assess outpatient clinics, on the clinical examinations and investigations, clinical interventions such as drug prescription and outpatient appointment (Kubheka 2015). Outpatient clinics may seem easy to manage, however there are some aspects that need to be looked into.
Assessing quality in outpatients clinics
|
Structure |
process |
outcome |
|
|
Effectiveness |
Access to medical resources such drugs |
The patient’s daily admittance The records of those treated The amount paid during treatment |
The daily successful treatment |
|
Acceptability |
Provision of the medical drugs and supplies Patient help in case of severe cases |
The patient ability to pay for the services The prescription dosage |
Follow up for the prescription of the drug The advice you get when done or when under medication |
|
Equity |
If treated, records to show according to attendance lists |
Evidence based on the service provided such as receipts |
|
|
Relevance |
Appropriate treatment according to diagnosis made The financial record of services offered and relevant costs |
Difference and monitoring of treatment done to patient The health status after treatment. |
|
|
Efficiency |
Enough Available medical personnel to attend to the patients |
Admission and discharge arrangements |
Costs for the cases treated and the facilities in case the services offered are being offered at a fee |
|
Access |
How many patients can be attended to a time Are facilities enough to accommodate the out patient |
What happens in a event there are no health clinical officers to attend to the patient What alternative means are put in place to ensure that it does not happen |
Risk management involves evaluation assessment and creating a communication and feedback of how to implement the risk management programs to evaluate the quality of services (Jones 2015). The health care giver in any case is supposed to critically evaluate a situation for example when a patient is brought in what they are ailing from. The health care giver is then supposed to communicate with the patient to learn more about the ailment and the views of the patient in question. This helps in determining what medical care will be given that will be best suited for the patient. This is done after looking at all the risks involved and picking an option that has the least risks involved or those that cannot be avoided.
Health care risk and quality has evolved and tends to work hand in hand. There exists a relationship between the risk management and quality management. Risk management programs are aimed at a better service for the patients, hospital and the staff without error. It these two merge we will look in to a greater quality improvement in clinical care. It can also apply to the surrounding environment that the practice stakeholders are under, the safety and the comfortability (Haghi, Gh and Aataran 2005). Risk management can be evaluated in the approaches as ensured within the quality dimensions. Donabedians classification is based upon these three classifications, and we will look at the quality dimensions in relations to the three classification.
Effectiveness; in relation to structure, risk management can be involved in ensuring highly trained professional who are competent enough to operate in such medical practices. In relation to process, a more efficient and thorough program should be put into place to ensure that the productivity is at maximum and that the tools, say the data analysis and data management system is efficiently stored and errors avoided. That way patients and staff records will only be accessed by the relevant and authorised personnel with a particular health care facility. Outcome in relation to effectiveness is an indication of the various successful approaches the practice gives. The outcome in this scenario could be the effectiveness of the tools and the successful medical operation.
Efficiency; this involves the efficient use of the available resources to the maximum. This also focuses on the avoidance of extravagance in the staffing, ensuring that there is no equipment that is being over utilised or underutilised. The processes and the costs of the whole operations are to be considered efficiently to avoid errors that might in turn lead to the practice being put at burdens and eventually closure. The main aim of efficiency is to ensure that the health care facility is correctly and accurately using its facilities for the betterment of health of the patients.
Appropriateness/Relevance; the underlying factor to this is having in mind exactly how the process applies relevantly to a patient, what appropriate resources are to be used and in to what expenditure level is acceptable.
Acceptability; this refers to what policies or measures that are acceptable to the hospital facility and perhaps the visits from relatives or what privacy and confidentiality factors are put in place. As for the outcome the risk management is to look at the errors that might occur if such policies may seem to pose a threat or create a vulnerability to the system in place.
Access; this is a matter of urgency as access to proper and quality medical health care is key to patients. The same also applies to the hospital staff. In an event the facilities are full, what then happens to the surplus? Is there an alternative plan that is implemented to ensure quality healthcare? All these can be answered by the risk management program in place to evaluate the whole system (Bagheriyan, Setareh, Nezhadnik and Niknam 2011).
Equity; this applies to same or an equilibrium or a state of balance within the organization either resources, service providers or access to the medical care there should not be a balance system. If so, the risk management program has to rectify this and look on to how the equal distribution should be implemented to offer quality health care services without discrimination at any cost (Haghi, Gh and Aataran 2005).
Part II
1: Questions
Are these cases belonging to the same surgeon of the hospital?
Are cases happening from the same operating room?
Are we sure that the procedures and protocol for cleaning the surgical tools being followed strictly?
Is anybody on the team consistent in the cases that are being reported?
The Chief of General Surgery and the Head of pathology could have suggested the following;
No physicians that are constant with respect to these injections.
There is no common operating room or staff involved with these cases.
No common organism is identified in these infections.
The clinical implications include; systemic infections, other complications, no response to first line of drugs, no treatment options, increased length of stay.
