Risk Management Handbook for Health Care Organizations, 3 Volume Set

By Roberta Carroll and American Society for Healthcare Risk Management (ASHRM)

Continuing its superiority in the health care risk management field, this sixth edition of The Risk Management Handbook for Health Care Organizations is written by the key practitioners and consultant in the field. It contains more practical chapters and health care examples and additional material on methods and techniques of risk reduction and management. It also revises the structure of the previous edition, and focuses on operational and organizational structure rather than risk areas and functions. The three volumes are written using a practical and user-friendly approach.

• Language: English
• Publisher: Wiley
• Release date: Jan 6, 2011
• ISBN: 9780470649190

Book preview

001

Table of Contents

Cover

Title

Copyright

Cover

Volume 1

List of Exhibits, Figures, Tables, Boxes, and Appendices

The Contributors

Preface

About This Book

Chapter 1: Basics of Enterprise Risk Management in Healthcare

RISK DOMAINS

SHORTCOMINGS OF TRADITIONAL RISK MANAGEMENT

HEALTHCARE ENTERPRISE RISK MANAGEMENT

RELATIONSHIP OF OBJECTIVES AND COMPONENTS

INFORMATION AND COMMUNICATION

CONCLUSION

Chapter 2: Healthcare Legal Concepts

LEGAL ISSUES COMMON TO ALL HEALTHCARE PROVIDERS

LEGAL ISSUES RELATED TO SPECIFIC HEALTHCARE PROVIDERS

CONCLUSION

Appendix 2.1: ESSENTIALS OF AMERICAN LAW

Chapter 3: Governance of the Healthcare Organization

CORPORATE STRUCTURE

BOARD COMPOSITION

LEGAL DUTIES OF BOARD MEMBERS

BOARD ACTIVITIES AND OVERSIGHT

THE MEDICAL STAFF

LEGAL PROTECTIONS FOR BOARD MEMBERS

EDUCATION

CONCLUSION

Chapter 4: Development of a Risk Management Program

RISK MANAGEMENT PROGRAM DEVELOPMENT

KEY STRUCTURAL ELEMENTS

SCOPE OF THE RISK MANAGEMENT PROGRAM

THE RISK MANAGEMENT PROCESS

EVOLUTION OF THE RISK MANAGEMENT PROGRAM

ASSESSING RISK MANAGEMENT AREAS

KEY COMPONENTS FOR GETTING STARTED

WRITING A RISK MANAGEMENT PROGRAM PLAN

ACHIEVING PROGRAM ACCEPTANCE

CONCLUSION

Chapter 5: The Healthcare Risk Management Professional

THE RISK MANAGER’S FUNCTIONAL AREAS OF RESPONSIBILITY

RISK MANAGEMENT ACROSS A SPECTRUM OF SETTINGS

A PROFILE OF THE RISK MANAGEMENT PROFESSIONAL

EDUCATION AND PROFESSIONAL RECOGNITION PROGRAMS

REQUISITE SKILLS FOR SUCCESS

RISK MANAGEMENT ETHICS

CONCLUSION

Chapter 6: Early Warning Systems for the Identification of Organizational Risks

EARLY IDENTIFICATION OF EXPOSURE TO LOSS

FOOD AND DRUG ADMINISTRATION

INSTITUTE FOR SAFE MEDICATION PRACTICES, UNITED STATES PHARMACOPEIA, AND NATIONAL COORDINATING COUNCIL FOR MEDICATION ERROR REPORTING AND PREVENTION

MEDICAL EVENT REPORTING SYSTEM—TRANSFUSION MEDICINE

NATIONAL ALERT NETWORK FOR SERIOUS MEDICATION ERRORS

PITTSBURGH REGIONAL HEALTHCARE INITIATIVE

OTHER VOLUNTARY PROGRAMS

STANDARDIZING A PATIENT SAFETY TAXONOMY

CONCLUSION

Chapter 7: Basic Claims Administration

THE CLAIMS ENVIRONMENT

THE CLAIMS PROCESS

THE RISK MANAGEMENT PROFESSIONAL’S RESPONSIBILITIES

REGULATORY REPORTING OF CLAIMS

CONCLUSION

Chapter 8: Introduction to Risk Financing

RISK FINANCING IN THE CONTEXT OF THE RISK MANAGEMENT PROCESS

RISK RETENTION

CONCLUSION

Chapter 9: Insurance: Basic Principles and Coverages

DEFINITION OF INSURANCE

SPECIFIC TYPES OF INSURANCE

CONCLUSION

Chapter 10: Patient Safety Organizations

THE AHRQ’S COMMON FORMATS

OVERVIEW OF THE PATIENT SAFETY ACT AND REGULATIONS

PSO BEST PRACTICES

CONCLUSION

Appendix 10.1: KEY DEFINITIONS

Chapter 11: Risk Management’s Role in Performance Improvement

THE EVOLUTION OF PERFORMANCE IMPROVEMENT

PERFORMANCE IMPROVEMENT

MANAGING PERFORMANCE IMPROVEMENT

CONCLUSION

Chapter 12: Using Data as a Risk Management Tool

THE USE OF DATA

CONCLUSION

Additional Resources

Chapter 13: The Clinical Record

PERSONAL HEALTH RECORDS, ELECTRONIC HEALTH RECORDS, AND ELECTRONIC MEDICAL RECORDS

MANAGEMENT OF THE CLINICAL RECORD

DOCUMENTATION PRINCIPLES TO SUPPORT PATIENT SAFETY

EMERGING RISK TRENDS IN ELECTRONIC RECORDS

CONCLUSION

Chapter 14: Physician and Allied Health Professional Credentialing

CREDENTIALING OF PHYSICIANS

DOCUMENTATION OF CREDENTIALING CRITERIA

POTENTIAL LIABILITIES

INFORMATION SHARING AND ALLOCATION OF RISK

CREDENTIALING OF ALLIED HEALTH PROFESSIONALS

SCOPE OF AUTHORITY

MINIMIZING POTENTIAL LIABILITY IN CREDENTIALING

CONCLUSION

Chapter 15: Interpersonal Communication Skills

GENERAL PRINCIPLES OF EFFECTIVE COMMUNICATION

PATIENT- AND FAMILY-CENTERED SYSTEMS

COMMUNICATING WITH PATIENTS AND FAMILIES

CLINICAL COMMUNICATION AMONG THE HEALTHCARE TEAM

OTHER INTERNAL COMMUNICATION

COMMUNICATION WITH OTHER KEY CUSTOMERS

CONCLUSION

Chapter 16: Ethics in Patient Care

ETHICAL PRINCIPLES AND MORAL OBLIGATIONS

RESEARCH

INSTITUTIONAL REVIEW BOARDS

REGISTRATION OF CLINICAL TRIALS

PATIENT SELF-DETERMINATION ACT

WITHHOLDING OR WITHDRAWING TREATMENT

CONCLUSION

Chapter 17: A Contract Review Primer for Risk Management Professionals

CONTRACT STRUCTURE

CRITICAL CONTRACT PROVISIONS

CONTRACTUAL RISK TRANSFER

HIPAA: BUSINESS ASSOCIATE REQUIREMENTS

HEALTHCARE CONTRACTING RELATIONSHIPS

CONTRACT FILE MANAGEMENT

CONCLUSION

Chapter 18: Information Technologies and Risk Management

RISK MANAGEMENT INFORMATION NEEDS

RISK MANAGEMENT INFORMATION SYSTEMS

ELECTRONIC HEALTH RECORDS

PERSONAL HEALTH RECORD

CLINICAL INFORMATION TECHNOLOGIES

POINT OF CARE TECHNOLOGY

TELEMEDICINE

CONCLUSION

Appendix 18.1: SOCIAL NETWORKING GLOSSARY

Appendix 18.2: IT GLOSSARY

Chapter 19: Emergency Management

THE STEPS OF EMERGENCY MANAGEMENT

PREVENTION

PLANNING AND PREPARATION

IMPLEMENTATION AND RESPONSE

RECOVERY

CONCLUSION

Chapter 20: Occupational Safety, Health, and Environmental Impairment

ADMINISTRATIVE PROCEDURE ACT

ADMINISTRATIVE ENFORCEMENT

SPECIFIC OCCUPATIONAL SAFETY AND HEALTH ISSUES

CONCLUSION

Appendix: A Guide to Medical Terminology

HISTORY

STRUCTURE OF MEDICAL TERMS

SUFFIXES

PREFIXES

ROOT WORDS

SINGULAR AND PLURAL FORMS

ABBREVIATIONS AND ACRONYMS

CONCLUSION

Glossary

Index

Cover

Volume 2

List of Boxes, Exhibits, Figures, Tables, and Appendices

The Contributors

Preface

About This Book

Chapter 1: Patient Safety and the Risk Management Professional: New Challenges and Opportunities

