Getting out of the silos


Getting out of the silos

President of the North Texas Society for Healthcare Risk Management Kristian Poitier believes that clear communication is the key to effective risk management. She explains her view to HRMR.

Having recently begun a new job as director of patient safety and clinical risk management at Tenet Health System, based in Dallas, Kristian Poitier is in the process of putting into practice one of the major lessons she has learned in the risk management industry: clear and effective communication.

“I’m reminded of the saying that a leader without any followers is simply taking a walk. Likewise, communication without the other party understanding is just talking, so we have to get from simply talking to each other to truly communicating,” she says.

This is especially important in a world where risk management is increasingly falling into different silos: it is important to ensure that those responsible for institutional risk are communicating with those responsible for clinical risk, for example. Communication is also vital when it comes to the healthcare organization’s relationship with its patients—especially when errors occur.

“I’ve learned the importance of communication through meeting with patients and having previously been at a hospital where I owned the grievance process as well,” says Poitier. “A lot of the issues that turn into grievances, even simple complaints, all stem from breakdowns in communication.

“Patients are often fearful, they don’t understand exactly what’s going on, and this can mean fear festers and grows bigger and bigger. What I’ve always asked of physicians and nurses is for everybody to be on the same page—and when you have multiple physicians involved in a case, you want to know that they are talking to each other. Patients are really sensitive about that and so are their family members.”

"I have seen leaders not owning or being accountable for even minor things. I’ve had to coax them into still leading in their space."

She adds that part of good communication is transparency within an organization: leaders need to be transparent about events rather than trying to hold back.

“They need to be able to communicate that there is a problem, so that we can truly address it and move on to implementing whatever process improvements are needed to get past it.”

Towards a common vision

The major part of Poitier’s new role is to facilitate the development of an enterprise-wide patient safety clinical risk prevention program for Tenet’s acute care ambulatory and physician practice divisions. She will also be managing patient safety projects and initiatives, and have oversight of the corporate event reporting system.

“Some of the hospitals have different systems so we have to pull all of that data, analyse it and isolate trends to determine what process improvement strategies need to be implemented for proactive measures,” she says.

Poitier is particularly looking forward to mentoring the facility risk managers and regional risk managers, with a focus on improving the process of carrying out root cause analyses.

“I want to help carry out that process and build relationships and trust within the organization,” she says.

This gets to the core of what made Poitier shift from nursing into risk management early on in her career. 

“I learned quickly, being at the bedside, that nurses have policies, procedures and protocols that they have to follow, but I want to be on the end where they establish those standards. I want to understand the rationale behind organizational standards and to make things better. And having participated in some root cause analyses, I fell in love with the field of risk management.”

For Poitier, the rewards of risk management are the relationships built and the problems solved. She loves to see strategies implemented as a result of near misses being properly communicated and addressed.

While good communication is at the core of this, she adds that risk managers have to be careful that as relationships are forged within the organization, the risk manager does not start to be viewed as a the person who fixes everything: instead, staff needs to take responsibility for risk solutions.

“One of the challenges is that when you build these relationships, you sometimes have people who just want to lean on you. They can start to think that if anything bad happens, all that’s needed is a root cause analysis and then everything will be fixed, everything will be documented, and there will be a nice action plan in place.

“In previous jobs I have seen leaders not owning or being accountable for even minor things. I’ve had to coax them into still leading in their space. Yes, when it’s appropriate, risk management can come in and lead but they have to realize we’re a team, and that patient safety is not just the risk manager’s role.”

A big achievement

In her career to date, Poitier is most pleased about being able to build trust. She loves it when she reaches a point where people call her asking for advice for harm prevention or flagging up potential issues instead of in reaction to an adverse event. ln hospital leadership rounds one of her favorite questions for frontline staff members was, “is there anything that keeps you up at night?”.

“It’s extremely important as a risk manager that people trust you, and that when you’re in a meeting where something really bad happened, you can say, ok: this is how we move forward,” she says.

“It feels good to be helping people through those hard times, or to see measurable improvements in your organization’s safety record. I also enjoy those tough wins—for example when you have a nurse saying they won’t do something, and you have to present the information in a way that will make them see that it makes sense.”

As president of her ASHRM chapter, the North Texas Society for Healthcare Risk Management, Poitier believes one of the biggest challenges risk managers are facing at present is defining where they fit in within a world of shifting roles: there is not only the divide between institutional risk and clinical but also the increased focus on patient safety, clinical risk and regulatory risk as distinct roles.

“A lot of the struggles I hear about from risk managers relate to how healthcare organizations are reconstructing, and how to stay relevant in what we’re doing,” she says.

“One of the biggest issues has been the shift to patient safety officers, which is funny when you consider that patient safety has always been a part of risk management. The whole patient safety initiative is something that risk managers have always done, but now it’s being highlighted and pushed to the forefront of risk.”

In the future Poitier wants to see risk managers staying proactive and consistently showing their value.

“I’d like to see fewer silos within risk management: clinical risk, enterprise risk, quality—whether you are staff, a patient or a visitor, the important thing is that information is being communicated and everyone in the organization is pushing to share its mission and values, to improve quality and provide safer care all together. We all have the same ideas but we’re sometimes not all talking.” 

Tenet Health System, North Texas Society for Healthcare Risk Management, Kristian Poitier, US