An evolving profession

It is a time of unprecedented change for healthcare risk managers. In the following pages we examine the changes their profession faces and conduct an in-depth

In 2011, the ECRI Institute (formerly the Emergency Care Research Institute), an independent non-for-profit organization that researches the best approaches to improve patient care, revealed the top 10 concerns facing healthcare risk managers that year and beyond, based on a biannual survey of its members.

The key themes that emerged reflect the changing landscape in the US healthcare system. Many of the items that feature highly in the list do so because they are a direct consequence of healthcare reforms, and the report suggests that these will continue to dominate the challenges facing healthcare risk managers as some of the deadlines for the implementation of many reforms draw closer.

Top of the list was the implementation of electronic health records. Organizations are being incentivized by the government to do this but it brings with it a multitude of challenges and new risks. “I’m not surprised to see electronic health records so high on the list. Larger organizations are up to their elbows with this,” said Theresa Zimmerman, the American Society for Healthcare Risk Management (ASHRM) president at the time of the report. Risks stemming from this include the accuracy of documentation and ensuring the privacy and security of data.

Their other top concerns were the integration of risk management, quality, and patient safety, ranked joint second with provider communication; the implementation of federal clawback initiatives (ranked third); and non-payment for hospital-acquired conditions (ranked fourth).

All these things, in different ways, relate directly or indirectly to the implementation of healthcare reforms. The report noted that such topics would continue to worry risk managers especially as organizations move towards forming bodies such as accountable care organizations (ACOs), a key tenet of the reforms.

The other concerns raised, in order, were: disruptive practitioner behavior; event management and investigation; a decline in risk management resources; falls reduction; time management; workplace violence; enterprise-wide risk management and security breaches of protected health information.

The report also identified a trend of risk managers being concerned about job security. Despite the profession very much coming to the fore with the onset of healthcare reforms, some expressed concerns about merging with previously distinct departments such as quality and patent safety, and a reduction in resources and budgets allocated to risk management.

Issues such as integration of risk management, quality, and safety, as well as demonstrating the value of risk management, earn prominent spots on risk managers’ lists of concerns.

The report suggests that to ease concerns over job security, risk managers must stay involved in the issues that are priorities for their organizations—especially issues such as healthcare reform. Zimmerman said that risk managers must “be more informed than the average healthcare executive” about new payment initiatives and health reform to help their organizations assess their readiness. Not everything will fall under risk management, but “risk managers can be part of the team that drives the organization’s response”, she said.

She added that risk managers should be open to change. “Many systems are trying to figure out where risk management fits,” said Zimmerman. As a result, issues such as integration of risk management, quality, and safety, as well as demonstrating the value of risk management, earn prominent spots on risk managers’ lists of concerns. “Healthcare will be constantly changing and flexing and so will risk management. We have to be open to change,” she advised.

The findings of this report tally with the responses of risk managers and risk management experts interviewed by this publication. Michelle Hoppes, an experienced healthcare risk manager who has recently accepted a senior role with AWAC Services Company, a member company of Allied World, as a healthcare and risk management expert, says the hottest topics in risk management all revolve around healthcare reforms. Her views mirror the topics highlighted in the report.

“The hot topics are clearly related to the changing environment of healthcare from the increasing scope of transparency, the change in the way healthcare organizations are reimbursed, the focus on eliminating preventable harm and hospital-acquired conditions, the activity of mergers and acquisitions and significant increases in physicians being employed by hospitals,” she says.

“There is also an expanding use of mid-level providers and issues with scope of practice; boarding and crowding in the emergency departments remains a top concern as well as teamwork and communication and the efforts to achieve high reliability in the care we provide.”

Mary Anne Hilliard, the chief risk counsel and vice-president of Safety & Patient Experience at the Children’s National Medical Center in Washington DC, agrees, and says she hears similar concerns from her peers.
She told this publication that risk managers face big challenges thanks to the raft of healthcare reforms that are being implemented. But she also believes these changes are raising the profile of risk management within healthcare providers and casting a spotlight on the important work done by the profession.

Insurance broker Marsh has written a white paper exploring the challenges the sector will face, the findings of which can be found on page 14. The report says much of the onus of the changes organizations must make thanks to the reforms will fall on risk managers. The change will also force organizations to make unprecedented cultural and operational shifts—many of which the industry has yet fully to identify and manage.

On the following pages, we speak to risk managers about their concerns and the changes facing their profession.