Risk and Quality Management Assessment
Risk and Quality Management Assessment
Risk and quality management are two key concepts that help run a successful business. Risk and quality management programs provide techniques, tools, and different methods for health care organizations. Using risk and quality management programs ensure organizations provide quality health care. Novant Health is an integrated system of outpatient centers, hospitals, and physician practices located in Winston-Salem, NC and Northern Virginia. They pride themselves on providing the best quality care for the people for their community. This executive summary will provide their current risk and quality management concepts, long and short-term organizational goals, and potential risks that might negatively affect quality outcomes within the organization.
Novant Health is an integrated system of hospitals, physician practices, and outpatient centers based in and around Winston-Salem, NC and Northern Virginia. Novant Health uses world-class technology, personal connections, and care that is easy to understand and access. The mission at Novant is to improve the health of the community. Their vision is that employees and physicians deliver remarkable patient experiences every time. The values at Novant Health consist of:
Risk and Quality Management
According to Donn (2004), “Risk management is a systematic process that helps healthcare providers identify, evaluate, and address problems that might injure patients, lead to malpractice claims, and cause financial loss to health care entities (“Risk Management” para. 1). Quality management is a structured approach used by organizational management that seeks to improve the quality of services and products. Quality management includes calculated planning, distribution of resources, and other systematic activities for quality such as operations, evaluations, and quality planning (Dodwad, 2013). According to Dodwad (2013), “Quality in health care is defined as everything the health care organization needs of its customer” (“What is quality?” para. 1).
The differences and similarities of risk and quality management play important roles in maintaining a successful organization. Wittkofski (2013), stated “Both have different objectives, scope, and approaches, but when looking at the activities of both in a complex health care setting, risk management and quality improvement are more similar than different” (para. 4). The purpose of risk and quality management at Novant Health is to help provide customers with reliable and comprehensive information about the quality of care their facilities provide. Risk management is taken seriously at Novant. Physicians who participate in specific risk management continuing education activities through Novant Health Risk Retention receive a 5% annual premium discount.
Risk and quality management are critical key concepts. Novant Health works to limit the chances of medical malpractice. Some key concepts of quality and risk management are:
Using evidence-based measures to provide excellent care
Successfully implementing electronic health records
Promoting high standards of infection prevention
Use of Know 5ive save live programs to reduce serious safety events Managing risk through education
Adopting best practices
Decreasing patient injuries
Improving awareness of day-to-day potential risks in practice
Identifying and managing risks
According to Carroll (2009), “Viewing risk management as a process helps the risk management professional set priorities and assists in ensuring a comprehensive risk management effort” (para. 3). There are five steps in the risk management process: 1. Identify and analyze loss exposures-the loss exposures are identified at Novant by collecting data from independent sources. The organization has programs to measure their performance and compare results with other hospitals. If Novant does not see where they measure in quality and safety, unidentified exposures can lead to financial loss through settlements and liability judgments. 2. Consider alternative risk techniques- According to Carroll (2009), “Risk treatment strategies include two general categories: risk control and risk financing” (para. 1).
Controlling risks involves preventing losses and mitigating the amount of losses; risk financing involves paying for losses that occur. As stated earlier Novant Health takes risk management seriously. The organization engages in practices that help reduce risks; a key practice is participating in continuing medical education. To control risk financing, Novant has a risk retention group that specializes in medical malpractice liability coverage for preferred risk physicians. 3. Select the best risk management technique or combination-According to Carroll (2009), “Health care organizations accept a certain amount of patient care liability risk through an insurance deductible or self-insured retention” (para. 5).
Novant works to evaluate market rates and offer package malpractice coverage based on the practice’s needs. 4. Implement selected techniques- Carroll (2009), stated “The implementation process involves both technical risk management decisions that are made by risk management professionals and related decisions that are made by other managers within the organization” (para. 4). New Star Program was implemented to impact medical malpractice premium costs. 5. Monitor and improve risk management programs- assess the adequate and appropriateness of the techniques used to analyze, identify, and treat risks to ensure long-term success. Novant Health participates in benchmarking and performance improvement tracking.
Risks at Novant Health
There are many risks involved when running a hospital. Risks can have a negative impact on the quality of care given at facilities. Three risks that might negatively impact Novant Health are: 1. Maintaining quality and safety of patients- hospitals are being held accountable for patients. According to Peters (2009), “Medical errors are far too common. Researchers have found the threat of tort liability does little to discourage them” (para. 1). If hospitals cannot maintain the safety of patients from avoidable injuries, they will pay hefty fines. Medicare is penalizing hospitals with high rates of infections and patient injuries. 2. HIPPA violations- is a risk that affects quality and finances of the hospital. Employees must comply with HIPPA rules and regulations to avoid fines, lawsuits, and possible jail time.
