Making a difference

For Angie King, president of the Georgia Society of Healthcare Risk Management, risk management is about more than responding to adverse events. She spoke to HRMR about why risk managers should also be educators, facilitators and excellent communicators—and why the role gives you the opportunity to really make a difference.

Asked for the most important tip she would like to pass on to other healthcare risk managers, Angie King chooses two words: empathetic transparency.

“I think that says it all,” she says. “Let’s say something has happened to a patient: you have to have full disclosure, it needs to be done with genuine empathy, it needs to be coordinated and it’s important that you’re honest. Don’t try and hide it and say ‘this did not happen’. A lot of times a risk manager has to educate the staff, including the physicians, on how to do it.”

Another aspect of transparency is the need for prompt reporting of incidents that could affect staff or patient safety. King says all staff members need to know it’s their responsibility, their duty, to report any such events—and to support this, there needs to be a non-punitive response to reporting.

“Staff need to report any occurrence even if it’s a near-hit—and if they report it, we don’t just bury it and go forward,” she says. “If you’ve got a patient who makes a threat, then report it immediately—those sort of things need to be taken seriously. By the same token, if a member of staff sees a patient who has had a medication error then they need to report that straight away.”

King is speaking from many years’ experience in healthcare. She started out with a bachelor’s degree in nursing and after a short time on the floor spent eight years working in critical care, followed by three years in the operating room. After that she moved into performance improvement—an area that appealed to her because she felt she could make a difference to the experiences of both staff and patients. “I used to say that if you had poor quality you had high risk,” she says. “Risk management was starting to change from a very reactive process with lawsuits being filed to a more proactive risk prevention model. It is still not fully developed but it’s continued to grow every year.”

King has worked as administrative director for patient safety and quality at St Francis Hospital, Columbus, Georgia, since 2007, and enjoys the unique combination of disciplines the job requires.

“The appeal of the job is not only that it’s a blending of quality and risk, but how we also have that input on patient safety. When you increase patient safety actions then the other two are also going to be improved. For any nurse it’s always the same—it’s about making a difference with what you’re doing.”

With this in mind, King has taken on the role of this year’s president of the Georgia Society for Healthcare Risk Management (GSHRM). Part of her role entails making sure the society is aligned with the national body ASHRM, and that it evolves its mission from claims management to improving patient safety. She also believes it is important to fully integrate the different collaborative functions from the brokers and the insurance carriers, and to talk about long-term care, getting all the members on the same page with regards to improving patient safety, risk prevention and enterprise risk management.

Her society also performs an important educational role. “For our membership we offer free two or one-day programs—the organization picks up all the expenses and brings in a variety of speakers to improve networking; once a year we have a three-day meeting. Plus, we do a publication twice a year. The aim of all this is to share information, provide education and improve networking,” King says.

Asked about her members’ major concerns she cites the issue of patient ‘elopement’, which was revealed as a major issue in a risk assessment for GSHRM’s members. She says that after an elopement occurs it is important to undertake a detailed examination of what happened and why.

“It’s important to do an intense drill-down on events that happen and on top of that have an ongoing review of the data, and analyse what the data is showing. We need to ask: why did they leave, was it a long wait time, are they not getting their medicines, are they just not going to be happy, was there a patient satisfaction issue?”

Significant risk factors sometimes accompany patient elopement. “If they leave the facility and their condition deteriorates or they even die, then we need to ensure we are doing due diligence to reduce the inherent risk in an elopement.”

On a day-to-day basis King’s job is varied and often challenging. Besides what she calls the “traditional stuff”—looking at claims made, tracking them to measure whether the hospital is improving, determining how much money the hospital has to spend on insurance—she also has to address healthcare reform-related issues such as decreased reimbursement and how that will affects patients’ experiences. She sees her role as a proactive one that involves uniting staff around a shared vision for the hospital.

“I think the risk manager is a great facilitator. The role is about education and communication, and about saying, ‘these are the regulations and the overall mission; this is what are we trying to accomplish here; this is the beneficiary’. If you don’t have a passion for the job then you shouldn’t do it because it can be very taxing. If you’re easily frustrated, this is not the job for you. You need to be able to find the small improvements and celebrate them.”