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Risk and Quality Management Essay

Executive Summary

The following paper will be addressing the Risk and Quality management of one of the leading health care organizations in the world today and an organization whose benefits many of us have had the pleasure of experiencing: Kaiser Permanente, which is one of the most esteemed and flourishing organizations within the health care field. Kaiser Permanente provides and offers leading health care technologies, outstanding doctors, emergency services, laboratory needs, pharmaceuticals, and other hospital services among other things. They also have a very detailed and successful risk and quality management program which they enforce within their various organizations.

Purpose of Risk and Quality Management

“Quality assurance, corporate compliance, and risk management have common elements, they all represent processes by which care and services are scrutinized, audited, and generate action plans intended to benefit patients” (Sollins, JD, 2008). So it is no surprise that within the health care field, risk and quality management’s main purpose is to ensure that patients and employees are always safe and receive the best care possible. Ensuring that both patients and employees are always safe reduces the possibility of any undue or unnecessary risks to the organizations which is why quality assurance and/or management go hand in hand with risk management. In health care Risk management is very critical as it covers so many different areas ranging from proper procedures when handling medications, protecting patient information, making sure training is happening for all employees, and so much more.

Risk management is so important because it is what makes sure the facility is operating in accordance with regulations. Quality management insures that patients are receiving quality care for a decent market value, which includes good customer service, timely visits and advanced technology. At Kaiser they value both risk and quality management and make it a core focus at all times. In fact, “Kaiser Permanente’s Care Management Institute (CMI) is one of the first organizations in the United States to earn disease management (DM) certification from the National Committee for Quality Assurance (NCQA). The 2-year NCQA DM certification was awarded in program design. The program design certification was awarded for four areas: diabetes, asthma, heart failure, and depression. CMI was one of 18 to apply for the NCQA certification/accreditation” (ManagedHealthcare.Info, 2002).

Managing the Risks

Like all other health care organizations Kaiser Permanente faces many risks on a daily basis, especially since they are dealing with people’s well-being. It is critical that first and foremost a health care organization knows what their risks are and what strategies are in place to address these risks. “Kaiser Permanente is concerned that too many diverse drug safety programs will impose a burden on the healthcare system and on patients and that this will drive up costs and limit access to therapies. At issue is the growing number of Risk Evaluation and Mitigation Strategies. The FDA has approved nearly 100 in the last three years” (Wechsler, 2010). Suffice it to say any industry that deals with the making or distributing of pharmaceutical or any other type of drugs made for the consumption of the general public has to make sure they have great risk management because there are many risks involved. In drug distribution situations if situations are not handled properly, they can lead to not only costly mistakes but can also put people’s well being in danger.

Two other typical risks for this type of organization would be patient confidentiality and cleanliness as there are so many germs and diseases that these facilities face daily. These risks could affect the quality because medication may not be correct, confidentiality breaches will have negative results on the organization and the patients, and cleanliness risks will affect the patients, and possibly even the employees’ overall experience and/or health. Kaiser is always taking steps towards better risk management and trying new policies and training to achieve this. “Licensing agencies and professional organizations prescribe minimum standards for a health care risk management program. These standards require direct interaction and
support between the Risk Management Team, Administration, the Legal Department, Medical Staff, and Quality Management. Mechanisms must be in place for expeditious investigation and reporting of occurrences, prospective and retrospective analysis, and implementing preventive programs. The Joint Commission on Accreditation of Healthcare Organizations published its guidelines for hospitals in its Accreditation Manual for Hospitals.

A major part of health care risk management is being knowledgeable of the Joint Commission on Accreditation of Healthcare Organization guidelines and ensuring that departments comply with them. Valuable safety measures with inherent checks and balances are put into place which increase quality of care and also help to curtail liability claims”. Kaiser believes that a complementary relationship exists between risk and quality management and that this relationship, in part, helps improve quality. It is this belief that created a synergistic approach within their Quality Management and Risk Management Departments.

In the mid 90’s The Los Angeles branch of Kaiser Permanente’s Patient Care Management Committee voted on actions to improve their risk management. Those actions were: * Incorporation of collective instructional programs to assist in keeping health care staff updated on new techniques. * Develop deeper understanding of confidentiality practices. * Annual risk management refreshers for health care employees. * Providing courses on how to improve medical record documentation. * Updating protocols on preoperative and post-operative administration. * Educating and establishing centers of excellence for catheter replacement and selection processes. * Upgrade existing incident report forms to ensure more accurate documentation.