THE SCOPE OF MEDICAL ERRORS

CAUSES OF MEDICAL ERRORS

CONCLUSION

Chapter 2: The Risk Management Professional and Medication Safety

LATENT AND ACTIVE FAILURES

SYSTEMS THINKING

A PRIORITIZING APPROACH

CONCLUSION

Chapter 3: The Risk Management Professional and Biomedical Technology

STRATEGIC CONSIDERATIONS

RISK MANAGEMENT INPUT

FINANCIAL CONSIDERATIONS

CONTRACTS WITH VENDORS

BULK PURCHASING ARRANGEMENTS

STAFF TRAINING

TRAINING NONMEDICAL USERS

OPERATIONAL FACTORS

REALITIES OF IMPLEMENTATION

REPORTING AND FOLLOW-UP OF ADVERSE EVENTS AND NEAR MISSES

TRACKING BIOMEDICAL DEVICES

RECALLS OF BIOMEDICAL DEVICES

REPROCESSING OF SINGLE-USE MEDICAL DEVICES

DISPOSAL OF BIOMEDICAL TECHNOLOGY-RELATED DEVICES

THE FUTURE OF PATIENT SAFETY AND BIOMEDICAL TECHNOLOGY

Chapter 4: Informed Consent as a Loss Control Process

INFLUENCE OF LEGAL DECISIONS ON THE CONSENT PROCESS

ELEMENTS OF CONSENT TO TREATMENT

EXCEPTIONS TO THE GENERAL RULES OF CONSENT

IMPRACTICALITY OF CONSENT

EFFECTIVE COMMUNICATION IN THE CONSENT PROCESS

RIGHT TO WITHDRAW CONSENT

SPECIAL NEEDS PATIENTS AND THE CONSENT PROCESS

CONSENT REQUIREMENTS ALONG THE CONTINUUM OF CARE

BREAKDOWN IN THE CONSENT PROCESS

RISK MANAGEMENT AND CONSENT TO TREATMENT

CONCLUSION

Chapter 5: Clinical Research: Institutional Review Boards

ETHICAL PRINCIPLES

REGISTRATION OF CLINICAL TRIALS

CONCLUSIONS

Chapter 6: Patient Safety in Surgery: The Essential Continuum

SAFETY LEADERSHIP

PATIENT EDUCATION

PREOPERATIVE PREPARATION

OUTPATIENT SURGERY

IN THE OPERATING ROOM

POSTANESTHESIA CARE UNIT

OPERATING ROOM ENVIRONMENT

ORGANIZATIONAL STRUCTURE

PERIOPERATIVE SCORECARD

CONCLUSION

Chapter 7: Managing Risks and Improving Safety in the Intensive Care Unit

ICU CULTURE AND PATIENT SAFETY

COMMUNICATION AND TEAMWORK

ICU STRUCTURE, STAFFING, AND TRAINING

INITIATIVES REQUIRE INTEGRATED SYSTEMS

EVENT, ERROR, AND NEAR-MISS REPORTING

TECHNOLOGY AND SAFETY IN THE ICU

MEDICATION ERRORS IN THE ICU

HIGH-ALERT MEDICATIONS IN THE ICU

INFECTIONS IN THE ICU

CLINICAL CARE BUNDLES

INFORMATION TECHNOLOGY AND THE ICU

QUALITY IMPROVEMENT IN THE ICU

ICU TELEMEDICINE

TRANSPARENCY, DISCLOSURE, AND THE PATIENT-CENTERED ICU

END-OF-LIFE CARE IN THE ICU

CONCLUSION

Chapter 8: Management of Risk: Promoting Perinatal Patient Safety

SCOPE OF PROBLEM

AN EMERGING SOLUTION?

ATTEMPTS TO MANAGE OBSTETRICAL RISK

STEPWISE STRATEGY FOR MANAGING PERINATAL RISK

CLINICAL PRACTICES THAT INCREASE RISK OF INJURY AND HARM

CONCLUSION

Chapter 9: Pediatric Risk Management

CLINICAL ISSUES

SLEEPING POSITION

MEDICATION MANAGEMENT

OFF-LABEL USE OF MEDICATIONS

ENVIRONMENTAL SAFETY

PERSONNEL ISSUES

SPECIAL ISSUES

CHILD ABUSE AND NEGLECT

CONCLUSION

Chapter 10: Risk Management in the Laboratory

REGULATORY ENVIRONMENT

KEY INFRASTRUCTURE

RISK REDUCTION STRATEGIES IN THE PREANALYTICAL PHASE

RISK MANAGEMENT STRATEGIES IN THE ANALYTIC PHASE

RISK MANAGEMENT STRATEGIES IN THE POSTANALYTIC PHASE

RISK MANAGEMENT STRATEGIES IN LAB SPECIALTIES

BILLING COMPLIANCE

CONCLUSION

Chapter 11: Managing Clinical Risk and Enhancing Patient Safety in Radiology

TECHNOLOGY

INTERFACE WITH OTHER CLINICAL AREAS

TRADITIONAL RISK MANAGEMENT PRINCIPLES

CONCLUSION

Chapter 12: Emergency Department Risk Management: Promoting Quality and Safety in a Chaotic Environment

IN-HOSPITAL EMERGENCY MEDICINE CARE

TRENDS IN ED MALPRACTICE

MANAGEMENT OF PSYCHIATRIC PATIENTS

PROCESS ISSUES

POLICY AND PROCEDURE ISSUES

NATIONAL PATIENT SAFETY GOALS AND THE ED

INTEGRATION OF ED AND HOSPITAL OPERATIONS

INFORMATION SYSTEMS

ORIENTATION AND TRAINING OF PERSONNEL

EMS MEDICAL CONTROL IN PREHOSPITAL CARE

CONCLUSION

Chapter 13: Prehospital Emergency Medical Services

LEGAL DUTIES

BRIEF HISTORY OF EMS SYSTEMS

EMS STRUCTURE AND ORGANIZATION

EMS RESPONSE

FEDERAL GUIDELINES

ACCREDITATION

STAFFING

AMBULANCE DIVERSION

DESTINATION PROTOCOLS

AIR AMBULANCE SERVICES

RISK OF VEHICULAR EMERGENCY RESPONSE

GROUND AMBULANCE OPERATION

COMMUNICATION SYSTEMS

CONFIDENTIALITY

DOCUMENTATION

CONSENT AND REFUSAL TO ACCEPT SERVICES

DO NOT RESUSCITATE OR COMFORT CARE

DISCONTINUATION OF LIFE SUPPORT EFFORTS

BLOODBORNE PATHOGEN CONSIDERATIONS

RISK AND RESPONSIBILITY OF RESPONDING TO VIOLENT SCENES

LIABILITY INSURANCE

CONTINUOUS RISK IMPROVEMENT

ACCIDENT ANALYSIS

BENCHMARKS

PROACTIVE RISK MANAGEMENT

POTENTIAL CLAIM INVESTIGATION AND LOSS MITIGATION

CONCLUSION

Chapter 14: Risk Management and Behavioral Health

HISTORICAL PERSPECTIVE

LEGAL ISSUES

ACCESS TO BEHAVIORAL HEALTH SERVICES

SCOPE OF PRACTICE

CLINICAL RISKS

ABUSE RISKS

ENVIRONMENTAL RISKS

CONCLUSION

Appendix 14.1: Latent Risks in the Built Environment for the Behavioral Health Patients: Concerns for the Healthcare Risk Manager

Chapter 15: Managing Risk in the Ambulatory Environment

COMMON CONCEPTS

CLINICAL AND SAFETY ISSUES

HUMAN RESOURCES ISSUES

PERFORMANCE IMPROVEMENT

ACCREDITATION, LICENSURE, AND REGULATORY ISSUES

RISK MANAGEMENT ISSUES

CLINICAL ISSUES

AMBULATORY CARE SYSTEMS AND PROCEDURES

PUBLIC HEALTH DEPARTMENTS AND AGENCIES

AMBULATORY SURGERY CENTERS

ALTERNATIVE MEDICINE

CONCLUSION

Appendix 15.1: Complementary and Alternative Medicine

Chapter 16: Risk Management Considerations in Home Healthcare

THE RAPID EVOLUTION OF HOME CARE

STAFFING

RISK MANAGEMENT CONSIDERATIONS

CLINICAL CONSIDERATIONS

INFECTIOUS AND HAZARDOUS WASTE MANAGEMENT

CONCLUSION

Chapter 17: Risk Management for Retail Clinics

THE EMERGENCE OF RETAIL CLINICS

EXISTING LAWS GOVERNING RETAIL CLINICS

NEW RETAIL CLINIC LAWS

AREAS OF LIABILITY

CONCLUSION

Chapter 18: Managing the Obese Patient: Risks Across the Continuum of Care

ENTERPRISE RISK MANAGEMENT APPROACH

FACILITY DESIGN AND EQUIPMENT

PATIENT SENSITIVITY AND WEIGHT BIAS

OBESE PATIENT RISK FACTORS

PREPARING FOR OBESE PATIENTS

SAFE PATIENT HANDLING

BARIATRIC SURGICAL PROCEDURES

PROFESSIONAL LIABILITY RISKS

CONCLUSION

Chapter 19: Risk Management and Patient Safety in Oncology

ORIGINS OF ONCOLOGY

THE ONCOLOGICAL CONTINUUM OF CARE

REDUCING RISK AND ENHANCING SAFETY IN ONCOLOGY

CHEMOTHERAPY

RADIATION THERAPY

FALL PREVENTION

CONCLUSION

Chapter 20: Seniors Housing and Long-Term Care

INDEPENDENT LIVING

OPERATIONAL RISKS AND EXPOSURES

ASSISTED LIVING

NEGOTIATED RISK AGREEMENTS

SKILLED NURSING FACILITIES

PUBLIC AND MEDIA RELATIONS AND LONG-TERM CARE’S NEGATIVE IMAGE

INSURANCE FOR SENIORS HOUSING AND LONG-TERM CARE

RISK MANAGEMENT PROGRAM

CONCLUSION

Glossary

Index

Cover

Volume 3

List of Exhibits, Tables, Figures, Boxes, and Appendices

The Contributors

Preface

About This Book

Chapter 1: Statutes, Standards, and Regulations

REGULATORY AGENCIES

PAYMENT

PATIENT CARE

MEDICARE REGULATIONS

REPORTING REQUIREMENTS

MEDICAL DEVICES

PRIVACY

CASE LAW

CONCLUSION

Chapter 2: Accreditation, Licensure, Certification, and Surveying Bodies

THE ERA OF TRANSPARENCY IN HEALTHCARE

WHAT RISK MANAGERS NEED TO KNOW

RISK MANAGEMENT PROGRAM RESPONSIBILITIES

WHY PARTICIPATE IN VOLUNTARY ACCREDITATION ACTIVITIES?

