Risk Management, Legal, and Ethical Responsibilities PDF

Risk Management, Legal, and Ethical Responsibilities FAHED HERBAWI, PT PHD  OBJECTIVES  Discuss insurance as a risk management tool.  Compare the categories of potential risks and strategies for reducing them.  Discuss security of documentation, environment, and stakeholders. ...

Risk Management, Legal, and Ethical Responsibilities FAHED HERBAWI, PT PHD  OBJECTIVES  Discuss insurance as a risk management tool.  Compare the categories of potential risks and strategies for reducing them.  Discuss security of documentation, environment, and stakeholders.  Develop a strategy to improve a practice’s bad reputation.  Determine the role of job descriptions in reducing personnel-related risks.  Discuss the risks associated with the direction of supportive personnel. OBJECTIVES  Determine the role of establishing patient rapport in reducing risks.  Analyze an incident report.  Apply root cause analysis to given scenarios.  Discuss legal rights, duties, and remedies.  Discuss a manager’s role in contracts and professional malpractice.  Discuss the role of managers in addressing the legal duties of organizations.  Overview What is risk managements ? Risk management is the process of identifying potential threats that could severely damage or completely ruin an organization and taking action to reduce those risks. What do Risk management requires ??  A broad scope of effort that depends on the attentiveness and carefulness of all employees at all times. Overview  Which level of manger does considered in risk mangement ?? Mid-level managers provide data and implement risk management plans within their units of responsibility as part of the larger organization’s plans.  What about Private practitioners in physical therapy ? They must consider the importance of risk management. AND WHY ?? To the financial success of their businesses  Overview Managers must focus on the legal duties of their organizations and employees as well as on the rights of employees and patients.  Hazard  Market  Reputation  Operations  Human capital Hazard Risks Hazard Risks ?? The risks of natural disasters demand property damage insurance coverage. Depending on location, managers may identify the need for extra protection against hurricanes, fires, or floods, for example. In areas where hazard risks are particularly high, business interruption insurance that will cover the losses that occur while the business is temporarily unable to operate.  Hazard Risks Managers who are part of the upper management team in large healthcare systems may negotiate all categories of insurance policies for their organizations in consultation with professional risk managers. Both types of organizations need to establish ongoing review of their insurance policies to ensure compliance as new governmental regulations are imposed. Hazardous Materials Although not as critical in outpatient physical therapy practices as in other practice settings, the identification of risks related to infections, bloodborne pathogens, the disposal of sharps and other waste, and the provision of protective devices assures the safety of employees and patients. Hazardous Materials Hand washing between patients, disinfecting surfaces and equipment, and supplying fresh or disposable paper linens contribute to a safe and healthy environment. So how to control it ? Policies and procedures in compliance with universal precautions. Failure to identify and reduce hazards in the broad categories may result in serious violations of federal mandates under the Occupational Safety and Health Administration (OSHA). Market Risks Defining a market as a specified category of potential buyers, managers of private (independent) physical therapy practices face the possibility of revenue losses if:  Employers in the community change healthcare policies for their employees so that coverage for rehabilitation services is more limited or eliminated.  Insurers reduce the buying for services that are covered.  Physicians who refer to the practice relocate, retire, or choose other providers.  Insurers reduce the number of contracts offered to independent practitioners to control their administrative costs. Market Risks  Populations shift so the percentage of people who seek rehabilitation services changes.  Technological advances in medicine reduce the number of people.  Healthcare policy changes such as accountable care organizations (ACOs)  Market Risks The ability of managers to develop contingency plans for market changes may be critical to the survival of their businesses. How to reduce the risk ?  Diversification of services,  New collaborations  Partnerships with other healthcare providers.  Alternative sources of revenue are some possibilities that may be considered. Cash Flow The stability of the organization’s assets, resources, and expenses. Managers soon discover that hands-on, ongoing, diligent attention to the flow of money in the organization is essential to reduce the risks of spending too much, or not collecting enough, money. Cash Flow Managers often set “payment due when service is rendered” procedures to reduce the risk of patients who fail to make co- payments or fail to pay their bills on time. Because most patients have to make co-payments, failure of a large number to pay may be ruinous, particularly to a small practice. Reputation Risks How the organization’s reputation could be lost ? Because of poor patient outcomes, suspicious accounting, fraud, false advertising, or unprofessional behaviour. At least the potential impact of negative actions should be identified to reduce risks.  