Risk Management in Organizations

Risk Management, Legal, and Ethical Responsibilities

• Risk management is the process of identifying potential threats that could severely damage or ruin an organization and taking action to reduce those risks.
• Risk management requires a broad scope of effort, depending on the attentiveness and carefulness of all employees at all times.
• Mid-level managers provide data and implement risk management plans within their units.
• Private physical therapy practitioners must also consider the importance of risk management for financial success.
• Managers must focus on legal duties of their organizations and employees, as well as the rights of both. Hazard, market, reputation, and human capital are key areas of focus.
• Natural disaster risks demand property damage insurance coverage; extra protection may be needed against hurricanes, fires, or floods. Business interruption insurance is also important in areas with high hazard risks.
• Healthcare systems' upper management teams may negotiate all insurance policies with professional risk managers. Organizations need ongoing review of insurance policies to comply with new governmental regulations.
• Hazardous materials include infections, bloodborne pathogens, sharp waste disposal, and protective gear for employee and patient safety.
• Hand washing, disinfecting surfaces, and providing fresh or disposable linens are important for a safe environment.
• Policies and procedures, adhering to universal precautions, are vital to control hazards.
• Failure to manage hazardous materials risks can result in violations of OSHA standards.

Market Risks

• Employers may change healthcare policies, which limit or eliminate coverage for rehabilitation services.
• Insurers may reduce coverage for services.
• Physicians who refer to a practice may relocate or choose other providers.
• Insurers may reduce the number of contracts offered to independent practitioners to control administrative costs.
• Populations shifting affects the demand for rehabilitation services.
• Technological advances in medicine reduce the number of people needing rehabilitation services.
• Healthcare policy changes, such as accountable care organizations (ACOs), affect the market.
• Diversification of services, new collaborations, partnerships with other healthcare providers, and alternative revenue sources are strategies to reduce market risk.

Cash Flow

• Cash flow stability involves the organization's assets, resources, and expenses.
• Diligent attention to the flow of money is vital to reduce the risks of spending too much or not collecting enough.
• "Payment due when service is rendered" procedures reduce risk from patients failing to pay.
• Failure of a large number of patients to pay co-payments can be ruinous to a small practice.

Reputation Risks

• Loss of reputation stems from poor patient outcomes, suspicious accounting, fraud, false advertising, or unprofessional behavior.
• Restoring reputation requires strategic planning, which tackles difficult managerial challenges and financial devastation.

Operations Risks

• Operations involve the way work is conducted. The risks are related to the safety and security of workers and patients.
• Regular equipment maintenance, especially electrical equipment calibration, reduces the risk of adverse effects.
• Managers establish maintenance schedules, service agreements, and ensure repairs are completed in a timely manner by qualified personnel.
• Operations manuals must be easily accessible.
• Managers must emphasize equipment inspection and proper use to prevent harm to patients and potential legal action.
• Frayed electrical cords, loose connectors, and poorly maintained equipment can undermine confidence and reputation.
• Ergonomics involving office staff and workstations is important to reduce workers' compensation claims.
• Establishing safe patient handling guidelines addresses the challenges of lifting and moving dependent or obese patients.

Operations Risks: Environmental Safety

• Spills immediately cleaned up.
• Sufficient space for patients and staff to move about.
• Stairways/steps used for gait training are well-lit and free from obstacles, and functional fire alarms and extinguishers are present.
• Building security reduces personal safety risks and inventory/property damage.
• Maintaining entryways, streets, and parking lots ensures they're free of debris, obstacles, ice, and snow. Proper floor coverings prevent tripping and falling.

Operations Risks: Security and Personal Safety

• Building security reduces personal safety and belongings risks. Building security reduces loss of inventory and property damage.

Operations Risks: Patient Care Safety

• Visible security staff in healthcare organizations reflects safety concerns.
• Emergency assistance plans are essential for receptionists and therapists.
• Managers rely on physical therapists' and physical therapist assistants' skills to ensure patient safety and well-being.

Operations Risks: Documentation

• Medical records protect patients, practitioners, and healthcare organizations in case of questions or issues.
• Proper documentation minimizes the risk of lawsuits related to any reason.
• Patient records are presumed to be true. Only the person delivering care must document that care.

Identifying Risks

• Review the effectiveness of risk prevention and control efforts at least every six months to monitor and enhance efficiency.
• Identifying areas requiring risk management interventions helps staff develop professionally.

