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[Risk management and clinical path].

In the risk management of medical practice, developing an efficient system to prevent medical accidents and trouble is required. For this purpose it is important to promote a cooperative team practice, to clarify each staff member's role, for each staff member to accurately carry out that role, for each staff member to always try to understand the patient's condition, and for staff members to ask each other whenever in doubt as to a patient's condition or the medical practice itself. These points for risk management share the same goal as the clinical path. The introduction of a clinical path is useful from the viewpoint of risk management. Electronic medical records and computer ordering systems in the medical practice should be developed as tools to decrease medical accidents.

Critical Pathways↗

Risk management: a proactive process.

Successful risk management is a proactive process designed to prevent litigation and possible loss of assets. Some examples of standards of care and legal implications for nurses in ambulatory and PACU units are discussed. Suggestions are made regarding specific risk management issues.

Humans↗

The development of a risk management program in response to the spread of bloodborne pathogen illnesses.

Risk management and total quality management are both focused on prevention, and together they provide the means to achieving improved outcomes. In total quality management, we are constantly looking for ways to improve processes, by continuously evaluating systems, identifying root causes, and providing employees with training, resources, and empowerment. Total quality management identifies opportunities for improvement, and risk management is used to prioritize these. Risk management involves identification and analysis of risk, development of action plans to deal with risk, examination of financial issues, and constant evaluation of the system. This article will describe the development and implementation of a risk management program, both in general and regarding bloodborne pathogen illnesses.

Blood-Borne Pathogens↗

Application of risk management to the production chain of intensively reared fish.

Principles of risk management, as a part of risk analysis, are described with respect to their application to the production chain of intensively reared fish. According to the outcomes of the FAO/WHO Expert consultation on the Application of Risk Management (Rome, 1997), there are four steps: risk evaluation, risk management option assessment, implementation of management decisions, and monitoring and review. There is a lack of information on risk assessment for farmed fish though, regarding bacteriological hazards, the data on farmed fish pathology and microbiology suggest a potential prevalence of Vibrio spp. and Aeromonas spp. Other bacterial contaminants could be introduced on handling during selection and packaging of products. On the basis of the above qualitative risk evaluation, risk management options have been individuated. These concern the monitoring of the health status of fish during the fattening period, harvest parameters, hygiene of selection and packaging, and storage characteristics.

Animals↗

Risk management: an important tool for improving quality.

Risk management implies that one has identified and analysed the root cause of the risk. In blood transfusion public and political opinion on the perceived risks are mainly related to product stigmatisation, to cognitive aspects of risk. Therefore this perception is affective, and has a negative connotation. In order to manage risk in an optimal manner, we need to understand how people think about it, and recognise that thoughts, feelings and behaviour are determined not only by psychological factors, but also by social, cultural and political influences. Perception of risk is always situated within a context, which may differ. Therefore people (i.e., public and political opinion) seem to act inconsistently from one risk context to another. Crucial for understanding the logic behind different risk perceptions is how people think about a hazard and organise information about it. The blood supply system has aspects that make it very vulnerable to crises of confidence, as the subject of blood can easily become stigmatised. The impact of the latter on the perception of blood transfusions and their recipients as well as the willingness of the public to accepttransfusions can be dramatic. Risk perception needs to be monitored in order to anticipate and adequately deal with public and political acceptance. We know that risk and stigmatisation are closely interconnected, and that the costs are likely to be high both for human health and for the maintenance of the healthcare system. Thus there is a global need to carefully monitor the safety of the blood supply systems and communicate risk information in a way that both informs people and builds up public and political confidence. It is therefore not sufficient to simply state that the blood supply is safe; it must also be made safe. So risk management becomes an integral part of quality management, as it deals with the public perception of the blood supply system and its respective elements: procurement and use.

Blood Transfusion↗

Risk management.

A practicing hospital administrator explores how a risk management program can function effectively in a hospital setting. Risk management is defined and methods of planning, developing, and organizing a practical risk management program are outlined. Certain principles are presented to ensure its effectiveness and the advantages and disadvantages of such a program are discussed in this article.

Financial Management↗

Informed consent: a stepping stone in risk management.

This article discusses 1 facet of risk management: informed consent. It provides a basis from which the concept of risk management has evolved to the current understanding of informed consent. It develops the concept of informed consent through discussion of the elements that make up this integral part of risk management. It should be noted that, as with any legal concept, local legal counsel should be consulted, because state law is it applies to informed consent may vary.

Costs and Cost Analysis↗

[Medical malpractice in surgery II: Ways of risk management].

The aims of risk management concerning medical malpractice are (1) the quick, correct and fair assessment of assumed medical failures, (2) to prevent the expansion of medical complications after an assumed medical failure and (3) the identification of patterns of risks. The latter has to be done locally and national-wide; it has to be done focussed to the respective medical subject and in a general matter as well.

Expert Testimony↗

Risk management.

All of the risk analysis tables, the risk control measures, verification results, risk/benefit analyses, risk evaluations, and traceability analyses need to be documented and available for inspection by auditors. One way to organize this documentation is to have a risk management file that includes or references each of these documents.

Device Approval↗

The future of managed care: integration of financing, risk management, and delivery.

The most significant transformation of health-care delivery and the health insurance industry is under way in the United States. It will change forever, and for the better, the way the delivery and financing of our nation's health-care is structured. We are witnessing the industrialization and consolidation of what was once a fragmented cottage industry. The new system--we call it wave III--will result in the re-establishment of the physician/providers as the key decision makers in our health-care system of the future. In this next phase of change, organized groups of physicians and hospitals will replace the current HMO insurance structure. This Third Wave will witness the integration of technology, managerial skills, marketing, sales, and negotiating acumen that were previously in the domain of health insurance companies (HMOs) into a delivery system where physicians and hospitals become partners focusing their coordinated efforts in managing health-care and the associated premiums.

