An expert view


An expert view

Michelle Foster Earle has seen plenty of changes in the field of healthcare since she launched OmniSure Risk Consulting Group in 2000. She tells HRMR why risk management has improved but is also becoming more complicated.

As technology and access to big data change the way in which risk management is delivered, it is vital to move with the times. So says Earle, who began her career in healthcare providing regulatory, clinical, operational and financial leadership to healthcare facilities nationwide, and who is now president of OmniSure, a provider of healthcare risk management services across the US via its nationwide network of clinical consultants.

“Suddenly we have a huge supply of data and one of the challenges facing healthcare risk management is how to use that data,” she says. 

“We are subject to information overload. Just think about how many emails we get every day, and the fact that there’s an app for everything—you almost have too many choices and that can be paralyzing,” she says.

“We need to simplify our choices so that we can take decisive action, and we need to take complex issues and provide simple solutions.

“Good risk managers start by analyzing the data and testing for results,” says Earle. “For example, a large amount of data on nursing homes comes from the regulatory environment and ratings—but should carriers reduce premiums for those with higher ratings?

“The reality is that in some cases a three-star facility might be a better risk than a five-star facility because there is no perfect correlation between the regulatory star ratings and risk level—yet I think that some people blindly accept the certain correlation without really asking the right questions and testing the data.”

Over the years, Earle has formed her own perception of what makes a good healthcare risk manager.

“The best risk managers are not only bright and driven to excellence, they have high emotional intelligence,” she says. “Because they really listen and empathize with others, they can get to core issues quickly. They’re open to new ideas and seek advice from front line caregivers before making decisions. They help others learn from mistakes and failures in a culture that values transparency.”

Earle argues that while people may think risk managers are risk-averse, a good risk manager is willing to take risks—but they like to have a plan.

“People see a good risk manager as someone who is trusted and credible, with strong values and high integrity,” she says. “They know there is a lot riding on their decisions and so they are very conscientious, open and forthright. There are no hidden agendas and they know how to foster the cooperation and alignment of their team.”

Earle has also noted that the best risk managers work through a strong quality assurance and performance improvement program. “This requires that they be disciplined and focused, setting clear and simple goals, prioritizing, setting a course that can be modified to respond to changing needs, and keeping others informed,” she says.

Communication skills

An area that, in Earle’s opinion, has seen progress but still has a way to go, is communication and relationships among hospital staff.

“Providers are often brilliant—they’ve gone through years of study and training but they’re not always good with people,” she says. “They don’t always have the best bedside manner or communication skills and that is one of the things that leads to breakdowns in communication during handoffs, disruptive behavior among staff members, and patient dissatisfaction.

“I believe we are going to see a lot more emphasis on preparing providers to have a higher emotional intelligence—to be better listeners, and to be more empathetic.”

A great motivator for Earle as she works to help providers reduce risk and improve relations with patients is the knowledge that money saved by the avoidance of lawsuits can directly benefit patient care.

“When people sue they think they’re going to sock it to the providers and take some of their profits but that’s not what happens—patient care suffers as a result,” she says. “Healthcare organizations have only a finite amount of money and their budget is set up to use that for patient care.”

Earle’s approach to risk is characterized by a firm belief that the focus should be not on blame but on encouraging a just culture. “It’s important to recognize that people are human. Instead of apportioning blame, we need to nurture a just culture in which you punish reckless behavior but you do not punish people for honest mistakes.

“That’s happening more in hospitals—we’ve made a lot of progress in helping to embrace a just culture for patient safety,” she says.

“In the past, when a nurse gave a patient the wrong medication and the patient had an adverse event, you fired the nurse. Now we’ve reached a position where we look at what it is about the system or process that made it possible for the nurse to make this mistake, and how can we change that to prevent recurrence. 

“In general, I think the industry is getting better about encouraging staff to speak up when they make, or almost make, a mistake.” 

For Earle and her consultants this is a great source of satisfaction, but the bottom line is that when mistakes occur, they are on hand to help, providing guidance in a crisis situation.

“OmniSure’s initial role is to help prevent problems from arising in the first place. Providers tend to use us as a trusted set of outside eyes—we work alongside them to identify areas for improvement. If a risk manager has implemented a number of initiatives we can come in and validate the quality and the performance of those initiatives.

“We also bring a level of credibility to training—we can provide experts from multiple areas to come and support them,” she adds.

“But having someone in your corner when something goes wrong is ultimately the best possible scenario,” she says.

According to her LinkedIn profile, Michelle Foster Earle is an enthusiastic visionary and out-of-the-box thinker with an entrepreneurial spirit and unique blend of operational, sales, and executive skills. In addition to designations as a Licensed Nursing Facility Administrator, Licensed General Lines Property and Casualty Agent in Texas, and Associate in Risk Management, Earle holds a Bachelor of Arts degree in psychology from the University of Houston.

She is a member of a number of professional organizations including the American Society for Healthcare Risk Management and has been a presenter and panellist at national industry conferences around the US. Omnisure can be contacted at

Michelle Foster Earle, OmniSure Risk Consulting Group, Healthcare Risk Management, US, Crisis management