LICENSURE, ACCREDITATION, AND CERTIFICATION ACTIVITIES

LICENSURE, ACCREDITATION, AND CERTIFICATION

MANDATORY SURVEYING BODIES

VOLUNTARY SURVEYING BODIES

COLLEGE OF AMERICAN PATHOLOGISTS

CLINICAL LABORATORIES QUALITY STANDARDS

COMMISSION ON ACCREDITATION OF REHABILITATION FACILITIES

AMERICAN ASSOCIATION FOR ACCREDITATION OF AMBULATORY SURGERY FACILITIES

URAC

ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE

COMMUNITY HEALTH ACCREDITATION PROGRAM

NATIONAL COMMISSION ON CORRECTIONAL HEALTH CARE

COMMISSION ON DENTAL ACCREDITATION

CONCLUSION

Appendix 2.1: ACCREDITATION AND LICENSURE ORGANIZATIONS, SURVEYING BODIES, AND GOVERNMENT AGENCIES

Chapter 3: Managed Care

BACKGROUND

RISK ASSESSMENT

RISK MANAGEMENT

CONSEQUENTIAL RISK FACTORS

CONCLUSION

Chapter 4: Corporate Compliance A Risk Management Framework

HEALTHCARE FRAUD AND ABUSE

A FRAMEWORK FOR COMPLIANCE MANAGEMENT

CONCLUSION

Chapter 5: Advertising Liability

FEDERAL LAWS AND HOSPITAL ADVERTISING LIABILITY

MANAGING ADVERTISING LIABILITY EXPOSURES

CONCLUSION

Chapter 6: Employment Practices Liability

EMPLOYMENT STATUTES AFFECTING THE EMPLOYMENT RELATIONSHIP

STATE WORKPLACE LAWS

ARBITRATION OF WORKPLACE DISPUTES

COLLECTIVE BARGAINING IN THE HEALTHCARE WORKPLACE

OSHA REQUIREMENTS

EMPLOYEE DISCIPLINE AND DRUG-TESTING

THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA)

OFFICE OF INSPECTOR GENERAL COMPLIANCE GUIDE

RED FLAGS RULES/IDENTITY THEFT PROTECTION PROGRAMS

CONCLUSION

Chapter 7: Emerging Liabilities in Partnerships, Joint Ventures, and Other Collaborative Relationships

CHARACTERIZATION OF THE BUSINESS RELATIONSHIP

EVALUATING POTENTIAL BUSINESS PARTNERS

DEVELOPING THE BUSINESS STRUCTURE

IMPLEMENTING THE BUSINESS RELATIONSHIP

MANAGING DAY-TO-DAY OPERATIONS

CONCLUSION

Chapter 8: Mergers, Acquisitions, and Divestitures

DUE DILIGENCE

RISK MANAGEMENT POLICIES AND PROCEDURES

DIVESTITURE

THE FINAL REPORT

CONCLUSION

Chapter 9: Request for Proposals

TYPES OF SERVICES REQUESTED

TYPES OF PROPOSALS

INITIAL STEPS IN THE RFP PROCESS

WHAT TO INCLUDE IN THE RFP

WHAT TO LOOK FOR IN RESPONSES TO THE RFP

ORAL PRESENTATIONS

MONITORING RESULTS AND EVALUATING SERVICES

CONCLUSION

Chapter 10: Cost of Risk

WHAT IS THE COST OF RISK?

THE COST OF HAZARD RISKS

THE COST OF OPERATIONAL RISKS

COR AND BENCHMARKING

ALLOCATION

CONCLUSION

Chapter 11: Risk Financing Techniques

OVERVIEW OF RISK FINANCING TECHNIQUES

INTEGRATED RISK FINANCING AND INTEGRATED HEALTHCARE

TAX ASPECTS OF RISK FINANCING

OTHER TAX AND LEGAL ISSUES

ACTUARIAL AND ACCOUNTING APPLICATIONS

CONCLUSION

Chapter 12: Claims and Litigation Management

CLAIMS IDENTIFICATION AND INVESTIGATION

CLAIMS FILE MANAGEMENT

RESERVING OF CLAIMS

LITIGATION MANAGEMENT

INSURANCE COMPANIES AND BROKERS

CLAIMS SETTLEMENT

ALTERNATIVE DISPUTE RESOLUTION MECHANISMS

NEGOTIATION TECHNIQUES

PROCESS OF A LAWSUIT

STATUTORY REPORTING REQUIREMENTS

STATE REPORTING REQUIRMENTS

CMS MANDATORY REPORTING REQUIREMENTS

CONCLUSION

Chapter 13: Workers’ Compensation Programs in Healthcare Organizations

LEGAL FRAMEWORK

WORKERS’ COMPENSATION BENEFITS

PROGRAM ADMINISTRATION

RISK FINANCING

CONTRACT ISSUES

CLAIMS MANAGEMENT

MODIFIED DUTY AND RETURN-TO-WORK PROGRAMS

TRACKING CLAIMS DATA AND ANALYZING TRENDS

COST CONTROL

RECORD-KEEPING

CONCLUSION

Chapter 14: Occupational and Environmental Risk Exposures for Healthcare Facilities

OCCUPATIONAL SAFETY AND HEALTH CONCERNS

OTHER OCCUPATIONAL HEALTH ISSUES

GENERAL SAFETY ISSUES

ENVIRONMENTAL IMPAIRMENT

ON-SITE MEDICAL WASTE INCINERATORS

ENVIRONMENTAL ISSUES IN ACQUISITIONS

CONCLUSION

Chapter 15: Telemedicine

BACKGROUND

THE EVOLUTION OF TELEMEDICINE

TELEMEDICINE TODAY

TELEMEDICINE RISK EXPOSURES AND CHALLENGES

THE ROLE OF THE RISK MANAGEMENT PROFESSIONAL

CONCLUSION

Appendix 15.1: GLOSSARY OF TERMS

Chapter 16: HIPAA

APPLICABILITY OF HIPAA

PATIENTS’ RIGHTS TO THEIR INFORMATION

AUTHORIZED USES AND DISCLOSURES

DISCLOSURES PERMITTED WITHOUT AUTHORIZATION

REQUIRED DISCLOSURES (AND OTHER DISCLOSURES FOR WHICH NO AUTHORIZATION IS REQUIRED)

ADDITIONAL RISKS

SECURITY REQUIREMENTS

BREACH NOTIFICATION OBLIGATION

ENFORCEMENT

AVOIDING RISK THROUGH PRIVACY AND SECURITY MANAGEMENT

CONCLUSION

Appendix 16.1: HIPAA NOTICE

Appendix 16.2: HIPAA AUTHORIZATION

Chapter 17: Medicare Recovery Audit Contractor Program

PUBLIC PAYOR AUDITS

RAC AUDITS

CONCLUSION

Chapter 18: Medical Tourism

INTRODUCTION

INBOUND MEDICAL TOURISM

OUTBOUND MEDICAL TOURISM

CONCLUSION

Chapter 19: Absence and Productivity Management

INTRODUCTION TO HUMAN CAPITAL RISK

THE IMPORTANCE OF ABSENCE

CURRENT TRENDS

OVERVIEW OF ABSENCE PROGRAMS

RELATIONSHIP BETWEEN ABSENCE AND PRODUCTIVITY

PRESENTEEISM PRODUCTIVITY CHALLENGES

WHY MANAGE ABSENCE?

