In a changing healthcare landscape, risk managers need to prove their value to protect the role for the future, Gregg Timmons, president of the California Society for Healthcare Risk Management tells HRMR.
After 20 years working in healthcare risk management, most recently as consultant for a leading US medical malpractice insurance company, Gregg Timmons—president of the California Society for Healthcare Risk Management (CSHRM)—is well placed to detect the changes and challenges now facing the profession. The view he offers is a startling one: he believes healthcare risk management is under threat as a result of healthcare reform, and is in danger of being absorbed or obliterated by other roles within healthcare organizations.
“The models are changing,” he says. “I’ve seen various things happen, from getting rid of the risk management role to bringing in a legal nurse consultant to handle some of the claims pieces and leaving the quality people to implement risk pieces.” In part he attributes these developments to changes brought about by the Affordable Care Act (ACA), which has placed a strong financial emphasis on ensuring that certain patient safety standards and quality measures are met.
Naturally, organizations have responded by channelling efforts into these areas in order to avoid financial sanctions—but this has happened at the expense of many areas covered by risk managers. “One member said her organization was taking money away from risk management to put into some of the compliance and performance improvement activities because that’s where there is a more direct impact on the bottom line,” says Timmons. “They recognise that if they don’t do this, they lose money. In contrast, the usual problem of risk management remains financially justifying your existence: how do you quantify how much money you’ll save if you do something that puts a patient at less risk? “Yes, if you implement prevention of back injuries or needlesticks to employees, you can make some money that way, but it’s hard to say if you do x, y will occur financially.”
He notes that as emphasis on regulatory compliance increases, there is a corresponding decline in emphasis on risk management. This poses a challenge for risk managers, who increasingly have to fight their corner, making sure the money is channelled in the right direction and risk management is not sidelined. Meanwhile, the ACA’s focus on specified quality and improvement measures such as rates of retained sponges and wrong site surgery has led healthcare organizations to channel more money into efforts to improve those scores while taking it away from other areas.
In the meantime, many long-running risk management issues persist, says Timmons. “Unfortunately we still have the same risks we had before. The issues raised by the ACA might be hot topics, but there are still issues of human error. “One of the topics people most wanted to hear about for CSHRM’s most recent conference, for example, was something we’ve discussed over and over again: wrong site surgery. It still occurs; we’ve had speakers talk about that for a decade but members still experience it.
“It’s the same with disclosure: we’ve been talking about it for about 15 years but so many places have a culture that makes it hard to implement that. You still have those doctors who grew up in a culture where they were taught not to talk to patients, but to be defensive and run to your risk manager—they still aren’t on board, so some of the issues we’ve been facing for the last decade are still around. It’s just that the easy, low-hanging fruit has been taken care of.”
When addressing these perennial problems, Timmons believes it is important to do more than simply meet The Joint Commission’s set standards. To truly tackle a problem, an in-depth, analytical approach is required. “Patient safety is much more of a focus than it was before, but I’ve talked to some risk managers who say their patient safety efforts are barely doing what The Joint Commission says they should—and even when an organization does meet those standards, that doesn’t always mean they have an effective working solution. In reality, it is about more than having a piece of paper that shows progress.”
A related issue is the erosion of risk management by the growth of the patient safety movement. There is considerable overlap between the risk management and patient safety roles, and Timmons believes this can lead to risk management being subordinated or even obliterated within an organization. “The overlap between patient safety and risk management means that there is confusion in hospitals over what risk management is. Unfortunately, the risk management community has itself to blame in that they’ve been more reactive and haven’t proven their value enough—to the point that there has been an entire discipline that’s evolved around them: patient safety.
“Over time, if risk management doesn’t say what it is and if it fails to establish itself as a leader for all risks in an organization, the function can go away, or it will be seen in some hospitals as a minor thing—a role that entails following events and writing reports, as opposed to something that is done by professional director with authority.”
The message is clear: risk management needs to prove its value in order to survive. Timmons believes that part of the solution is to nurture talent, bringing a fresh flush of skills and enthusiasm into the profession.
“Historically we have not done a very good job of mentoring new professionals in risk management and it’s been a challenge to find good candidates for employment and also to assert the role. It’s something that ASHRM is trying to change, and something that we are trying to address in CSHRM. There certainly needs to be more one-to-one mentoring.
“Nurses who are clinically savvy, curious and knowledgeable can make good risk managers. It’s a matter of finding them and promoting them. It’s all too easy to get caught up in our day-to-day responsibilities, but if we want to demonstrate the value of risk management, we should be finding the talent that will make good risk managers, finding roles for them in which they can develop risk management skills and nurturing them so that they become future leaders.”
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