Reputation Risks In any case, managers may discover that restoring a reputation requires starting all over, THEN WHAT SHOULD THE ,MANAGERS DO ? Strategic planning may be vital to tackling this restoration, one of the most difficult managerial challenges. A bad reputation affects interactions with all stakeholders and can be financially devastating. Transforming a “good reputation” into measurable, objective terms takes work. Operations Risks Operations is the way work is conducted. The risks of operations are most likely to be related to the safety and security. Of whom ?? workers and patients. Operations Risks Clinical Equipment and Other Furnishings Regular maintenance of all equipment used in patient care reduces the risk of adverse effects that are possible, particularly if electrical equipment requires calibration. Managers are responsible for establishing maintenance schedules and service agreements to ensure necessary repairs are completed and documented in a timely manner by qualified people. Operations manuals must be conveniently available Operations Risks Using Equipment Managers must demonstrate the importance of inspecting equipment before each use and proper usage of equipment. Should harm come to a patient because of failure to do so, there is little defense in a potential legal action. Operations Risks Using Equipment Not only are frayed electrical cords, loosened connectors, parts held together with tape, and missing parts potentially dangerous, but they also project a negative impression that may undermine confidence in the services delivered and the practice’s reputation. For example, using extension cords is electrically dangerous, and extending electrical cords across large spaces presents a hazard for tripping and falls. Operations Risks  Ergonomics Ergonomic analysis of office staff and their workspace is another important consideration for reducing the risk of workers’ compensation claims Managers must also consider implementing safe patient handling guidelines to address the challenges of lifting and moving patients who are dependent or obese. Operations Risks Environmental Safety Managers obtain general liability insurance policies to defer the risk of injuries that may occur on their property, and they reduce risks in an environment by making sure of the following:  Entryways, streets, and parking lots are free of debris, obstacles, ice, and snow.  Floor coverings are tightly adhered to prevent tripping or falling. CONTI… Environmental Safety  Spills are cleaned up immediately.  Adequate space is available for patients and staff to move about easily without bumping into walls or equipment.  Stairways and steps used for gait training are well lit, are free of obstacles.  Fire alarms and extinguishers are conveniently placed and functional.  Operations Risks Security and Personal Safety Building security not only reduces the risk to personal safety and belongings, but also reduces loss of inventory and property damage. Electronic passes and identification badges// why ?  Operations Risks Patient Care Safety Increased visibility of security staff in healthcare organizations is a reflection of these safety concerns. Having a plan to call for assistance is as important for the receptionist as it is for the therapist. Managers rely on the skills and decisions of physical therapists and physical therapist assistants involved in patient care to do no harm.  Operations Risks Documentation The medical record assists in protecting the patient, practitioners, and healthcare organization when questions about a patient’s care arise. If some basic principles of documentation are followed, the risk of lawsuits (for any reason) may lessen. These principles include the following:  The patient record is presumed to be true.  Only the person who delivers care can, and must, document that care. Mention all the risks that possible affect your project ( 10 minutes ) Operations Risks Documentation  Information included should clearly identify important characteristics of the patient,  Do not complain, criticize, or argue about the patient or other members of the team in the patient record.  The patient record also serves as a record of all communication among caregivers including phone calls, faxes, and verbal orders.  Human Capital Risks JOB DESCRIPTIONS ??? Organizations begin the management of human capital risks with current job descriptions that include qualifications, duties, reporting relationships, and key indicators of quality performance. Should a person for some reason be unable to perform his or her duties ? The risks presented by ineffective or suddenly dangerous employees and their effect on an organization must be controlled and eliminated. Human Capital Risks Workforce Shortages  What happenes when there is no enough people to do the work?? Often leads to unhappy, stressed employees and dissatisfied patients.  The risk of worsening patient conditions owing to lack of, or delay in, treatments is a serious concern. Human Capital Risks Recruitment  The risk of loss in the recruitment process is the investment in the costs of employment recruiters, want ads (newspapers, direct mail, online.  If the supply of employees is small, then encouraging people who are employed in other organizations Human Capital Risks Hiring  What risks can the manger face with hiring people ?  One of the greatest risks is a staff member who falsely represents his or her license to practice or other credentials.  Conducting background checks of all healthcare employees  Checking references and work history to verify information is as important for solo practitioners as it is for human resource professionals in large organizations.  