Identifying Risks (Specific Questions)

• Therapists should limit treatments to their qualifications and be aware of legal duties.
• Being careful about optimism with prognosis is critical.
• All patients should agree to rehabilitation with informed consent.
• Patient records should not jeopardize the organization.
• Proper action should be taken if a patient doesn't follow directions or discontinues treatment.
• Therapists should be tactful when dealing with patients and families.
• Therapists need to consult with each other and other professionals for patient care. Instructions should be complete and understandable.
• Patients should be notified if therapists are away and arrangements made for their care.

Identifying Risks (Further Questions)

• Seeking expert legal advice when possible negligence is anticipated.
• Ensuring equipment and environment safety.
• Ensuring all therapists are technically equipped to use all equipment.
• Ensuring all employees have the necessary qualifications, capacity, and conduct themselves with courtesy.
• Maintaining and keeping current with courses and publications.
• Avoiding adverse criticism of other workers.
• Addressing disagreements with fees.
• Careful and appropriate documentation in cases involving work-related injuries, indigents, or any other parties involved in potential litigation.

Identifying Risks (Additional Concerns)

• Comparing therapists' professional skills and experience to others in the profession.
• Advise patients of any treatment's potential efficacy uncertainties.
• Ensuring attentive, thoughtful, and secure patient interactions.
• Considering social, religious, and economic factors that might affect patients.
• Labeling incidents, occurrences, and sentinel events appropriately. Incident reports should include date, time of incident, details on involved persons (age, sex, diagnosis), physician name if applicable, witness information, description of the event, medical treatment offered, details on the person completing the report, and signature and date.

Analyzing Risks

• Root cause analysis involving the systems and processes is vital to understand an unwanted event's what, why, when, and where. In order to eliminate the issue/incident, the root cause must be established.

Legal Responsibilities of Managers

• Every legal right entails a duty for oneself and others, like the right of speech not involving shouting "Fire" in a crowded theater.
• Expert legal counsel is needed for complex decisions, especially for independent practitioners.
• Contracts (oral or written) entail mutual benefits/considerations. Managers must perform according to contract, and only the court can decide on compensation substitutions. Contracts are important for service and equipment maintenance, employee benefits, third-party payers, registry placements, employment contracts, implied contracts with patients, and clinical education agreements.
• Contracts negotiated by professionals are legally binding.
• Identifying what risks are involved by consulting with lawyers helps protect the organization's interests in contracts. Question examples (if an employee can work for a competitor, and if so how soon?).

Legal Responsibilities of Managers: Torts

• A tort involves committing an injury or wrong on a person or property which allows the injured party to seek compensation.
• In healthcare, the duty to respect and protect patient privacy and rights is vital. Failure to do so can constitute negligence and lead to liability for resulting injuries.

Legal Responsibilities of Managers: Professional Malpractice

• Malpractice is a tort focused on negligence and relevant to healthcare.
• Malpractice involves a duty to conform to a certain standard of care, and a failure to conform to this required standard of care.
• Actual injury or damage, and a causal connection between conduct and injury, are essential elements.
• Healthcare providers must adhere to an appropriate and acceptable skill and treatment level.

Legal Responsibilities of Managers: Managers and Harm to Patients

• In situations involving harm to patients, managers need to ensure staff avoids discussing incident details, report it internally promptly following established procedures, and even directly report to the insurance company if a risk manager is unavailable. Managers need to support staff by encouraging them to seek assistance from appropriate parties during difficult times.

Ethical Responsibilities of Managers

• Healthcare ethics include professional, managerial, and social responsibility - guiding ethical decision-making in patient care, organizational function, and the larger good of society.
• Managers have broader responsibilities to enhance community well-being, patient dignity, and healthcare system efficiencies and effectiveness. This involves positive responses to errors, celebrating error reporting, removing immunity for wrongdoings, open communication with the public to include mistakes, and maintaining honesty and trust.

Ethical Responsibilities of Managers: Conflicts of Interest

• Conflicts of interest may be a matter of degree and difficult to recognize. Managers must avoid benefits from using their positions to gain information, harm the organization, or accept gifts for influence.
• Failure to disclose involvement or affiliations with other organizations could raise ethical and legal concerns for organizations.

A Manager's Responsibility

• Risk management, legal, and ethical responsibilities are foundational managerial responsibilities.
• Managers view these as consultative, rather than punitive, which helps others understand the importance of these issues. Reminders for staff should include Clean Up (Don't Cover Up), Defect Prevention (Rather Than Defect Detection), Inform Before You Perform, Listen (Listen, Listen, Listen), No Second Chances, Actions (Actions Speak Louder Than Words), Treat Others (Treat Others As You Expect to Be Treated), Under Promise and Over Deliver, and Follow Up (Follow Up and Follow Through).