Risk and Quality Management Assessment


Riskand Quality Management Assessment

Riskand Quality Management Assessment

Overthe years there have been frequent campaigns on how to improvepatients’ safety in healthcare more so after the report released bythe institute of Medicine indicating that the number of patientsdeath due to malpractices surpassed the deaths related to breastcancer which is ranked as the 8thcourse of death in USA. Despite the massive efforts by thegovernment and private hospitals to improve health care workenvironment, the malpractices cases filed against healthcareproviders continued to soar thus the importance of managing risks inhealthcare sector cannot be over emphasized. Secondly, due to currenteconomic climate, healthcare organizations are forced to operateefficiently and minimize losses thereby pushing the profit margin up.The above two scenarios necessitates the health sector to integraterisk management and quality control efforts. This paper will examineMayo clinic, which is one of the largest integrated medical practiceinstitution based in Rochester, Minnesota.

Riskand quality management is core in ensuring loss reduction andprevention. This is done by designing a system that is able to detectthreats at an early stage to allow time for investigations beforesuch threats become enacted and cost the organization. The Riskmanagers in collaboration with quality managers come up with policiesand procedures to address the threat infiltrated areas (Savage&ampFord, 2008).The integration of both risk and quality management is a moreefficient and cost effective way of loss reduction. Qualitymanagement team identifies the risky areas and the risk managementinstitutes strategies to prevent or reduce liability exposure.

Secondly,risk and quality management plays a vital role in claims management.Mostly, claims are handled by the risk managers. There is need tocheck the validity of claims. This involves reviewing files foractual claims, coordinating with the third parties for claimsettlement and keeping up to date with the status of such claims. Itmay also entail claims supervision and review of claim reportingprocedures. By identifying risk exposures, risk managers are able tonegotiate with Insurance agencies for premiums, coverage and costs.

Inaddition, all hospitals are worried of financial loss emanating fromlegal liability. Every hospital is faced with the challenge ofidentifying the possibility of a medical error or negligence. If thehospital is found to be negligent, they are required to make a publicaddress to the affected family apologizing to them and explaining themeasures that they are going to put in place to avoid such incidencesfrom happening in future (Sollecito&ampJohnson,2013).The hospital will also be required to compensate the affected familyby refuting the hospital bills. Risk managers therefore, identifyrisky areas or activities within the organization that may expose thehospital to potential loss and determine the magnitude of such lossthereby coming up with measures to reduce the risk exposure(Sollecito&ampJohnson,2013).

Lastly,ensuring proper documentation of the patient condition, medicalhistory and the medicine prescribed to the patients. Medical recordsare vital since they are used by many people, for reference. Thisincludes the Insurance when following up on the patient claim, otherphysicians registered for electronic medical records that might treatthe patients in future and the quality control managers to ensurethat proper medical care was accorded to the patient (Savage&ampFord, 2008).Therefore, risk managers should ensure that the physicians keepproper documentation to avoid the assumption that ‘what was notdocumented was not done.

Therisk manager ensures compliance to all the mandatory regulatorybodies and also conduct background checks to ascertain that all thephysicians have the necessary qualifications and with the assistanceof quality control managers, ascertain that all services offered tothe patients are according to the stipulated standards.

Riskmanagement is an on-going activity focusing on two major outcomesnamely action and awareness. Action is the control measures taken,whereas awareness is a product of risk analysis. The first step inrisk management is the risk Assessment. This entails identifying allthe risk factors that are likely to pose threats to the hospital orhealth facility currently or in future. Secondly, the risk managersperform a risk evaluation aiming at detecting the impact of the riskfactors. The risk is classified into three categories, low risk whichrequires less or minimal attention, medium risk which requiresmoderate action and high risk which will call for undivided attention(Sollecito&ampJohnson,2013).Third step is the Risk reduction. This will depend on the results ofresults evaluation. Risk reduction may involve taking actionimmediately or instituting plans to minimize the risk or secondly,setting up strategies that will lower the impact of the riskidentified to the organization.

AfterRisk reduction strategies have been implemented, the risk managers goto the next step of monitoring the risk. First, the managers do afollow up of their recommendation to the identified risk and analyzewhether it has been dealt with or whether there are any changes thatcould call for more action. They will also assess whether there arenew risks that emerged.

Thefinal step involves risk reporting. The Risk managers write adetailed report about the risks identified, measures implemented,whether such measures were able to address the risk and any newemerging risks and suggested recommendations.

Themost common risks in hospitals include but not limited to thepossibility of missing test results, use of expired prescriptions andbroken communication between the physician and the patients. Therisks negatively affect the quality of services offered to thepatients. For example missed test results may lead to wrongprescription to the patient or failure to detect the condition thatthe patient is suffering from. It may also imply mixing up of samplesresulting to wrong diagnosis. Proper labelling and documentation ofsamples should be encourage to prevent test mix up. In addition useof expired prescriptions may deteriorate the patient’s condition orcause adverse reactions to medicine. The patients therefore, pays forsubstandard medicines. Keeping up to date stock records while keepingtrack of the expiry date will help both the hospital and thepatients. For patients who need medicine to be consumed for a longperiod, the physician should ensure that they are not near theexpiration date,

Lastly,broken communication between the physician and the patients. Thisnormally happens when the patient does not understand the physicianas a result, the patient will not be able to follow the instructionsgiven by the physician. The Hospital should therefore, have asystematic way of checking whether the patients have understood thedoctors instructions. Taking the wrong dosage will interfere with thepatient’s recovery process.