COMPONENTS OF AN EFFECTIVE ABSENCE MANAGEMENT PROGRAM

MEASURING THE COSTS OF ABSENCE AND PRODUCTIVITY

IMPLEMENTATION

CONCLUSION

Glossary

Index

End User License Agreement

List of Tables

Volume 1

Chapter 1: Basics of Enterprise Risk Management in Healthcare

TABLE 1.1 Risk Categories and Domains

TABLE 1.2 Qualitative Measure of Risk Frequency

TABLE 1.3 Measure of Time to Impact

TABLE 1.4 Qualitative and Quantitative Measures of Risk Severity

TABLE 1.5 Fetal Hypoxia

Chapter 2: Healthcare Legal Concepts

APPENDIX 2.1 TABLE 2.1 Standard Legal Abbreviations

Chapter 5: The Healthcare Risk Management Professional

TABLE 5.1 Current Work Settings

TABLE 5.2 Location of Primary Work Setting

TABLE 5.3 Organizational Type

TABLE 5.4 Current Professional Level

TABLE 5.5 Current Position Title

TABLE 5.6 Functional Areas of Responsibility

Chapter 8: Introduction to Risk Financing

TABLE 8.1 Types of Insurance

Chapter 12: Using Data as a Risk Management Tool

TABLE 12.1 Risk Management Assessment: Key Elements

TABLE 12.2 Hospital Action Plans

Chapter 17: A Contract Review Primer for Risk Management Professionals

TABLE 17.1 Components of Contract Review

Chapter 18: Information Technologies and Risk Management

TABLE 18.1 Stage of Meaningful Use Criteria by Payment Year

Appendix: A Guide to Medical Terminology

TABLE A.1 Common Medical Suffixes

TABLE A.2 Common Medical Prefixes

TABLE A.3 Musculoskeletal System Root Words and Meanings

TABLE A.4 Nervous System Root Words and Meanings

TABLE A.5 Reproductive System Root Words and Meanings

TABLE A.6 Urinary System Root Words and Meanings

TABLE A.7 Cardiovascular System Root Words and Meanings

TABLE A.8 Gastrointestinal System Root Words and Meanings

TABLE A.9 Endocrine System Root Words and Meanings

TABLE A.10 Integumentary System Root Words and Meanings

TABLE A.11 Respiratory System Root Words and Meanings

TABLE A.12 Singular and Plural Forms of English Words

TABLE A.13 Singular and Plural Forms of Certain Words Derived from Greek or Latin

TABLE A.14 Common Medical Abbreviations

TABLE A.15 Some Common Medical Acronyms

Volume 2

Chapter 2: The Risk Management Professional and Medication Safety

TABLE 2.1 PCA Problems and Safety Recommendations

Chapter 6: Patient Safety in Surgery: The Essential Continuum

TABLE 6.1 Balanced Scorecard Project

TABLE 6.2 Sample Measures

Chapter 7: Managing Risks and Improving Safety in the Intensive Care Unit

TABLE 7.1 Critical Care Settings Rate Unit’s Patient Safety Culture

TABLE 7.2 The Doctors Company/OHIC Insurance Top 10 Allegations in ICU Claims, 2000 to 2008

TABLE 7.3 The Doctors Company/OHIC Insurance Top 11 Risk Management Issues in ICU Claims, 2000 to 2008

Chapter 9: Pediatric Risk Management

TABLE 9.1 Specific Indicators that Warrant an Abuse Evaluation

TABLE 9.2 Characteristics of Abuse—Child

TABLE 9.3 Characteristics of Abuse—Parental or Caretaker

TABLE 9.4 Neglect—Specific Indicators

TABLE 9.5 Characteristics for Neglect—Child

TABLE 9.6 Characteristics for Neglect—Parental or Caretaker

TABLE 9.7 Characteristics for Emotional Maltreatment—Child

TABLE 9.8 Characteristics for Emotional Maltreatment—Parental or Caretaker

TABLE 9.9 Sexual Abuse—General Indicators

Volume 3

Chapter 2: Accreditation, Licensure, Certification, and Surveying Bodies

TABLE 2.1 CMS Regional Offices

TABLE 2.2 Major Requirements of ISO 9001 Standards

Chapter 3: Managed Care

TABLE 3.1 Capitation Budget with Utilization

TABLE 3.2 Continuance Table/Claims Distribution

TABLE 3.3 Risks by Prospective Payment Method

Chapter 4: Corporate Compliance A Risk Management Framework

TABLE 4.1 Common Requirement—OIG Compliance Program Guidance Models

TABLE 4.2 Risk Areas—OIG Compliance Program Guidance Models

TABLE 4.3 RAC Contractors

Chapter 9: Request for Proposals

TABLE 9.1 Comparison of Quality Cycle with Risk Management Process and Broker Service Cycle

Chapter 10: Cost of Risk

TABLE 10.1 Conceptual Approach for Defining the Cost of Hazard Risks

Chapter 11: Risk Financing Techniques

TABLE 11.1 Qualitative and Quantitative Factors for the Use of a Captive

Chapter 15: Telemedicine

TABLE 15.1 Telemedicine Applications Across a Health Care System

TABLE 15.2 Sample Policies and Procedures Related to Telemedicine

TABLE 15.3 Stakeholders in Telemedicine

Chapter 19: Absence and Productivity Management

TABLE 19.1 States with Current and Pending FMLA Laws

List of Illustrations

Volume 1

Chapter 1: Basics of Enterprise Risk Management in Healthcare

FIGURE 1.1 Three-Dimensional Matrix in the Form of a Cube

FIGURE 1.2 Sample Risk Map

Chapter 4: Development of a Risk Management Program

FIGURE 4.1 Steps in Risk Management Decision Making

Chapter 8: Introduction to Risk Financing

FIGURE 8.1 Risk Management Process Structure

FIGURE 8.2 Risk Financing Continuum

Chapter 10: Patient Safety Organizations

FIGURE 10.1 Flow of PSWP

Chapter 12: Using Data as a Risk Management Tool

FIGURE 12.1 Improved Incident Reporting

FIGURE 12.2 Ten Most Prevalent Conditions in Emergency Department Claims

FIGURE 12.3 Sample Run Chart: Length of Stay (LOS) by Week

FIGURE 12.4 Run Chart: Shift in Data

FIGURE 12.5 Run Chart: Trend in Data

FIGURE 12.6 Sample Pareto Chart: Root Causes of Sentinel Events

FIGURE 12.7 Sample Histogram: All Facilities Claims/Lawsuits

FIGURE 12.8 Sample Control Chart

FIGURE 12.9 Risk Management Assessment: Hospital Results

FIGURE 12.10 System Risk Assessment: Gap Analysis

FIGURE 12.11 Three-Year Results

Volume 2

Chapter 1: Patient Safety and the Risk Management Professional: New Challenges and Opportunities

FIGURE 1.1 Swiss Cheese Model of Accident Causation

FIGURE 1.2 The Sharp End/Blunt End of a Complex System

FIGURE 1.3 Human–Machine Interface

FIGURE 1.4 Components of Human Factors Assessment

FIGURE 1.5 Poorly Designed Paper Towel Dispenser and Disposal Unit

Chapter 2: The Risk Management Professional and Medication Safety

FIGURE 2.1 Chart Entry—Benzathine

FIGURE 2.2 Door-Pull Handle

FIGURE 2.3 Faxes Aren’t the Problem

FIGURE 2.4 Capsule Quantity Is Often Confused with Product Strength

FIGURE 2.5 Merthergine versus Brethine

FIGURE 2.6 Mix of Ophthalmic and Respiratory Solutions

FIGURE 2.7 Tubing Lines

FIGURE 2.8 IV Tubing to Oxygen

FIGURE 2.9 IV Misconnect

FIGURE 2.10 Rank Order of Error Reduction Strategies

Chapter 4: Informed Consent as a Loss Control Process

FIGURE 4.1 Patient Presents

Chapter 6: Patient Safety in Surgery: The Essential Continuum

FIGURE 6.1 Patient Safety Continuum

Chapter 7: Managing Risks and Improving Safety in the Intensive Care Unit

FIGURE 7.1 ICU Adverse Events and Near Misses Reported to Pennsylvania Patient Safety Authority, 2008

Chapter 12: Emergency Department Risk Management: Promoting Quality and Safety in a Chaotic Environment

FIGURE 12.1 Emergency Department Patient Registration Time

FIGURE 12.2 Emergency Department Flow

Chapter 20: Seniors Housing and Long-Term Care

FIGURE 20.1 2008 Loss Cost per Occupied Bed–Limited to $1M

FIGURE 20.2 Long-Term Care Benchmark General and Professional Liability Loss Cost per Occupied Bed–Limited to $1M All States

FIGURE 20.3 Long-Term Care Benchmark General and Professional Liability Claim Frequency per Occupied Bed All States

FIGURE 20.4 Long-Term Care Benchmark General and Professional Liability Claim Severity–Limited to $1M All States

Volume 3

Chapter 3: Managed Care

FIGURE 3.1 Example Risk Contract

FIGURE 3.2 How Coverage Terms Affect Recovery

Chapter 10: Cost of Risk

FIGURE 10.1 Hospital Professional Liability Benchmark

FIGURE 10.2 Hospital Professional Liability Benchmark Analysis

FIGURE 10.3 Obstetrical Case Rate

FIGURE 10.4 Surgical Cases

FIGURE 10.5 Diagnostic Process of Care

FIGURE 10.6 Surgical Cases

Chapter 11: Risk Financing Techniques

FIGURE 11.1 Premium Dollar Pie Chart

FIGURE 11.2 In Either Case, Umbrella or Excess Coverage Can Be Purchased to Provide Additional Protection

FIGURE 11.3 Direct Issue Captive

FIGURE 11.4 Fronted Reinsurance Captive

FIGURE 11.5 Traditional Nonintegrated and Integrated Programs

FIGURE 11.6 Traditional Program Structure

cov01

The Essentials

Sixth Edition

VOLUME 1

Roberta Carroll

Series Editor

Peggy L. B. Nakamura

Volume Editor

Roberta Carroll

Volume Editor

Risk Management Handbook for Healthcare Organizations

001

Copyright © 2011, John Wiley & Sons, Inc. All rights reserved.