The financial and legal implications can be due to increased length of stay, this in turn will lead to increment in cost of treatment, the rise in hospital bills increases, as well as the related ethical issues related with the patients and diseases. This could even lead to the facility to be sued (Wiryoatmojo and Surya 2013).
A monitoring plan to be implemented will have to focus on the specific job title and the roles or functions to be operated and handled at what particular time and by who. This will facilitate the smooth running. The work plan will ensure that;
(b) To keep check on emergence of new pathogens
(c) To sterilize wards, instruments and to implement hand wash practices among health care workers.
(d) To routinely screen surgery patients for surgical site infection.
(e) To ensure no outsiders inside ward of surgery patients
Part III: Scenario Analysis
REGISTRATION PAYER INTERFACE BILLING
TYPES OF RISKS
The risks that might be encountered include
Information and data manipulation
False money expenditure
Registration flaw
Harm caused.
As the administrator, information confidentiality is key. Therefore, the safety of the patients’ records need to be saved. In an event one gets access to them, it can cause private information leaking resulting to blackmailing (Singh and Ghatala 2012). The patient records need to be saved in manner that only those who have an obligation to access them can do so. Also at times information between patients can be mixed up which may cause a patient to be treated for the wrong diagnosis. It is important for the hospital to have an accurate filling system to avoid such mishaps. Being special care facility, records might be tampered with for example altering the list of surgery and some miss the opportunity.
Who would be potentially harmed?
The patients trust with the medical facility; the medical facility will be harmed as it will lose credibility. The employees who might be involved in data manipulation. The patient will also be harmed because they will continue being sick or get another ailment due to the wrongful diagnosis.
The risk level, precautions that are already in place
The check system of the information should be in place to regulate data manipulation
Only authorized personnel are to access the data
Additional precautions needed prior to implementation
Better access to billing system that shows and gives receipts after service delivery.
Registration form in an online system so as to show the number of admissions, discharge and anomaly that might be encountered.
|
Evaluation Of Performance |
Percentage Ratings |
|
Focusing on the departments from top to bottom Close monitoring on the services Measuring the consistency between policy of an organization and performance of operations Task management Employee engagement Patient satisfaction Smooth functioning of departments · Collection of Data : Employee feedback on the present processes Patient feedback on services of employees and organization facilities Performance results Daily reports Compliants from patients Regular monitoring on employee performance Completing the rest of Plan : · Plan For changing processes Setting up of operational standards and systems Identifying the blocks in the processes Making policy to improve the overall performance of an organization · Testing of new practices/ideas Observe the results Evaluation of result- long term/short term benefit Decide whether to include in policy or not On the job training if necessary Check : Key issues in processes Analysis of data Data designing using charts for proper decision making Comparison of past results with test results Additionally, If results are fine, new process techniques are to be added to the policy Framing new change policy Communicate it to the staff members If need make an arrangement of training for staff |
References
Bagheriyan, H., Setareh, M., Nezhadnik, M. and Niknam, M., 2011. Ayubiyan a. Prevalence and causes of medical errors in the cases referred to Isfahan Legal Medicine. Health Information Management, 9(1), pp.101-9.
Chourey, R., 2015. Risk Management in Hospitals. Editorial Board, 44(2), p.9
Haghi, Z., Gh, Z. and Aataran, H., 2005. Factors affecting the surgical team trials in medical malpractice lawsuits and claims handling system Mashhad University of Medical Quality. Forensic Mwdicine, 11(3), pp.141-5.
Jones, V., 2015. Hospital and physician professional liability trends and industry topics. Journal of Healthcare Risk Management, 35(1), pp.7-19.
Keikavoosi Arani, L. and Nasiripour, A., 2012. Overt Threats Affecting Medical Errors in Public Hospitals in Tehran Province. Teb Va Tazkieh, 20, pp.65-76.
Kubheka, B., 2015. Risk management competencies for medical practitioners working in South African hospitals (Doctoral dissertation, University of Pretoria).
Pandey, A. and Sharma, R., 2017. Risk Management For Health Care Operations And Protected Healthcare Information. International Journal of Pharmacology and Biological Sciences, 11(1), p.55.
Singh, B. and Ghatala, M.H., 2012. Risk management in hospitals. International journal of innovation, management and technology, 3(4), p.417.
Wiryoatmojo, A.S. and Surya, B.A., 2013. Risk Management Analysis of Third Construction Stage in Diagnostic and Cardiac Center Building at Dr. Hasan Sadikin General Hospital. Indonesian Journal of Business Administration, 2(11).
Zaboli, R., Karamali, M., Salaem, M. and Rafarti, H., 2011. Evaluation of risk management in various parts of Tehran city hospitals. Journal of Military Medicine, 12(4), pp.197-202.
Zaboli, R., Karamali, M., Salaem, M. and Rafarti, H., 2011. Evaluation of risk management in various parts of Tehran city hospitals. Journal of Military Medicine, 12(4), pp.197-202.
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