Human Capital Risks Employment  The failure of staff to closely monitor patients’ ongoing responses to treatment is another cause of unfortunate incidents.  Failure to modify or correct interventions to assure patient safety during treatment sessions may also lead to injuries.  Employers are responsible for the actions of their employees— vicarious liability. Human Capital Risks  Patient Rapport The most powerful risk management tool is establishing a professional rapport with patients. People may not take legal action when unintentional or unavoidable harm occurs if they feel they have been treated with respect and dignity in a caring manner. Focusing on the patient’s best interest often leads to more positive outcomes than Efforts to minimize a problem or attempts to protect reputations.  Human Capital Risks Patient Rapport Reassuring patients that what they are feeling is expected and normal is often all that is needed to reduce many concerns about potential harm as a result of treatment. Staff must identify adverse reactions as such and address them immediately and appropriately.  Human Capital Risks Patient Rapport Managers need to be sure that staff is prepared for patients with whom it is difficult to establish a rapport. If not clearly explained, and if permission to touch is not obtained, patients may misinterpret touching as sexual advances. Inform before you perform is a particularly important mantra in physical therapy practice. Identifying Risks Like the care given to keep policies and procedures current and relevant, all organizations need to formally review the effectiveness of efforts in preventing and controlling risks in detail, at least every 6 months. They may be used to identify areas that require risk management interventions as staff plan their professional development. Identifying Risks 1. Do therapists limit treatments of patients to those they are qualified to handle? 2. Do therapists know their legal duties to their patients? 3. Are therapists careful of being overly optimistic when discussing goals or prognosis with patients? 4. Do all patients participate in rehabilitation with informed consent? 5. Would the organization be embarrassed or prejudicially affected by its patients’ records? 6. Would the medical records give the organization and the individual maximum protection in a lawsuit? Identifying Risks (conti) 1. Do therapists take special action if a patient does not follow directions or discontinues treatment? 2. Are therapists tactful with patients and families? 3. Do therapists consult with each other and other health professionals to protect the patient? 4. Are instructions to patients and families complete and understandable? 5. Are patients notified when therapists will be away and that other arrangements have been made for their care? Identifying Risks 1. Is expert legal advice sought whenever the possibility of negligence is suggested? 2. Are all equipment and the environment in the safest condition possible? 3. Are all therapists technically prepared to use all equipment? 4. Are all employees qualified? Capable? Courteous? Identifying Risks 1. Do therapists keep current with courses and publications? 2. Do therapists refrain from adverse criticism of other healthcare workers? 3. Are disagreeable misunderstandings about fees avoided? 4. Is special care taken in documentation on patients with work-related injuries, who are indigent, and all others who may be involved in litigation? Identifying Risks 1. How do the professional skills and experience of therapists compare with others in the profession? 2. Are patients advised if treatments may be of doubtful efficacy? 3. Are therapists always attentive and thoughtful so that patients feel confident and secure? 4. Is consideration given to social, religious, and economic factors affecting patients? Identifying Risks Incidents, Occurrences, and Sentinel Events an incident is anything that is not consistent with routine care or normal operations. In healthcare, sentinel events is another term for incidents or occurrences that signal that a death or serious physical or psychological injury or risk thereof has occurred. Any poor outcome may be labelled as a sentinel event to emphasize that healthcare organizations are to be held accountable for them. Identifying Risks Incidents, Occurrences, and Sentinel Events The basic content of an incident report consists of the following: 1. Date and time of incident 2. Names of persons involved 3. Age, sex, diagnosis, and physician (if patient involved) Identifying Risks Incidents, Occurrences, and Sentinel Events Description of the event 5. Name and contact information of witnesses 6. Witness’s description of the event 7. Treatment offered or rendered 8. Name, title, position of person completing the report 9. Signature and date of person preparing the report  Analysing Risks What the therapist or the team should make ? Analyse the data about potential risks and incident reports to arrive at a root cause. In order to eliminated, the incident or potential risk will not recur. Therefore the therapist make a root cause analysis focuses on systems and processes to determine the what, how, why, when, and where of an unwanted event.   Legal Responsibilities of Managers* Managers must understand that every legal right includes a duty for themselves and others. An example of the about the legal rights of the mangers ? The classic example is that the right of free expression does not include the right to scream “Fire!” in a crowded theater when there is no fire.. Legal Responsibilities of Managers* So what the mangers need for the Legal Responsibilities ?  Require expert legal advice for many of the complex decisions they face.  Independent practitioners also need access to legal counsel for many decisions.  