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Library of Congress Cataloging-in-Publication Data

Risk management handbook for health care organizations / Roberta Carroll, series editor. – 6th ed.

p. ; cm.

Includes bibliographical references and indexes.

ISBN 978-0-470-62080-9 (set) – ISBN 978-0-470-62081-6 (v. 1 : cloth) – ISBN 978-0-470-62082-3 (v. 2 : cloth) – ISBN 978-0-470-62083-0 (v. 3 : cloth)

1. Health facilities–Risk management. I. Carroll, Roberta.

[DNLM: 1. Health Facilities–organization & administration. 2. Risk Management. 3. Health Facilities–economics. WX 157 R59532 2010]

RA971.38.R58 2010

362.11068–dc22

2010017899

List of Exhibits, Figures, Tables, Boxes, and Appendices

EXHIBITS

Exhibit 4.1 Risk Management Program (Sample)

Exhibit 5.1 Chief Risk Officer Position Description

Exhibit 5.2 Patient Safety Officer Job Description

Exhibit 5.3 Risk Manager Position Description, Level One

Exhibit 5.4 Risk Manager Job Description, Level Two

Exhibit 5.5 Risk Manager Position Description, Level Three

Exhibit 5.6 Physician Risk Manager Job Description

Exhibit 5.7 ASHRM Code of Professional Ethics and Conduct

Exhibit 6.1 MedWatch Form 3500 for Voluntary Reporting and Advice about Reporting

Exhibit 6.2 USP Medication Errors Reporting Program Form

Exhibit 6.3 NCC MERP Index for Categorizing Medication Errors

Exhibit 6.4 NCC MERP Index for Categorizing Medication Errors Algorithm

Exhibit 12.1 Contributing Factors Investigation Tool

Exhibit 17.1 Policy: Contract Review and File Maintenance

Exhibit 17.2 Contract Review and File Maintenance

Exhibit 17.3 Annual Evaluation of Service Provided by Contract

Exhibit 19.1 Vulnerability Analysis Chart

Exhibit 19.2 Training Drills and Exercises Schedule

Exhibit 19.3 Hazard Vulnerability Analysis

Exhibit 19.4 Emergency Management Planning—Standards and Regulations

FIGURES

Figure 1.1 Three-Dimensional Matrix in the Form of a Cube

Figure 1.2 Sample Risk Map

Figure 4.1 Steps in Risk Management Decision Making

Figure 8.1 Risk Management Process Structure

Figure 8.2 Risk Financing Continuum

Figure 10.1 Flow of PSWP

Figure 12.1 Improved Incident Reporting

Figure 12.2 Ten Most Prevalent Conditions in Emergency Department Claims

Figure 12.3 Sample Run Chart: Length of Stay (LOS) by Week

Figure 12.4 Run Chart: Shift in Data

Figure 12.5 Run Chart: Trend in Data

Figure 12.6 Sample Pareto Chart: Root Causes of Sentinel Events

Figure 12.7 Sample Histogram: All Facilities Claims/Lawsuits

Figure 12.8 Sample Control Chart

Figure 12.9 Risk Management Assessment: Hospital Results

Figure 12.10 System Risk Assessment: Gap Analysis

Figure 12.11 Three-Year Results

TABLES

Table 1.1 Risk Categories and Domains

Table 1.2 Qualitative Measure of Risk Frequency

Table 1.3 Measure of Time to Impact

Table 1.4 Qualitative and Quantitative Measures of Risk Severity

Table 1.5 Fetal Hypoxia

Table 2.1 Standard Legal Abbreviations

Table 5.1 Current Work Settings

Table 5.2 Location of Primary Work Setting

Table 5.3 Organizational Type

Table 5.4 Current Professional Level

Table 5.5 Current Position Title

Table 5.6 Functional Areas of Responsibility

Table 8.1 Types of Insurance

Table 12.1 Risk Management Assessment: Key Elements

Table 12.2 Hospital Action Plans

Table 17.1 Components of Contract Review

Table 18.1 Stage of Meaningful Use Criteria by Payment Year

BOXES

Box 6.1 Common Barriers to Incident Reporting

Box 6.2 Key Points to Remember About Incident Reports

Box 6.3 Emergency Department–Occurrence Reporting Criteria

APPENDICES

Appendix 2.1 Essentials of American Law

Appendix 10.1 Key Definitions

Appendix 18.1 Social Networking Glossary

Appendix 18.2 IT Glossary

The Contributors

Craig L. Allen, CSP, ARM, MPH, is the director of Safety, Security, and Environmental Health for Intermountain Healthcare, Inc. His responsibilities include oversight of the Occupational Safety, Health, and Industrial Hygiene efforts, as well as Disaster Response and Business Continuity planning for certain segments of the corporation. Allen received his master of public health degree from the University of Utah and currently holds the Certified Safety Professional (CSP) as well as the Associate in Risk Management (ARM) designation. Craig has served in various capacities with the American Society of Safety Engineers (ASSE), including president of the Utah Chapter from 2008 to 2009. He currently serves as an executive member of the advisory board for the Rocky Mountain Center for Occupational and Environmental Health at the University of Utah.

Geraldine Amori, Ph.D., ARM, CPHRM, FASHRM, Director of the Professional Development and Education Center for The Risk Management and Patient Safety Institute, develops, coordinates and delivers educational programs in all aspects of patient safety and risk management. She has previously served as principal of Communicating HealthCare, as well as risk manager for Fletcher Allen Health Care in Burlington, VT. Dr. Amori is a nationally known speaker, facilitator, and consultant on risk management, focusing on communication issues in healthcare and patient safety. She is a past president ASHRM, as well as past president of the Northern New England Society for Healthcare Risk Management. In 2004, she received ASHRM’s coveted Distinguished Service Award. She has a master of science degree in counseling and human systems from Florida State University and a PhD in counselor education from the University of Florida. She serves on the Board of Consumers Advancing Patient Safety board of directors and as an advisor to Partnership for Patient Safety, and is a lifetime member of the American Society for Healthcare Risk Management.

Ellen L. Barton, JD, CPCU, DFASHRM, Principal, ERM Strategies, LLC, is an independent consultant. Previously, Ms. Barton held positions as vice president, Risk Management, MedStar Health, Inc., an integrated healthcare delivery system, (1999–2000); vice president, Claims and Health Care Practice Leader, Aon Risk Services, Inc. of Maryland, (1998–1999); vice president, Legal Services for American Radiology Services, Inc., (1997–1998); and vice president and general counsel of New American Health, Inc., (1996–1997). She served as president, Neumann Insurance Company and director of Risk Management, Franciscan Health System (1987–1996). She also served as general counsel for Franciscan Health System (1993–1996) and as senior vice president of Legal Services (1994–1996). Ms. Barton sat on the board of directors and served as chairperson of Preferred Physicians Insurance Company, a Nebraska stock insurance company, Consolidated Catholic Casualty Risk Retention Group, Inc., a Vermont based captive insurance company, and Alternative Insurance Management Services, Inc., a captive insurance company management firm based in Colorado. Ms. Barton also served as a member of the Trinity Health System Insurance Management Advisory Committee. Ms. Barton is a graduate of Rosemont College and received her J.D. degree from the University of Cincinnati. She also holds the distinction of Chartered Property and Casualty Underwriter. Ms. Barton has conducted numerous seminars on risk management issues on a national as well as regional level and has published articles in related areas. Ms. Barton is admitted to the Bars of Ohio, Maryland, and Pennsylvania and holds membership in the Maryland Bar Association, the Society of Chartered Property and Casualty Underwriters, the American Health Lawyers Association—in which she currently serves as chairperson of the Risk Management Affinity Group of the Hospitals and Health Systems Practice Group, the Maryland Society for Healthcare Risk Management of which she was President for 2002–2003, and the American Society for Healthcare Risk Management of which she was President for 1990. She is also the 1993 recipient of the American Society for Healthcare Risk Management’s Distinguished Service Award. In 2001, the ASHRM Modules Program—The Barton Certificate in Healthcare Risk Management—was named in her honor.

