A driving force for quality

In 25 years as a member of Michigan Society for Healthcare Risk Management, Dean Etsios has seen risk management move from being an afterthought for many organizations to a driving force for quality and safety. He told HRMR why risk managers now play such an important—and multifaceted—role in healthcare.

As president of one of the most active ASHRM chapters in the country, Dean Etsios is keen to continue the culture of keen engagement and active involvement from Michigan Society for Healthcare Risk Management (MSHRM) members.

“I’ve been a member since 1997 and we’ve had some fantastic people who really put in the time and effort to make the organization what it is,” says Etsios, a principal with law firm Kitch Drutchas Wagner Valitutti & Sherbrook.

The society has over 230 members and holds regular educational sessions and meetings throughout the year, including a three-day annual meeting.

“The purpose of MSHRM is to educate our members on any trends and issues. We try to find topics that everyone will relate to, and we bring in speakers from throughout the state and beyond.”

During his 25 years with MSHRM, Etsios has seen the role of the risk manager, and the way it is perceived, evolve and grow.

“At first it was an afterthought for each institution: they would bring in someone from infectious diseases or some other place and put them in the role of risk manager. In those days, risk managers were not able to be proactive in terms of setting rules and regulations and promulgating safety issues.

“Now most places have a professional core of people who are qualified and really understand what they are doing.”

As US healthcare provision has developed, the risk management role has expanded beyond the hospital arena. Part of Etsios’ role during his presidency has been to reach out to risk management, quality assurance and safety staff who are working in healthcare but in practice groups outside of the hospital environment to get them involved with MSHRM.

MSHRM is also working to link members through its blog, creating an arena where people can ask questions about issues they are facing in their organizations and get answers from people all over the state. They are also looking at developing an app to make this process even easier.

“This year has been very much about integration: trying to integrate other practice groups and their risk teams into our organization as well as to integrate everyone together through technology,” he says.

Proactive engagement

One of MSHRM’s proudest achievements over the years has been to create a very strong call for professional risk management and quality assurance within the state, achieving progress from a legal standpoint but also from a patient care and safety perspective.

“Having a proactive group going back to the hospitals with what they have learned is tremendously important for the patient in the hospital. It helps with the prevention of issues that might come up during the hospitalization and equips staff to be able to deal with these issues proactively if they do occur.

“This approach has been very successful over the years. When I first started there was a real lack of education around these issues but now, with teaching programs and networking, we have been able to create real change.”

“Having a proactive group going back to the hospitals with what they have learned is tremendously important for the patient in the hospital.

The current hottest topic for MSHRM members is enterprise risk management (ERM), so the society has organized a teaching program based around this topic that aims to help risk managers with issues such as safety and risk prevention from an ERM standpoint.

“ERM is a huge issue: it entails changing cultures in hospitals in terms of issues such as how they deal with risk; how they deal with confrontational patients; and how they deal with a confrontational physician. It’s about trying to be proactive, and making sure that if there is an issue, the risk manager is involved as early as possible.

“We will also be looking at the future of risk and how the risk landscape changes. We’ve been very proactive in issues such as electronic medical records and the issues of privacy and legal protection.”

Lessons from litigation

Etsios’ own work is focused at the sharp end of healthcare risk management, when incidents lead to litigation. It’s a job that demands a sound understanding of the clinical issues surrounding adverse events, and Etsios enjoys this learning aspect of his work.

“The beauty of it is that every day, every year, every case is different, and you learn so much. I handle very diverse cases, everything from a fracture to complicated brain cases, and no two cases are alike.

“The most rewarding thing for me is to be able to do my best to protect the interests of my clients. I’m not saying all cases are frivolous—there are some reasonable cases out there, and my job is to help determine that by providing information and being fair to both the litigant and the hospital. I also have to be proactive and tell the hospital about the issues raised by a case.”

The most common pitfall he sees in the course of his work is lack of communication between physicians, nurses and the risk manager.

“That is still the culture of some institutions—they are insular, they don’t want to bring things up and unfortunately the risk manager becomes involved at a later stage rather than at an earlier point where they could have been more proactive in dealing with issues.”

He finds this particularly true with cases involving older physicians, who often resist divulging much about what has happened, with the result that the case is more likely to go against them.

“The cover-up is worse than the crime sometimes and if a jury perceives that you are hiding something, you might lose even if you did everything right.”

Levelling the playing field

A hot topic in Michigan is discrepancies in the payouts litigants can receive for different types of incidents. Tort reform has set a cap on the amount that can be claimed for medical malpractice, but there is no cap on the amount that can be claimed for incidents such as slips and falls—meaning that patients who have suffered the latter can claim much more money than those affected by malpractice.

Etsios expects there to be more discussions around this in the future and also expects to see risk managers continuing to become more and more highly trained and educated in how best to manage risk within their organizations.

“Risk management is a career now rather than an afterthought for an organization, and organizations such as MSHRM can really help in terms of providing education and addressing many of the issues that risk managers deal with every day.”

As the role continues to develop, he expects to see the job of risk manager dividing into several separate sectors.

“As the job becomes more professional and specialized, risk managers are going to take off some of the hats they are wearing: they cannot take on everything and do everything well, so I think there is going to be further bifurcation of the roles: quality becoming a separate department, for instance.”

In Etsios’ view, risk management is one of the most underrated and hardest jobs there can be at a hospital, as it requires such a broad range of skills and knowledge, from understanding all the relevant rules and regulations to addressing sensitive issues on the spot.

“There is no better person to be on the front line, preventing not just potential litigation but also issues with regard to patient safety,” he says.

“Risk management and the related safety and quality roles are all going to be needed more and more, especially as hospitals in the US are such a growing industry.”