Thequality of health care given to the patient is determined by variousexternal and internal factors such as the patient’s socio-demographic variables. The socio demographic variables affects theinteraction between the physician and the patients making itdifficult to obtain a desired outcome. Health care personnel shouldtherefore comprehend the character traits of their patients in orderto provide quality health care. Patient’s beliefs and attitude mayalso affect the quality of health care towards the patient. Somepatients believe that they have to take medicine in order to behealed. Any other prescription is deemed to be inappropriate. Theattitude of the patient will consequently affect the attitude of thephysician. If the patient is stubborn, the physician may lose themorale to conduct further tests and examinations thereby affectingthe quality of health care. Patient cooperation is core in healthcare provision.

Qualityof healthcare depends heavily on the financial status of the patient.Sometimes the patients are unable to afford medicines prescribed bythe doctors thereby slowing down their complete recovery. The doctormay have given the correct prescription but the patient fails to takethem due to financial constraints. Also, lack of equipped referralsystems and affordable medical tariffs may compromise the quality ofthe health care as the physicians struggle to attend to numerouspatients so as to meet the high cost of maintaining their clinicssuch as rent and cost of drugs and medical equipment.

Workingenvironment condition contributes highly to the quality of medicalcare. The nurses working under poor environment may be demotivatedthereby compromising the quality of services they offer to thepatients. Poor working environment may also increase the possibilityof nosocomial transmission of infections from physician to patient orfrom patient to another patient. Better communication in hospitalsfacilitates employee’s engagement to their work. An engaged workervoluntarily follows procedures and adapts quickly to newtechnologies.

Inorder to improve the quality of health care, Mayo clinic have come upwith the following short term and long term goals. First, to procurefunding from willing donors in order to purchase medical supplies andequipment. This could also be carried out using fundraisers andmaking proposals to donors and institutions that have an interest inthe healthcare industries. In addition, it is imperative that moresurgical and support staff are engaged in the wards (McLaughlin&ampKaluzny, 2006).This may take up the cost of hiring but will increase the efficiencyin the theatres as more patients will be served within the sameduration. Finally, managing the financial costs by encouraging peopleto use the care centers for minoroperations instead of usingemergency centers. This will take the cost down in the short term. Onthe other side the hospital may come up with long-term goals startingwith the reduction of financial cost of healthcare through wellnesscampaigns (Youngberg,2011).Wellness campaigns inform people of healthy living thereby reducinglifestyle complications or diseases. Improve metrics on themanagement of chronic diseases. The hospital will carry out acommunity assessment on chronic and most prevalent conditions whichcan be managed on low cost therapies (McLaughlin&ampKaluzny, 2006). Establishment of permanent mentorship affiliation whereby thehospital staff will be visiting identified schools frequently.

Thehospital should implement a comprehensive quality performanceimprovement program with locally and nationally developed qualityindicators. This will act as a guide to evaluate the performance ofstaff members. The quality indicators should be able to capture allthe occurrences and incidences (Sollecito&ampJohnson,2013).Therefore the staff will be prompted to be keener in order to reducethe incidences that may poorly reflect on the performance improvementprogram consequently improving the quality of healthcare servicesprovided by the staff.

Thehospital should also prompt the different teams to come upwith goalsand recommendation to achieve those goals. This may be goals such asto reduce the maternal cases due to medical error to 0.1% in the nextfive years. This will lead to improved health care.

Lastly,create monitoring programs to document compliance with bestpractices, clinical pathways, policies and procedures. This will actas a guide to new recruits thereby maintaining the culture of qualitycare provision.

Qualitymanagement is the process by which services are executed effectively,efficiently and economically. Standardized services are delivered tomeet or exceed the patient’s expectations with maximum utilizationof viable resources and minimal wastage and therefore generates therequired process revenue in order to sustain the organization. On theother hand, Risk management the process by which threats areidentified, addressed and eliminated in order to achieve organizationobjectives (McLaughlin&ampKaluzny, 2006).Therefore integrating the two will enable the physicians to minimizeimpending risks and errors, enhancing efficiency and consequentlyimproving care.


McLaughlin,C. P., &amp Kaluzny, A. D. (2006).&nbspContinuousquality improvement in health care.Sudbury, Mass: Jones and Bartlett.

Savage,G. T., &amp Ford, E. W. (2008).&nbspPatientsafety and health care management.Bingley, UK: Emerald JAI.

Sollecito,W. A., &amp Johnson, J. K. (2013).&nbspMclaughlinand Kaluzny`s continuous quality improvement in health care.Burlington, MA: Jones &amp Bartlett Learning.

Youngberg,B. J. (2011).&nbspPrinciplesof risk management and patient safety.Sudbury, MA: Jones and Bartlett Publishers.