Roberta L. Carroll, RN, ARM, CPCU, MBA, CPHRM, CPHQ, LHRM, HEM, DFASHRM, Senior Vice President, Aon Healthcare, based in Tampa, Florida. Previously she was Director of Risk Management Consulting Services and senior vice president and manager of the healthcare unit, Aon Risk Services of Northern California. She has held a variety of positions, including vice president of risk and insurance management for UniHealth in Burbank, California; senior vice president and manager of the healthcare unit for Corroon & Black of Illinois; vice president of risk management, claims and marketing for Premier Alliance Insurance Company; trust administrator and risk manager for Premier Hospitals Alliance in Chicago, Illinois; and director of risk management at Mount Sinai Medical Center, Miami Beach, Florida. Ms. Carroll served on the ASHRM board for six years and was president 1995–1996. She was elected to the Board of the Southern California Association for Healthcare Risk Management (SCAHRM) and was one of the founding members, first president, and board member of the Florida Society for Healthcare Risk Management and Patient Safety (FSHRMPS). In addition, she was one of the founders and an officer of the Florida Medical Malpractice Claims Council, Inc. (FMMCCI). She is a Licensed Healthcare Risk Manager (LHRM) in the State of Florida and faculty member for the healthcare risk management course at the University of South Florida (USF). Ms. Carroll is also a faculty member for the ASHRM-sponsored Barton certificate program Essentials module. Previously, she was a faculty member for Module 1-The Fundamentals of Health Care Risk Management: Constructing the Comprehensive Program, for eight years. Carroll received a bachelor of science degree in Health Services Administration and a certificate in Emergency Medical Services Systems Administration from Florida International University and a master of business degree from Nova Southeastern University. She has earned the right to use the ARM, CPCU, HEM, CPHQ, and CPHRM designations. She is a contributing author and editor of the Risk Management Handbook for Health Care Organizations 2nd (1997), 3rd (2000), 4th (2004) editions, the series editor for the 5th edition (2006) and the Student Edition of the Risk Management Handbook for Health Care Organizations and accompanying online Faculty Guide (2009). Carroll has received the following awards: in 1997, ASHRMs highest honor, the Distinguished Service Award (DSA), 1998 Distinguished Alumni Achievement Award from the School of Business and Entrepreneurship, Nova Southeastern University, Most Contributing Member to Risk Management in 1996 from the Southern California Association of Healthcare Risk Management (SCAHRM), and the Most Valuable Contribution to the Field of Risk Management in 1993 from SCAHRM. She is a member of ASHRM, FSHRMPS, and is a member of the Enterprise Risk Management Affinity Group of the American Health Lawyers Association (AHLA) and a contributing author for AHLAs Enterprise Risk Management Handbook for Healthcare Entities, 1st Edition, 2009. She is a well-known published author, speaker, and teacher in the areas of alternate risk financing, risk mitigation strategies and solutions, claims administration, early intervention programs, enterprise risk management (ERM), strategic planning, and reengineering. Her activities are on a local, state, and national level. Her professional and committee activities are numerous.

Dominic A. Colaizzo, MBA, is managing director of Aon’s National Healthcare Alternative Risk Practice, based in Philadelphia. He is responsible for directing Aon resources for the development, implementation, and servicing of alternative risk transfer programs for the healthcare industry. His sixteen years of experience in healthcare administration and nineteen years of broking and consulting experience with Aon have provided him with a broad understanding of the issues faced by all healthcare providers. He has served as chief operating officer and senior vice president of a community hospital and has held various administrative positions in a major teaching hospital. He has extensive experience in developing and servicing alternative risk financing and innovative insurance programs for profit and not-for-profit health systems, health insurers, managed care organizations, extended care organizations, and physicians’ groups. Colaizzo also serves as a key advisor for Aon’s National Healthcare Practice. He has earned a master of business administration for the Leonard Davis Institute for Health Economics at the Wharton School of the University of Pennsylvania. He has also earned a bachelor of arts degree in economics and mathematics from Washington and Jefferson College. Colaizzo is a diplomat of the American College of Health Care Executives and holds memberships in the American Society for Healthcare Risk Management (ASHRM), The American Hospital Association, and the Health Care Financial Association. He serves on the faculty for professional development seminars and has written two chapters for ASHRM’s Risk Management Handbook for Health Care Organizations. He has co-authored an article for the ASHRM Journal entitled, Integrating Quality With Risk Financing Through a Risk Retention Group.

Frank Federico, R.Ph., is the director at the Institute for Healthcare Improvement in Cambridge, Massachusetts. His primary areas of focus include patient safety, application of reliability principles in healthcare, and the Idealized Design of Perinatal Care. He is also a faculty member for the Patient Safety Officer Training Program. Federico has worked with the Institute for Healthcare Improvement since 1996 as a faculty member and co-chair of several Patient Safety Collaboratives. Before joining IHI, Federico was the Program Director of the Office Practice Evaluation Program and a Loss Prevention/Patient Safety Specialist at Risk Management Foundation (RMF) of the Harvard Affiliated Institutions in Cambridge, Massachusetts. He, along with a team of nurse surveyors, developed a compendium of effective practices to reduce risk and harm in the office setting. Federico is one of the executive producers of First, Do No Harm, Part 2: Taking the Lead. He served as Director of Pharmacy at Children’s Hospital, Boston. While in that position, he was co-chair of a quality improvement team charged with revamping the medication system and chaired the Adverse Drug Event Committee. Federico has worked with the Institute for Healthcare Improvement in Boston since 1996 as a faculty member and co-chair of several Patient Safety Collaboratives. He is co-author of a chapter in Achieving Safe and Reliable Healthcare, Strategies and Solutions. Federico lectures extensively, nationally and internationally, on patient safety.

Ann D. Gaffey, RN, MSN, CPHRM, FASHRM, is a risk management and patient safety consultant with nineteen years experience in risk management, patient safety and performance improvement. She has worked in a variety of roles in healthcare settings, providing both in-house and consulting risk management services to academic medical centers, acute care facilities, ambulatory care facilities, physician practices, and assisted-living and long-term care facilities. Ann’s experience includes managing large self-insured claim programs, administering and managing third-party claim programs, and insurance purchasing. She has risk management consultative experience with the medical malpractice insurance industry and management experience with a Top-100 broker providing risk management services for group and single-parent captives, risk retention groups, commercially insured and self-insured healthcare facilities. Ann has also worked in traditional risk management, including risk identification, risk analysis, and loss prevention relative to clinical care, and serves as a resource to healthcare professionals for issues related to clinical risk management, including situations involving actual or potential claims. Ann is a frequent lecturer, is a past president of the Virginia chapter of ASHRM, and a member of the Board of Directors of ASHRM.

Sharon L. Groves, BSN, MSA, ARM, FASHRM, CPHRM, is an assistant vice president, Risk Management, with BerkleyMed, where she is responsible for developing and implementing a variety of healthcare risk management activities for lead insureds. Ms. Groves has over thirty-one years of healthcare and insurance industry experience as a nurse, director of risk management, and senior risk management consultant for healthcare and medical malpractice insurance companies. Over the years, she has been heavily involved in many healthcare and risk management associations, including AWHONN, ACOG, AORN, American Psychiatric Nurses, ENA, Virginia Society of HealthCare Risk Managers (VASHRM), Central Pennsylvania Society of HealthCare Risk Managers (CPAHCRM), North Carolina Society of HealthCare Risk Mangers (NCASHRM), Ohio Society of Health Care Risk Managers, and the national nursing honor society of Sigma Theta Tau. She is a past member of the board for the American Society of Healthcare Risk Managers (ASHRM) and is a member of the National Center for Missing and Exploited Children Healthcare Colloquy, which collaborated on the seventh and eighth edition of For Healthcare Professions: Guidelines on Prevention of and Response to Infant Abductions. Groves is also a volunteer for the Health Services Core and the Disaster Action Team of the American Red Cross. Groves earned her BSN in Nursing from Otterbein College in Westerville, Ohio and her masters in administration in healthcare from Central Michigan University in Columbus, Ohio. She is a licensed nurse in the state of Ohio, a Fellow of the American Society of HealthCare Risk Managers, a Certified Professional in HealthCare Risk Management, and an Associate in Risk Management with the Insurance Institute of America.

Harlan Y. Hammond, Jr., MBA, ARM, CPHRM, DFASHRM, is the assistant vice president for Risk Management Services at Intermountain Health Care (IHC) in Salt Lake City, Utah. His responsibilities include oversight for IHC’s risk financing, loss prevention, loss control, claims administration efforts, safety, security, and systemwide emergency response. Hammond received his bachelor’s degree in business administration from the University of Utah, followed by a master’s of business administration degree from the University of Washington. Hammond has served in various capacities with ASHRM, including twice as a member of the ASHRM board of directors and as a faculty member for the Barton Certificate in Healthcare Risk Management Program. He received ASHRM’s Distinguished Service Award in 2000.

Judy Hart is executive vice president of Endurance Specialty Insurance, Ltd. and heads the company’s healthcare practice. Hart has more than thirty years of experience in the insurance industry and has been dedicated to healthcare risk financing for the past twenty-six years. She spent most of her career at Alexander & Alexander Services, where she was a managing director and deputy national director of their healthcare practice. During that period of time she participated in the development of alternative risk financing programs for healthcare organizations across the United States. Before joining Endurance, she spent four years as vice president, Employers Reinsurance Corporation, where she was responsible for marketing, new product development, and the development of healthcare strategies. At ERC she was a member of the healthcare senior leadership team. She is the current president of the Bermuda Society for Healthcare Risk Management. She is a frequent speaker and author on risk management issues associated with risk financing, managed care, and the evolving risks facing healthcare providers. She attended Southeast Missouri State University and Washington University in St. Louis, Missouri.