* Revamp the use of Administration Records
* Audit of Critical Care Units
* Upgrading the admission policies and procedures.
* Introducing policies for patient medication procedures. Managing Quality

There are clearly so many factors which can negatively affect the quality of an organization let alone one that is in the health care field. In fact Health Care organizations may face a magnitude of issues which are not seen in other types of organizations. This is mainly due to the nature of having to deal with not only their employees but also with the welfare and wellbeing of so many different patients. However, as you can imagine some internal factors that this organization or any other health care organization may face would be training, customer services, and services rendered to the patients. In addition, some external factors that can affect the quality of an organization would be third party vendors, budget cuts, and technical issues with electronic medical records or even any other technology system.

These factors could be detrimental to any organization if not addressed properly and quickly. However, one of the reasons that Kaiser is considered one of the leading health care organizations is that Kaiser has a very large focus on quality management and wants to makes sure they are always providing the best quality. Their attention to detail is not only evident in how they perform but also in the reputation that they have acquired based on their extreme attention to these details. According to “Health Span” (n.d).

“The Kaiser Permanente Quality Management program was designed to improve the quality and safety of clinical care and the quality of services provided to our members. The Quality Improvement (QI) program prioritizes quality activities aligned with the region’s strategic plan and provides resources in support of achieving the QI work plan. This complies with applicable regulatory and accrediting body requirements. Kaiser Permanente’s QI work plan must address:

* Quality and safety of clinical care
* Quality of service
* Program scope
* Yearly objectives
* Yearly planned activities
* Timeframe within which each activity is to be achieved
* The staff member responsible for each activity
* Monitoring of previously identified issues
* Evaluation of the Quality Improvement (QI) program
Kaiser Permanente’s Goals

Kaiser Permanente’s organization has many goals many of which include helping to lower the nation’s obesity rate, promoting wellness care, promoting global health care, educating the public on health and wellness through classes and seminars, offering the best quality health care for a good price, and much more. According to the organization’s website in 2002, Kaiser Permanente and CAPH/SNI entered into a formal business cooperative effort to broaden their ability to offer quality care as well as work towards improving the type of health care that is available in many communities regardless of their economic standing. This goal is not only one that would benefit the communities in which they are used but also serve to broaden the vision of those involved in the partnership at the state and local levels between community health care providers, organizations and leaders and staff of Kaiser Permanente to cooperate towards mutal objectives which include:

* Collaborating on strategies and resources to promote quality care and enhance the efficiency within the systems * Working in association with community partners to improve the health within our neighborhoods In closing, Kaiser Permanente is one of the leading health organizations in the nation and it is no surprise that they also have some of the best risk and quality management practices to go along with their great reputation. In my experience with Kaiser risk and quality management are a focus at all times. One policy that I know is in place, just from visiting them, is that they conduct mailer surveys regarding patient satisfaction. This is important because it gives the patient the opportunity to voice what they think is great or what the organization could improve about the quality of care and services they received.

It is also an important point that this industry has and strives to maintain good risk and quality management because they are dealing on a daily basis, every day of the year with the health and wellness of quite a number of people. Based on the facts stated above, Kaiser is always striving for the best quality and risk management possible. It is evident thru the numerous awards that this organization receives, that they are clearly doing a great job and they are example of how an organization should and could properly manage risk and quality management in a way that not only benefits the organization itself but also the people which it serves.

California Health Care Safety Net Institute. (2013). Partnership with Kaiser Permanente.

Retrieved from http://safetynetinstitute.org/goals/enhancequalityofcare/kaiserpartnership/

Health Span. (n.d). Kaiser Permanente’s Quality Management program. Retrieved from



ManagedHealthcare.Info, . (2002, November 11). Quality Assurance; Kaiser Permanente institute earns NCQA Disease Management Certification. NewsRx. Retrieved from http://search.proquest.com.ezproxy.apollolibrary.com/docview/210597878?accountid=458 Sollins, JD, H. L. (2008, May – June). Quality Assurance, Corporate Compliance, and Risk Management: Overlapping but Not Identical Tools. Geriatric Nursing, 29(3), 157-159. Wechsler, J. (2010, February). Kaiser Questions Safety Policies. Pharmaceutical Executive, 30(2), 1-18. ProQuest.

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