Delivery of Health Care, Integrated↗

A risk management approach to the security of hospital information systems.

Risk management in today's technologically advanced health care system demands proactive rather than reactive strategies. Risk management is defined as a planned program for liability control and involves the identification, analysis and evaluation of legal risks followed by strategies to reduce or eliminate these risks. The concept of risk management is most often associated with quality assurance and direct patient care activities. For current purposes, the risk management concept is borrowed from arena of patient care and applied to the security measures surrounding hospital information systems. In this context, risk management/liability control is viewed as proactive activities designed to protect both the hospital information system and the confidentiality of patient information.

Computer Security↗

Risk management through staff education.

The staff members of a healthcare organization are recognized as students of risk management. The risk manager, through application of the fundamentals of andragogy (i.e., learning strategies specific to adult learners), is in an advantageous position to assist staff in successfully applying risk management thought processes and related actions.

Adult↗

The risk management of infections.

Unfortunately, risk management, that is avoiding lawsuits, is a retro-active pastime instead of being pro-active. What this means is that we often take action only after a problem has manifested itself, rather than identifying potential problems and correcting them. This is, however, only human nature and occurs in most other walks of life. In dental malpractice, what appears to have been happening during the past few years in California is that plaintiff's lawyers have identified a problem and then started to sue dentists for it (and even run courses on how to sue dentists for it!), after which the profession has tried to take steps to identify the cause of the problem, and has then attempted to reduce it or eliminate it altogether. In the past, the dental malpractice companies (the equivalent of the Medical Protection Society and Medical Defense Union) were merely bystanders who paid out on claims and subsequently raised premiums accordingly. Now that most of the malpractice companies in California are actually run by (and often owned by) members of the profession, they are much more interested in getting involved at a very early stage, as soon as a potential problem is identified, in order to take action so that premiums do not rise unnecessarily.

Anti-Bacterial Agents↗

Risk management issues in the perinatal setting.

The frequency and severity of obstetric lawsuits make the perinatal area a risk management priority. Risk management deals with the probability that a given risk will result in an adverse outcome and attempts to mitigate the consequences of adverse events. Perinatal care providers cannot escape risk in their everyday work environment. The article explores perinatal risk issues and offers recommendations and risk management strategies that may help minimize perinatal liability in the antepartum, intrapartum, and postpartum areas.

Female↗

Misinterpretation of drinking water quality monitoring data with implications for risk management.

A survey of two groups of environmental professionals was conducted to explore the degree of understanding in the interpretation of monitoring results for informing decision-making and responding to data appropriately to manage environmental health risks. Specifically, the understanding of the predictive value of a monitoring result and the appreciation that false positive results will inevitably predominate when monitoring for rare or infrequent hazards was explored. Results indicate evidence of misinterpretation and overconfidence in the meaning of monitoring results, and the ability of laboratory methods to detect reliably an infrequent hazard in environmental samples. A hypothetical monitoring scenario was presented with characteristics sufficient to estimate what level of confidence was warranted in a positive result. The majority of respondents in both groups (most of whom had more than 10 years experience in their field) reported between very likely to almost certain confidence (80-100% likelihood) in a hypothetical monitoring result which was, in fact, less than 5% likely to be correct. Additionally, there was little influence of the beliefs expressed about the validity of the monitoring result on the actions proposed to be taken in response to finding that monitoring result. The independence of respondents' follow-up action to what they believe of a monitoring result implies a level of detachment between the understanding of the monitoring data and the resulting risk management response.

Data Interpretation, Statistical↗

Risk management: a management-oriented program implemented through the medical director's office.

General management approaches can be applied effectively to a medical facility's risk management program. By centralizing organizational structure, anticipating and controlling risk, investigating claims liabilities, and educating the medical and administrative staffs and other hospital employees, the risk management staff at Geisinger Medical Center has established a solid base for an effective program. Moreover, the risk manager "makes rounds" throughout the institution to obtain a firsthand view of risk control in action. Conversely, physicians and nurses "rotate" through the risk manager's office to learn more about the program and their vital roles in its success. Even though the concept of risk management is fairly new, the staff at Geisinger Medical Center already is using the information generated by incident reports, medical care evaluations, utilization reports, and claims investigations to enhance its understanding of the risk control program. By encouraging the involvement and the support of medical and administrative staffs, and by using a management-oriented approach, the administration of the Geisinger Medical Center believes its risk management program has a solid foundation and a strong framework for success.

Financial Management↗

A deliberative method for ranking risks (II): Evaluation of validity and agreement among risk managers.

A deliberative method for ranking risks was evaluated in a study involving 218 risk managers. Both holistic and multiattribute procedures were used to assess individual and group rankings of health and safety risks facing students at a fictitious middle school. Consistency between the rankings that emerged from these two procedures was reasonably high for individuals and for groups, suggesting that these procedures capture an underlying construct of riskiness. Participants reported high levels of satisfaction with their groups' decision-making processes and the resulting rankings, and these reports were corroborated by regression analyses. Risk rankings were similar across individuals and groups, even though individuals and groups did not always agree on the relative importance of risk attributes. Lower consistency between the risk rankings from the holistic and multiattribute procedures and lower agreement among individuals and groups regarding these rankings were observed for a set of high-variance risks. Nonetheless, the generally high levels of consistency, satisfaction, and agreement suggest that this deliberative method is capable of producing risk rankings that can serve as informative inputs to public risk-management decision making.

Adolescent↗