A changing role

From dealing with changes stemming from Obamacare to adopting an ERM approach, healthcare risk managers face new challenges and opportunities in 2013. HRMR spoke to Fay Rozovsky, president of the Rozovsky Group, about the changing nature of her work.

In what ways have you seen the field of healthcare risk management change in recent years?
It’s changed from being focused largely on patient safety and clinical risk to enterprise risk management (ERM). It’s in transition now; we’re moving away from the traditional situation of handling an event once it’s occurred.

We’re realising too that as we try to evolve new strategies, we’ve also been buffeted by financial constraints. Healthcare is going through reforms and we’re seeing the onset of the babyboomers coming into healthcare. We’ve had a recession, there’s been a lot of uncertainty, so healthcare risk management needs to move toward the ERM model which is more focused on asking: “What are the risks to the enterprise? What do I have to do to change?”

There are people who are holding on to clinical risk and patient safety. ERM is not saying to end that approach—quite the contrary. What we are saying is that ERM subsumes patient safety, subsumes the whole issue of clinical risk into a much bigger ball of wax because if we aren’t looking at all the potential impacts on the healthcare entity or organization, we will not have the resources to turn the lights on in the first instance to even think about doing patient safety or clinical risk management.

Over the last several years what I’m seeing is a transition of the thinking process from clinical to enterprise and it is exceedingly difficult to move to a more strategic, pre-emptive approach. There are glimmers of hope, particularly among health lawyers; indeed the American Health Lawyers Association, an organization of more than 11,000 lawyers, has an ERM group within its constellation of special interest groups. They have already produced two handbooks on ERM and healthcare. The American Society for Healthcare Risk Management (ASHRM), the largest trade association for healthcare risk management professionals, is also trying.
What problems will healthcare risk management face over the coming years?

Risk management as a profession has a succession problem—many of the original risk managers who embraced the field back in the late 1970s and early 1980s are now retiring or have retired and there is a lack of training to help people acquire the skillsets beyond clinical, beyond patient safety, and to encompass this ERM approach. So we’re going to have a paucity of well qualified individuals to replace those who are retiring.
Healthcare is going to have to ask itself “Who is going to replace these individuals and how are we going to replace them?” It’s one thing to have a graduate degree MHA (Master of healthcare administration) or an MBA or go to a school that has an undergraduate program in insurance and risk management; it is quite another thing to take this this type of knowledge and apply it in healthcare ERM.

We’ve got opportunities for young people trying to figure out what they want to do. Risk management is wide open, we need all comers, we are not locked into one discipline. And I think because we’re moving into ERM, where it might be two steps forward, one step backward, there’s ample opportunity for people who like dealing with complex issues to join us—the field is wide open.

What can be done to move risk management forward?

The opportunity is there for groups such as ASHRM and the American Health Lawyers Association to embrace colleagues across the continuum of care, not just in hospital settings; using the disciplines of ERM in community health centers, physician practices and long-term care, is great.

The fact remains that globally it’s the same problem whether you’re in the UK, Australia, France, New Zealand or Germany—they all require people, equipment, communication systems, adherence to law and regulation, and that’s what healthcare risk management can bring to the table.

We transcend all the legal requirements and provide a disciplined approach to making the right choices, so that all our patients can be satisfied—that’s the exciting future for healthcare, and we can all learn from each other.

One highlight of my career was the privilege of going to Australia for three-and-a-half weeks as a consultant and seeing what folks have done there, which was light years ahead of what we were doing in the US. When I consider what the Australians are doing I know we don’t have all the answers, nor should we, but I know that we are part of a global village in healthcare risk management—so why don’t we take advantage of it. .

Meet Fay Rozovsky

Fay Rozovsky has more than three decades of experience in healthcare risk management. A lawyer, she has served as a consultant in Australia, Canada and throughout the US. She has provided consulting services to trade associations, government, hospital, long-term care, home health, and physician practices on a range of topics.

She is renowned as an educator in healthcare risk management and patient safety. She pioneered ‘live to air’ risk management education in Canada, first by satellite radio uplink to remote nursing outposts in Newfoundland and Labrador and then on television throughout Atlantic Canada.

Rozovsky is a former faculty member in the department of legal medicine at Virginia Commonwealth University Medical College. Currently, she teaches in the Barton Certificate Program in healthcare risk management. On an annual basis she offers dozens of educational programs on specific topics in risk management and patient safety.

Rozovsky has published more than 500 articles on subjects in health law, risk management, patient safety, and medical ethics. With more than 18 books to her credit as an author, co-author or editor, she is known as the authority on consent to treatment. Her treatise on the subject has been cited by the highest courts in several states and the US Supreme Court. A past president of the ASHRM, Rozovsky received the highest honor bestowed by the society, the Distinguished Service Award.