Pulling together


Pulling together

If there is one thing Oregon Society for Healthcare Risk Management president Beth Underwood has learned in her career, it’s the importance of all staff members uniting around the common cause of improving safety. She spoke to HRMR about the value of collaboration.

As president of the Oregon Society for Healthcare Risk Management, Beth Underwood has the role of upholding a 25-year history of cutting edge education and advocacy for those who practice risk management in healthcare. An affiliate chapter of the American Society for Healthcare Risk Management, OSHRM is committed to enhancing the professional development of its membership through educational and networking opportunities.

Toward that goal, Andrew Oppenberg, ASHRM president and Matthew Hornberger, associate executive director, spoke at the OSHRM Education Conference in May of this year. The message ‘Everyone is a Risk Manager’ was overwhelmingly well received.

Membership in the state chapter is diverse, encompassing individuals from risk management, quality, patient safety, law, compliance, front-line staff, retired nurses, and medical-legal consultants.

Underwood herself has recently switched roles after years as a risk manager. She now works for Northwest Permanente Physicians and Surgeons, a self governing medical group of more than 1,200 physicians which is part of the 495,000-member Kaiser Permanente integrated healthcare system in the Pacific Northwest. Her role within the Practice Support department is dedicated to improving documentation and coding. The team of physicians, analysts, and nurses provides an ongoing process to find ways to better serve their patients. 

“My current role is about seeing the bigger picture of potential organizational risk, a behind the scenes look, providing support to the physicians. I like it because it’s very proactive, what many in risk management yearn for,” says Underwood.

An important aspect of her job involves reviewing patients’ electronic health records (EHRs). She has extensive experience with EHRs and is certified in both the ambulatory and inpatient modules of the Epic software system. As such she is aware of the importance of concise, accurate, and objective documentation.

She is also at the sharp end of the forthcoming switch to ICD-10 codes. “The new codes are definitely more explicit,” she says. “At the moment we don’t really know how that’s going to play out—it’s a big change for everyone.”

Underwood’s current position represents a natural progression from her work as a risk manager.

“The new job attracted me because I was ready to take my skills and utilize them in a different way. There are clear linkages between risk management and every department. My goal is to bridge any perceived gaps throughout the organization.” she says.

“Everyone is a risk manager. You don’t need a title or an office—risk management is a philosophy, it’s a mindset. Safety is everyone’s business.”

She also remains in tune with the needs of risk managers through her role at OSHRM. A major concern for members at present is keeping pace with regulatory changes. Also top of mind is the ongoing shift towards greater transparency and better communication.

“The need for greater transparency has evolved over the years,” she says. “The other thing that has changed is the relationships between departments. We are professionals and have come to really appreciate the expertise and contribution others make within an organization. Trust is paramount. We rely on others—they are our eyes and ears. Early reporting is all about building a solid trustworthy relationship.”

A new development in Oregon is the Senate Bill 483, which gives healthcare facilities, providers and patients the ability to report that an adverse event has happened.

“This is a huge shift.” she says. “The bill authorizes a healthcare facility, provider and patient to file notice of an adverse healthcare incident with the Oregon Patient Safety Commission. It sets forth procedures for facilities, providers, and patients to engage in discussion and mediation related to an adverse event. The commission is directed to use information received to improve patient outcomes and reduce frequency of events.”

In many ways the bill serves a similar function to a patient safety organization (PSO), in that it promotes information-sharing but prohibits insurance from taking certain actions based on notice of adverse healthcare events.

OSHRM holds a meeting every other month including an educational presentation focusing on subjects that are on people’s minds, such as regulatory issues, ethics, disaster preparedness, and ICD-10. Based on her experiences in risk management and as president of OSHRM, Underwood says she would like to see greater education on risk management fundamentals for a wide range of healthcare staff.

“Risk management basics should be offered to everyone in your organization and not limited to clinical staff,” she says. “It should be listed as one of your job responsibilities, no matter where you work. Risk management is everywhere, we do it every day.”

She also pinpoints mentorship as a key need for many risk managers, and indeed for all staff involved in managing risk in their own environments.

“Early on in my career, I worked with a nurse in Texas who was solid, would question things, and wasn’t afraid to speak up. I learned patient advocacy from her. In risk management I owe so much to my first manager, she taught me the importance of being a resource and that building trusting relationships across the organisation is essential to a successful risk management program.” 

Mentorship has been identified as a need for OSHRM’s members. In 2014 a mentorship program led by Underwood will be available. The objective is guiding and assisting new members and those who might be new in their roles.

“There is tremendous value in being part of ASHRM and my local chapter. You get together in a safe environment and talk about what is going on in your world and realize you’re not alone,” Underwood says.

One of the most important lessons she has learned in her career is to be open to change, because it is an inevitable part of working in healthcare. Integration of all staff within an organization is also important.

“You may have a quality group, patient safety group, compliance group, risk management group—all these different groups, but really everybody is in it together,” she says. “We are all guardians of patient safety.”


Oregon Society for Healthcare Risk Management, OSHRM, Beth Underwood, ASHRM