Reinforcing Privacy Rules helps protect patient information. 3. Fraudulent Claims- are a typical risk within hospitals. Fraudulent claims include double-billing, charging for services not rendered, and false statements. Novant Health demands their employees to comply with regulations and statutes that govern Novant business regarding claims. These factors might negatively affect the quality of the organization by losing customers and accreditation. According to Agarwal (2010), “Accredited hospitals offer higher quality of care to patients. Accreditation also provides a competitive advantage in the health care industry” (“Importance of accreditation in hospitals” para. 1). If the risks mentioned occurred at Novant Health, the organization would experience tremendous economic collapse.
Factors that influence quality
Internal factors that influence quality at Novant Health are: 1. Electronic health records- the organization finalized the implementation of EHR in all physician practices in July 2013. With the implementation of EHR Novant patients can view their medical records online and on mobile devices 2. Creating a wellness program- illnesses such as obesity, diabetes, and hypertension cause $266 billion in medical costs if left untreated (Novant Health, 2014). The organization is a part of the community wellness initiative that informs, educate, and activates the community in managing their wellness. 3. National quality scores- To ensure patients at Novant Health are receiving the best care possible, the organization tracks different quality measures. The data collected is used to create appropriate care measures. External factors that influence quality at Novant Health are: 1. Affordable Care Act- lowering the number of readmissions that are preventable is a provision of the Affordable Care Act. Readmissions are responsible for $15 billion in medical costs (Novant Health, 2014).
There are several programs at Novant Health that aids in lowering readmission rates. 2. Population Demographics- with an aging population comes chronic disease increase. As the years progress the aging population will grow, this population will need more care. There will be need for training in geriatric care and a possible shortage of personnel (supply and demand). 3. Local market competition- the next largest hospital in Winston-Salem is Wake Forest Baptist Health. It has a hospital, children’s hospital, and medical school. The facility is fully integrated that comprises of medical education and research components.
Novant and Wake Forest Baptist offer exceptional care but over the years Novant has made the necessary changes to keep up or surpass their competition. The only factor that might have a negative effect on quality outcomes is the Affordable Care Act. One of the provisions of the act is to ensure hospitals complies with requirements to report quality measures and patient outcome. Hospitals will need to hire outside help to in order to report findings. Pay-for-performance models is another provision that can have effects on quality outcomes. With the passing of the Affordable Care Act it means that all Americans must have health insurance, more people are seeking health care in an industry facing shortages.
Short and long-term goals are important in any organization. Long-term goals for a non-profit organization such as Novant Health is stated in their mission. Short-term goals should support long-term objectives. An important long-term goal for Novant Health is to continue to improve the health of the state of North Carolina and to deliver excellent patient experiences. Short-term goals at Novant Health are preventing infection, improving patients stay, surgical outcomes and cardiac outcomes. Combining both short and long-term goals Novant Health will become one of the safest and highest quality health care organization in the United States.
Risk and Quality Management Policies
Three risk management policies that need to be applied within Novant Health are: 1. False Claims Act Policy- imposes liability on any person or entity who submits a claim to the federal government this is knowingly false. 2. Billing and Coding Policies- hospitals should implement policies and procedures to ensure accurate billing to patients, government payers, and commercial payers. 3. Privacy and Security Policies- hospitals need to implement policies and procedures that comply with HIPPA laws to protect patient privacy and security of personal information. Three quality management policies that need to be fulfilled within Novant Health are: 1. Sentinel events- hospitals must implement policies on how to handle unexpected occurrences involving death or physical injuries that are serious. 2. Safe medical devices- the use of advanced technology in various health care settings is suitable. The Food and Drug Administration requires that health care facilities report patient deaths contributed to medical devices. 3. Patient surveys- implementing the use of patient surveys allow organizations to use feedback as a way to improve care and services.
Although risk and quality management have different meanings, they share a relationship. According to Perkins (2011), “By changing your perspective to view quality as a risk function, you can shift from a largely reactive approach of measuring and controlling variances” (p.3). Risk management is the process of addressing, prioritizing, and identify sources of failure. Quality management improves those risks to meet customers’ expectations. Quality and risk management programs rely on leadership support in order to be successful.
Quality management provides guidelines that lessen the possibility of risks; risk management provides guidelines on what quality work should be. The leaders at Novant Health ensure employees follow strict rules, regulations, and policies so patients can receive the best service possible. With an active risk management program through risk retention and quality management through national quality scores, Novant Health will continue to increase the value of their organization.
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