Keith M. Higdon, MITM, is the senior vice president and director of the business intelligence team for Sedgwick Claims Management Services, Inc. in Schaumburg, Illinois. Keith has fifteen years of experience in program evaluation, benchmarking, and information system design and development. He joined Sedgwick CMS in 1999 as a benchmarking manager and directed the data warehouse initiative and team from 2000 through 2002. Prior to joining Sedgwick CMS, Keith worked as a consultant to employers and administrators specializing in workers’ compensation, integrated disability management, program design, and assessment. Prior to consulting, Keith worked in the research and development department of an association focusing on healthcare and health facility administration issues. In January of 2003, Keith assisted in the creation of the business intelligence group that focuses on proactive evaluation of client programs and industry trends, development of risk modeling techniques, and the use of technology to better evaluate and communicate program results. He became director of the department in January 2008. Keith has a bachelor’s degree in sociology from Northern Illinois University, a master’s degree in information technology and management from the Illinois Institute of Technology, and additional graduate work in program evaluation and statistics.

Peter J. Hoffman, M.A., J.D., is a member of the Philadelphia office of Eckert Seamans Cherin & Mellott, LLC, a large general practice law firm headquartered in Pittsburgh, Pennsylvania. He received his B.A. from Washington and Jefferson College, his M.A. from State University of New York Graduate School of Public Affairs, and his J.D., cum laude, from Temple University School of Law where he was the executive editor of the Law Review. Mr. Hoffman was a member of the Pennsylvania Select Committee on Medical Malpractice from 1984–1986. He was a member of Governor Rendell’s Medical Malpractice Task Force and was Counsel to the Commonwealth of Pennsylvania Patient Safety Authority. He is a past president of the Pennsylvania Defense Institute. He was the recipient of the Defense Research Institute Exceptional Performance Citation in 1989 and the Fred H. Sievert Award in 1989. Mr. Hoffman was a co-author of the book Laws and Regulations Affecting Medical Practice. He was the chairman of Hearing Committee 1.15, Supreme Court of Pennsylvania Disciplinary Board from 1993 to 1998, and served on the faculty for the Temple University School of Law, Masters of Laws in Trial Advocacy and Academy of Advocacy. He has been listed as a top attorney in Philadelphia Magazine each time the article appears and has been listed in Best Lawyers in America since 1995. He was listed as one of the top 100 lawyers in Pennsylvania in Pennsylvania Super Lawyers 2004, 2005, 2007, and 2008 and was named one of the top 10 lawyers in Pennsylvania in 2009. Mr. Hoffman was a member of the Temple Inns of Court. Peter also serves as an adjunct professor of law, Earle Mack School of Law, Drexel University. He is a member of ASHRM, a fellow of the International Academy of Trial Lawyers and fellow of the American College of Trial Lawyers, as well as the American Board of Trial Advocates.

Michelle Hoppes, RN MS, DFASHRM, is the president and CEO of Patient Safety and Risk Solutions LLC. She also serves in the role of senior vice president for the Emergency Physician Insurance Company and secretary/board member for the Emergency Medicine Patient Safety Foundation. She will serve as president elect for the American Society of Healthcare Risk Management in 2010 and as president in 2011. In the past, she has served as a board member for ASHRM in the past, president of the Michigan Chapter of Healthcare Risk Management, and as a committee member for the United States Pharmacopeia-safe medication practices and education committee track co-chair for the National Patient Safety Foundation. She has earned recognition as a Distinguished Fellow of ASHRM. Hoppes has more than twenty-five years’ experience in the healthcare risk management and patient safety field and is a national consultant specializing in simulation methods, human factors, risk management analytics, and the design of methods to demonstrate the business case for risk management. She has lectured extensively and has written or co-authored numerous articles and books, including Patient Safety and Staffing Effectiveness; A Statistical Approach. She has also completed the AHA/ASHRM/NPSF leadership program as a patient safety fellow where she developed a toolkit on creating a just culture.

John Horty, Esq., is the managing partner of Horty, Springer & Mattern, P.C., in Pittsburgh, Pennsylvania and the editor of all HortySpringer publications. He presently serves as the chair of the board and a faculty member of the Estes Park Institute in Englewood, Colorado, and president and chair of the Indigo Institute in Washington, D.C. He is an honorary fellow of the American College of Hospital Executives, a recipient of the Award of Honor of the American Hospital Association, and an honorary life member of the American Hospital Association. He is a founding member of the American Academy of Hospital Attorneys, a past board member of the Hospital Association of Pennsylvania, the Health Alliance of Pennsylvania, and the Hospital Counsel of Western Pennsylvania, and was chair of St. Francis Central Hospital in Pittsburgh, Pennsylvania from 1971–1999.

Mark A. Kadzielski is the partner in charge of the West Coast Health Law practice at Fulbright & Jaworski, L.L.P. He represents hospitals, medical staffs, managed care enterprises, and institutional and individual healthcare providers throughout the United States in a broad spectrum of matters, including government regulatory investigations, contracting issues, credentialing, licensing, medical staff bylaws, Joint Commission accreditation, and Medicare certification. Kadzielski has served on the board of directors of both the American Academy of Healthcare Attorneys and the American Health Lawyers Association. He has also served on many advisory bodies in the healthcare industry. Kadzielski is a member of the California Bar, the American Health Lawyers Association, and the California Society for Healthcare Attorneys. Annually since 1991, on the basis of peer evaluations, he has been selected for the Healthcare Law Section of The Best Lawyers in America. Each year from 2004 to 2010 he was selected as a Southern California Super Lawyer in Health Law. In 2005, he was named to the American Health Lawyers Association’s inaugural class of Fellows, one of only four attorneys in California and forty attorneys nationwide to receive this honor. Also each year from 2005 to 2010 he was selected as one of the top ten leading Healthcare Lawyers in California by Chambers USA as a result of extensive interviews with clients and peers. Kadzielski has written numerous articles and chapters in healthcare publications and is a nationwide speaker on a wide range of health-related subjects. Kadzielski is a 1976 graduate of the University of Pennsylvania Law School.

Krishna Lynch, RN, MJ, CPHRM, is the director of Risk Management Resources for the American Society for Healthcare Risk Management of the American Hospital Association in Chicago, Illinois. She is responsible for the development and execution of programs and initiatives to advance ASHRM in the areas of professional development, professional standards, and advocacy. Ms. Lynch has fiften years of experience in healthcare, including nursing, risk management, corporate compliance, and association management. She is past president of the Chicagoland Healthcare Risk Management Society and has served on their Executive Board. She is an Illinois registered professional nurse, has a bachelor’s degree in nursing, and a master of jurisprudence in health law. Krishna has co-authored journal articles for the Journal of Healthcare Risk Management and the American Medical Association’s Virtual Mentor.

Peggy Berry Martin, MS, MEd, ARM, CPHRM, DFASHRM, has held a variety of positions in healthcare facilities and captive insurance companies in her more than twenty-five years of risk management experience Most recently Ms. Martin was president of Lifespan Risk Services (LRS) and vice president for Risk Management for the Lifespan Corporation, Providence, Rhode Island. In this capacity, she was responsible for all clinical risk management in all affiliated hospitals and physician groups. In addition, as president of LRS she was responsible for all captive insurance activities, including the procurement of all property and casualty insurance, underwriting, and claims management activities for the system. Ms. Martin served as 2006 president of the American Society for Healthcare Risk Management, as chairperson of several committees, as faculty for programs, and as a member of the board of directors. On the state level, Ms. Martin was the first president and one of the founding members of the Massachusetts Society for Healthcare Risk Management and was the recipient of their first Distinguished Service Award in 2000.

Jane J. McCaffrey, MHSA, DFASHRM, is director of Quality Management Services at Self Regional Healthcare in Greenwood, South Carolina, with responsibility for organizational quality / performance improvement, safety, risk, infection prevention, emergency preparedness, and standards review and preparation. She has developed risk management programs at several South Carolina hospitals over the last twenty years. McCaffrey has served twice as the president of the American Society for Healthcare Risk Management (1985 and 2003) and was a faculty member for Fundamentals of Risk Management for over a decade. McCaffrey received ASHRM’s Distinguished Service Award in 1994. She participates on several state-level patient safety and risk committees and also serves on the editorial advisory boards for ECRIs Risk Management Reporter and American Healthcare Consultant’s Healthcare Risk Management. In 2005, she became a member of Health Research and Educational Trust’s 2005–2006 Patient Safety Leadership Fellowship Class. McCaffrey has a masters in health services administration and has earned the DFASHRM designation from ASHRM.

Peggy Nakamura, RN, MBA, JD, DFASHRM, CPHRM is assistant vice president, chief risk officer, and associate counsel for Adventist Health. In this role, she oversees a comprehensive Risk Management Department, including self-administered/self-insured programs in workers’ compensation and professional, general, and managed care liability. Nakamura has more than thirty-five years of healthcare experience and has worked in critical care nursing and nursing administration and as a medical malpractice defense attorney. In addition, she has developed multihospital system risk management programs. Nakamura holds an associate’s degree in nursing from Sacramento City College, Sacramento, California and a bachelor’s degree in biological sciences from the University of California, Davis. In addition she has a master’s in business administration from Golden Gate University in San Francisco, California, and a Juris Doctor from McGeorge School of Law, also located in Sacramento. Nakamura was awarded the Distinguished Service Award (2008) from the American Society of Healthcare Risk Management (ASHRM). In 2001, Nakamura was named to the Business Insurance’s Risk Management Honor Roll. She also was awarded the Outstanding Advocate Award from The American Association of Nurse Attorneys (TAANA). Nakamura is past president of the American Society of Healthcare Risk Management (ASHRM) and the California Chapter (CSHRM). In addition, she has served on the boards of both ASHRM and CSHRM, is a frequent national speaker on healthcare risk management topics, and has authored several articles. She is a contributing author and co-editor of Volume 1 of the Risk Management Handbook for Health Care Organizations, Fifth Edition, 2006. Nakamura is currently chair of the Enterprise Risk Management Affinity Group of the American Health Lawyers Association (AHLA) and a contributing author for AHLA’s Enterprise Risk Management Handbook for Healthcare Entities, First Edition, 2009. Nakamura is on the faculty for the California Hospital Association’s Consent Law, Consent Basics, and EMTALA seminars. She also is on the faculty for ASHRM’s Barton Certification Program in the Advanced Forum module.

