Integrity and accuracy

Co-president of Indiana Society for Healthcare Risk Management Dorinda Sattler combines a career in academia with a healthcare risk management consultancy. She tells HRMR why good relationships and clear policies and procedures are the cornerstones of good risk management.

Looking at her current work profile, Dorinda Sattler feels she has the best of both worlds: she is immersed in academia as a faculty member in the Health Information Management program at Indiana University Northwest, but she still has a foot in the world of active healthcare risk management, having set up Sattler Healthcare Consulting.

“It came about as a result of being approached by Indiana University Health Risk Retention Group (IUHRRG), the risk manager for the Indiana Residual Malpractice Insurance Authority (IRMIA), who asked if I would be interested in doing risk management consultant work,” Sattler says.

Having a passion for healthcare risk management, Sattler jumped at the opportunity, even though it was not the easiest undertaking: IRMIA provides medical professional liability coverage for healthcare providers who have been declined by at least two other insurers. The idea is to ensure Indiana has enough healthcare providers, and Sattler is delighted to be putting her years of experience in healthcare risk management to good use.

“I’ve been consulting for little over a year now and I am just starting to see providers who have maybe never been coached or educated on the benefits and value of risk management coming around and understanding that we need to be proactive and have policies and procedures in place,” she says.

“Many small practitioners and groups are not used to doing that, and it’s satisfying when you explain that they need to have a foundation of policies and procedures for what they do and you see that they start to trust what you are saying.

“Seeing them embrace the idea that you are there to help them lower their potential liability is a very nice achievement.”

As a consultant, Sattler’s focus is very much on enterprise risk management, taking in the full gamut of risk areas from clinical, to physical facilities; from general liability to employer relationships with staff. Medical record reviews, human resources and policies and procedures all fall within her scope.

A lucky discovery

While she is passionate about risk management, Sattler admits that, like many, she discovered it almost by accident.

“There was an opening in risk management and I applied for and got the job. When I found that all of my prior education and experience translated so well into the risk management role, I wondered why I didn’t step into it earlier.”

"You can make the desired changes only if people want to listen to you, enjoy working with you and if you can communicate to them."

She worked as a hospital risk manager for five-and-a-half years before transitioning into teaching, but when she took on that role she reached out to Indiana University Health Risk Retention Group and asked them to consider utilizing her risk management skills if a suitable opportunity arose.

“Luckily for me, they did. I feel so fortunate to be able to work in both risk management and in the education of health information management professionals.”

She gets a buzz when her health information management students start to think about careers in risk management—a role that is a natural fit for their skills.

“We focus on the integrity and accuracy of the records, and these aspects are very important to risk management endeavors. Health information managers are keenly aware of how information is organized and where to find it, and this can be very important in the risk manager role.”

Driving change

One of Sattler’s greatest pleasures as a risk manager has been playing a part in the culture change that has occurred all over the US in recent years, taking risk management from a role focused on defense to becoming a proactive and positive force in patient safety. As such, she believes, the skillset for risk managers has changed dramatically, with an increased emphasis on people management.

“The landscape has really changed. I believe that relationship-building skills are now a very important part of working towards improving patient safety. You can make the desired changes only if people want to listen to you, enjoy working with you and if you can communicate to them—none of that can happen unless they feel comfortable with you.”

It’s an attitude that has driven her own approach to risk management, helping her bring about such a culture change that staff at IU Health La Porte Hospital went from being afraid to report incidents to fully embracing a more transparent, honest approach. The key, Sattler says, has been dismantling the long-held belief that admitting to an error equates to taking the blame.

In her time at IU Health La Porte, the number of incident reports tripled—not because more incidents were occurring but because the staff felt more comfortable reporting both actual and near-miss events.

“We worked very hard to get them to understand it was not about a person making a mistake but about working out what process failed to allow them to make that mistake,” she says.

In her current role, the story is similar, in that she is focusing on the policies and procedures that need to be in place to cut back on risk.

“I’m finding there is a lack of written policies and procedures—a lack of the correct things in place that staff can refer to should a particular issue come up to ensure they are being consistent in managing a practice and responding to patients and employees,” she says.

She responds to this by providing the rationale for creating these policies and procedures.

“It’s a matter of persuading people that although they may have been in practice for 20-plus years and have the same loyal staff, and they might feel they don’t need written policies and procedures, you can’t predict the future. Relationships can sour and if something does come up you can minimize your liability and risk by having a source of truth to refer to that has already been communicated to everyone involved.”

Keeping it clear

As co-president of the Indiana Society for Healthcare Risk Management (ISHRM), Sattler is seeing similar issues, with the hottest topic being members’ need for greater consistency in electronic health records, the size of which can increase exponentially as the same pieces of information become duplicated in multiple locations.

“When you try to print out a record in light of a claim you can have as many as 2,000 pages because one piece of information prints out on multiple pages in different contexts. Providing a complete picture of the health record is problematic for litigation.”

Sattler’s solution is to capture a patient’s health record in its entirety at the moment that the provider receives notification of a claim. By saving this to a drive, server or disc, it is possible to present a much clearer picture of the relevant information when the need arises.

“It becomes the source of truth for future requests for the health record relating to that particular claim. This is important because an electronic health record is constantly changing: a patient might still be coming in for services and information about this can layer on top of previous data and information. Being able to show what the record looked like at one point in time is a way to combat that.”

Sattler is now putting her keen eye for policy and procedure to good use by addressing the administration side of ISHRM, working to build a clear set of guidelines and procedures that can be passed down from one administration to the next in order to ensure an easier transition between boards.

“Without laying out these procedures, some things can get lost in transition from one board to the next. We’re hoping this new approach will make it easier to serve our members’ needs.”

Like all healthcare risk managers, Sattler is now riding the wave of healthcare reform but she feels positive about the future of her profession in the light of these changes.

“I know there are a lot of pros and cons to reform but one way it is changing risk management for the better is that there is a focus on quality within the Affordable Care Act, and that lends itself to facilities being more proactive in the care they provide, which in turn decreases their liability.

“The opportunities for improvement continue to grow as risk management becomes more about proactive patient safety and about relationships with those involved in patient care, and not just about claims defense. The challenge is that we are often trying to do more with fewer resources.”