Legal Responsibilities of Managers* Contracts are legally enforceable agreements created when an offer by one party is accepted by another.  They may be oral or written and they must include some benefit or consideration for each party.  Each party in a contract is entitled to the benefit of its bargain under the contract; therefore, managers have a duty to perform exactly as a contract provides.  Only the court can decide that the substitution of damages is fair. Legal Responsibilities of Managers* Contracts Contracts that are of most interest to healthcare managers include:  Service and equipment maintenance contracts  Contracts for employee benefits  Contracts with third-party payers  Contracts with registries, placement agencies, or independent contractors  Employment contracts  Implied contracts with patients  Clinical education agreements  Legal Responsibilities of Managers* Both oral and written contracts are a legally binding exchange of promises or agreements between parties, enforceable as law. Managers should rely on lawyers to negotiate contracts to assure that their legal interests are protected. Examples ?? Can the employee work for a competitor? How soon? How nearby? Legal Responsibilities of Managers* Torts  A tort is an injury or wrong—committed on another person, his or her property, or reputation for which the injured party is entitled to seek compensation.  For example, In healthcare, the duty to respect and protect patients and their privacy is probably the most important duty. Failure to do so is taken very seriously by the law.  If reasonable care is not exercised, that failure in duty constitutes the tort of negligence and creates liability for any resulting injury. Legal Responsibilities of Managers* Professional Malpractice Malpractice is a particular tort based on negligence and of special interest to healthcare managers. The tort of professional malpractice consists of the following elements:  The duty to conform to a certain standard of care.  A failure to conform to the required standard of care.  Legal Responsibilities of Managers* Actual injury or damage. A legally sufficient causal connection between the conduct and the injury. Standard of care A given healthcare provider must provide the level of care, skill, and treatment that, in light of all relevant surrounding circumstances, is recognized as acceptable and appropriate by reasonably prudent similar healthcare providers.  Legal Responsibilities of Managers* Managers and Harm to Patients Unfortunately, managers may face incidents that result in harm to patients. When an incident occurs, managers must ensure that employees avoid discussions of the incident. The incident is reported  First within the organization according to its procedures.  In the absence of a risk manager, the organization may report directly to the insurance company Managers must insist that employees involved in incidents seek assistance from and follow the instructions of risk managers and lawyers during these difficult times. Ethical Responsibilities of Managers Healthcare ethics span professional ethics that guide what is right or wrong in patient care, managerial ethics that guides what is right and wrong for the organization, and social responsibility that guides what is right and wrong for the good of society. Ethical Responsibilities of Managers For instance, managers have broader responsibilities for enhancing the overall quality of life in a community and the dignity and well- being of patients, and for creating an equitable, accessible, effective, and efficient healthcare system.  Ethical Responsibilities of Managers Healthcare organizations must consistently make efforts to demonstrate their willingness to be held accountable for their important role in society. These efforts include 1. Enforcing standards that are followed every day while remembering that a standard is the floor and not the ceiling of performance that may be required for excellent quality care 2. Positive responses to errors and problems rather than finger-pointing and blame- fixing  Ethical Responsibilities of Managers 3. Celebrating rather than punishing the reporting of errors and problems 4. Eliminating immunity for wrong doing 5. Transparent public sharing of information about the organization, including mistakes 6. Honesty and trustworthiness that cannot be broken Ethical Responsibilities of Managers Conflicts of Interest is a matter of degree and often difficult to identify. Because there may be legal implications, managers must be careful to avoid the benefits that result from using their positions of authority to gather information, to use information to adversely affect an organization, or to accept gifts in exchange for influence. Ethical Responsibilities of Managers Conflicts of Interest Failure to inform their organizations of involvement in or affiliations with other organizations that may impact their decisions may raise legal and ethical issues. A Manager’s Responsibility Risk management, legal, and ethical responsibilities underlie all other managerial responsibilities. Managers who view these foundations as consultative rather than punitive are more likely to have others assume these responsibilities as part of their own work.  A Manager’s Responsibility Managers may need to remind staff of the following catchphrases that may help reduce risks and legal action:  Clean Up, Don’t Cover Up  Defect Prevention, Rather Than Defect  Detection  Inform Before You Perform  Listen, Listen, Listen  No Second Chances  Actions Speak Louder Than Words  Treat Others As You Expect to Be Treated  Under Promise and Over Deliver  Follow Up and Follow Through Thank you