Measurable value

For Kirsten Padgett, president of the California Society for Healthcare Risk Management, risk management is about helping providers reduce their liability risk and improve patient safety in a quantifiable way. She tells HRMR about the challenges of dealing with the risk management needs of a broad portfolio of clients.

The adoption of electronic health records (EHRs) has been a dominant theme in Kirsten Padgett’s career as a risk manager.

Having worked for NORCAL Mutual for 17 years, mostly handling medical malpractice claims, she transitioned to risk management in 2009 to work on a special project NORCAL started to address the risk issues providers were encountering with the implementation and use of EHRs.

After leading that project, in 2013 Padgett moved to her present role as Western Regional Manager in the Risk Management Department of NORCAL Mutual Insurance Company, a leading US medical professional liability carrier. She is based in San Francisco and has a team of five risk management specialists who handle the risk management needs of NORCAL’s policyholders in the western region (Alaska, Washington, Oregon, California, Nevada, Arizona and New Mexico). They provide risk management presentations, on-site risk assessments, continuing medical education (CME) activities, risk management resources and other services to policyholders in that region.

Padgett’s earlier experience in the field of EHRs has remained highly relevant in her new role. “I am still working on NORCAL’s EHR initiative as we head into Stage 2 of the Centers for Medicare and Medicaid’s (CMS) Meaningful Use program,” she says. “I have also been investigating the evolving risks that our policyholders are encountering, whether they are unique to a certain specialty or a certain region, or a nationwide project such as EHR and Accountable Care Organization (ACO) implementation.”

Looking over her risk management career to date, she says she is most pleased with her achievements in leading the company’s EHR initiative and building a cache of resources, articles and presentations that address the unique risks that EHRs present to healthcare providers and their patients.

“I am also very pleased with the fact that our department’s risk management assistance has been a contributing factor in many of our policyholders deciding to renew their policies with us,” she adds.

The support provided by NORCAL’s Risk Management Department is tailored to each individual policyholder’s situation: solo physicians or small groups tend to lean on NORCAL’s risk management support instead of employing their own staff. In large groups and hospitals NORCAL’s staff services are a supplement to their own risk managers and patient safety staff.

“There are a number of benefits to using our services, including the fact that we are available 24/7, have a robust arsenal of risk management resources to help with almost any medical liability risk issue, will work with accounts to tailor presentations and services to their risk management needs, and may provide on-site assessments with recommendations focusing on the issues in that practice,” she says. “We collaborate with our policyholders and don’t have a ‘one size fits all’ approach to risk management.”

Continuing education

A cornerstone of NORCAL’s services to its policyholders is its CME program, which teaches policyholders to reduce their professional liability risk through a wide range of activities, from live presentations to monthly publication and online webcasts.

“By offering a variety of ways to access CME, our enduring materials are accessible to all policyholders in the US, regardless of whether they are located in a remote area or in a large city,” says Padgett. “We are accredited by the Accreditation Council for CME (ACCME)—I believe our CME program is the most frequently used of any ACCME-accredited medical liability carrier in the US, with 32,741 CME certificates awarded in 2013.

“In addition, many of our policyholders can earn a discount on their malpractice premium if they complete at least two hours of NORCAL’s CME activities per year, which is another incentive for them to participate.”

After 17 years’ working on the reactive side of professional liability, handling claims that arose after a provider had made a medical error, Padgett has found it exciting to step into a proactive role with risk management, teaching NORCAL’s policyholders ways they can reduce their professional liability risk and improve patient safety.

Her biggest challenge to date has been juggling a team of five to meet the needs of policyholders over a seven-state region, and becoming familiar with the healthcare rules that apply in these different states.

“My goal is to show a quantifiable reduction in adverse events and professional liability claims as a result of our risk management programs,” she says. “This is a challenge because it is often difficult, if not impossible, to directly correlate what we do with a reduction in adverse outcomes and malpractice claims, but I will keep trying.”

In her time as a risk manager Padgett says she has learned that no two risk issues are the same. Each question has to be evaluated and answered taking into account the nuances of that particular practice or policyholder—their specialty; the state/area the practice is located in; and their patient population.

“I have also learned that helping our policyholders reduce their risk and improve patient safety is deeply rewarding—it makes me feel that my team and I are truly making a difference,” she adds.

Serving colleagues 

With the same goal in mind Padgett joined the California Society of Healthcare Risk Management (CSHRM), and is currently serving as its president.

“I became involved with CSHRM because I strongly believed in the mission of local ASHRM chapters to provide education and resources to their members in regions across the US,” she says.

“The value of being a member of CSHRM, or any local ASHRM chapter, is the ability to network with peers in your area, share ideas and resources, and attend educational events.

“In addition to our annual three-day educational conference, we conduct seven webinars per year, have an online forum for our members to share ideas and questions, and have a website where they can access risk management information and post job openings or educational events at their facilities.

“CSHRM gives our members a chance to discuss risk management issues that are occurring locally, which is invaluable to them.”

She adds that value-based purchasing and enterprise risk management are hot topics among CSHRM’s members currently, in addition to the ever-present need to ensure that changing methods of providing healthcare are not compromising patient safety.

The biggest changes are linked to the Affordable Care Act (ACA), with its incentives for healthcare providers to implement EHRs and the encouragement to develop ACOs.

“This has affected my job immensely. Research on those two programs and how they affect our policyholders and their risk issues has been much of what I have worked on for the past four years,” she says. Along with the development of ACOs and the implementation of value-based purchasing programs, the adoption of EHRs is one of the biggest changes healthcare has ever seen.

As she navigates this changing landscape, Padgett feels her job would be made easier if everyone in healthcare understood the value of risk management in their organizations and vigorously supported it.

“Since the results of an effective risk management program are often difficult to quantify and not always able to be directly correlated to cost savings in an organization, risk management departments can be under-valued and put at risk of being consolidated with other departments or eliminated entirely,” she says.

Despite these challenges, there are plenty of positives in her current role. “I really enjoy the feeling that we are making a difference not only to our policyholders but also to their patients,” she says. “I believe that our proactive work in helping them reduce their professional liability risk has, in turn, resulted in safer healthcare environments and better outcomes for patients.

“Additionally, the appreciation and positive feedback that our policyholders give us after receiving our risk management services is a very rewarding part of my job.”