Gisele Anne Norris, DrPH, is senior consultant, Aon National Healthcare, Alternative Risk Practice, Aon Healthcare, San Francisco, and California and managing director of the Western Region for Aon Healthcare. Norris has spent fifteen years in the healthcare industry focusing on issues of healthcare finance. She currently directs Aon’s Alternative Risk (ART) Practice in the western United States, where she assists clients with the formation, restructuring, and management of all types of alternative risk financing vehicles. Before accepting her role with the ART team, she was responsible for the development of new healthcare product opportunities for Aon internationally. Before joining Aon thirteen years ago, she provided consultation to various governments on issues of health finance policy on behalf of a contractor for the United States State Department’s Agency for International Development. Norris is widely published in various insurance industry publications. She received her bachelor’s degree from the University of California at Berkeley in 1988; master of public health and master of public administration degrees from Columbia University in 1994; and a doctorate in public health from the University of California at Berkeley in 2000. She worked full time in the insurance industry while completing her doctorate.

Madelyn S. Quattrone, Esq., is a senior risk management analyst for ECRI, Plymouth Meeting, Pennsylvania. She is editor of ECRI’s publication Continuing Care Risk Management, and is a regular contributor to ECRI’s Healthcare Risk Control System. She has been a panelist in ECRI audio conferences discussing risk management and legal issues involving the health information privacy regulations and the security regulations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Before joining ECRI, Quattrone was a shareholder in the law firm of George, Koran, Quattrone, Blumberg & Chant, P.A., in Woodbury, New Jersey, concentrating on the defense of medical malpractice cases from 1982 to 1999. A member of the bars of the Commonwealth of Pennsylvania, New Jersey, the U.S. District Court of New Jersey, the Third Circuit Court of Appeals, and the U.S. Supreme Court, Quattrone achieved certification by the New Jersey Supreme Court as a civil trial attorney in 1990 and was selected for membership in the American Board of Trial Advocates in 1993. Quattrone also provided risk management consultation to physicians, hospitals, and professional liability insurers, and contributed to the development of a clinicolegal correspondence course for the Medical Inter-Insurance Exchange of New Jersey. She wrote regularly for numerous publications, including the Emergency Physician Legal Bulletin, the Emergency Nurse Legal Bulletin, and the Emergency Medical Technician Legal Bulletin. For many years, Quattrone co-authored a column on legal and risk management issues affecting emergency nurses in the Journal of Emergency Nursing. She developed case scenarios and participated in mock medical malpractice trials for audiences of physicians, medical students, residents, and clinical engineers, and has been a frequent speaker in numerous risk management areas, including informed consent, ethical and legal issues involving human reproduction, obstetrics, the provision of emergency care, and medical record documentation. Quattrone earned a J.D. degree from Rutgers University School of Law, Camden, New Jersey, in 1981 and a B.A. degree in anthropology from Temple University, Philadelphia, Pennsylvania.

Rachel Remaley, Esq., is an associate of Horty, Springer & Mattern, P.C., in Pittsburgh, Pennsylvania. She focuses her practice exclusively on hospital and healthcare law, with particular emphasis on medical staff matters. She advises clients on a wide range of issues, including development of medical staff bylaws and hospital and medical staff policies, management of credentialing and peer review matters, and management of patient privacy investigations and other HIPAA privacy issues. Remaley received her bachelor of science in biology from Carlow College and her J.D. from Case Western Reserve University.

Elaine Richard, R.N., M.S., earned a master’s degree in public health at the University of Minnesota where she served on the faculty from 1972 to 1984. During her tenure there Ms. Richard pioneered one of the first post- R.N. and A.N.A-accredited geriatric nurse practitioner programs before nurse practitioner programs were recognized by the National League for Nursing. In 1977, she developed a National Institute of Occupational Safety and Health (NIOSH) graduate-level program in occupational health nursing and was subsequently promoted to Associate Professor. She later served as a NIOSH consultant reviewing University applications for occupational health training programs in the fields of medicine, nursing, safety, and industrial hygiene. She has lived in Tampa since 1984. Ms. Richard served as executive director of St. Joseph’s HealthLine and Community Care over a period of ten years. In this capacity, she planned and developed the Occupational Health Program/ Clinic and Corporate Wellness Programs. As part of the Hillsborough County initiative to serve the indigent population, she developed and implemented St. Joseph’s first off-site primary clinics to serve this population. In 1995, she became the executive director and regional vice president of EverCare, a subsidiary of United Health Care and implemented the EverCare Program in Florida for residents in long-term care institutions. This successful Medicare demonstration project utilizes geriatric nurse practitioners to bring added value to patients residing in nursing homes. Since retirement, she has worked with the University of South Florida, School of Aging Studies in the development and maintenance of the Risk Management Course.

Sheila Hagg-Rickert, JD, MHA, MBA, CPCU, PHRM, DFASHRM, is the senior system director of Risk Management, Christus Health based in Houston, Texas. She is responsible for oversight of Christus’s loss prevention, claims management, risk financing, and enterprise risk management programs. Prior to joining Christus, she served as the corporate risk manager for both for-profit and not-for-profit acute care and long-term care health systems, as an insurance broker, and as a healthcare risk management consultant. Ms. Hagg-Rickert has served on the board of directors for the American Society for Healthcare Risk Management (ASHRM) and has presented and written extensively on healthcare risk management and health law topics. She served as faculty for ASHRM’s Advanced Forum educational module for over ten years and is a contributing author of the Risk Management Handbook for Healthcare Organizations, first and sixth editions and The Enterprise Risk Management Handbook for Healthcare Attorneys published by the American Health Lawyers Association in 2009. She holds a J.D. from the University of Iowa and master’s of business administration and master’s of healthcare administration degrees from Georgia State University. She has earned Chartered Property and Casualty Underwriter (CPCU) and Certified Professional in Healthcare Risk Management (CPHRM) designations and is a distinguished fellow of the American Society of Healthcare Risk Management.

Ronni P. Solomon, JD, is executive vice president and general counsel at ECRI, a nonprofit health services research agency in suburban Philadelphia that focuses on the safety, quality, and cost-effectiveness of patient care. Solomon has approximately twenty years’ experience in healthcare risk management, patient safety, law, and regulation. She works with leaders at hospitals, health systems, government agencies, continuing care organizations, and insurance providers to implement patient safety and quality assessment systems. She has published numerous articles and book chapters, and has lectured frequently in the United States and abroad. Solomon serves as the center director for ECRI’s Collaborating Center for the World Health Organization in patient safety, healthcare technology and risk management. She is a past member of ASHRM’s board of directors and has served in many other leadership roles for ASHRM. She received ASHRM’s first Award for Writing Excellence.

Jeanie Taylor, RN, BSN, MS, AHQRM, is the assistant vice president for Patient Safety and Risk Solutions—a national consulting company with a focus on patient safety, risk management, and performance improvement in the healthcare industry. Taylor has more than thirty years’ experience in the healthcare industry with a focus on risk management and quality improvement. Past positions include vice president of Patient Care Services at South Haven Community Hospital in South Haven, Michigan; director of Quality Improvement and Risk Management at Ingham Regional Medical Center, in Lansing, Michigan; and senior risk management consultant for the Risk Management and Patient Safety Institute of Lansing, Michigan. Taylor has a bachelor of science degree in nursing from Grand Valley State University in Allendale, Michigan and a master of science degree in health law with a focus on risk management from the Sheppard Broad Law School at Nova Southeastern University in Fort Lauderdale, FL.

John C. West, JD, MHA, DFASHRM, is a senior healthcare consultant with AIG Consultants Inc., Healthcare Management Division. He holds a bachelor’s degree from the University of Cincinnati, a law degree from Salmon P. Chase College of Law, and a master’s degree in health services administration from Xavier University. He received the Distinguished Service Award from ASHRM in 2001, the highest honor bestowed by that society. He also received the designation of distinguished fellow of the American Society for Healthcare Risk Management (DFASHRM) in 1999. West has been a frequent speaker at national and regional educational programs and has published numerous articles on various aspects of healthcare risk management. He currently writes the Case Law Update column on a quarterly basis for the Journal of Healthcare Risk Management.

Kimberly M. Willis, CPCU, ARM, is senior vice president of Endurance U.S. Healthcare Insurance Services. In this capacity she is responsible for developing and executing strategy for the U.S. Healthcare practice. Previously, Ms. Willis served as vice president, Field Underwriting for