Scanning the horizon


Scanning the horizon

ASHRM president Ellen Grady Venditti combines decades of experience in the healthcare arena with a clear vision for the future of healthcare risk management. She told HRMR why risk managers must play a proactive role in moving their organizations forward—and why she is so honored by her current role.

During her long career in healthcare risk management, ASHRM president Ellen Grady Venditti has seen the profession evolve and change, but there is one quality that has always marked out the strongest risk managers—the ability to see the bigger picture.

“A really strong risk manager has to have a global vision,” she says. “You always have to be scanning the horizon so you can be ready for whatever might be coming around the next bend or what might show up on your doorstep. You have to be prepared to manage whatever that might be.”

However, she adds, this vigilance is not just a defensive position. “You should also be looking for potential value for an organization: risk is not always negative. Just as in day-to-day life taking a risk can sometimes expand your horizons by taking you into a new arena, so as a healthcare risk manager we are always in a position to spot the good things that lie ahead.”

This is equally true in the insurance industry. Venditti’s impressive CV includes time spent administering a self-insured/captive claims program for a captive insurance company and here too, she has seen the positive side of risk.

“I used to think in terms of insurance as just guarding against things, rather than thinking of it as presenting opportunities for entering into an arena,” she says. “It’s really important in the healthcare insurance industry to have an open mind to look for the potential value in taking risk.

“I remember, for example, when hospitals first started carrying out open heart surgery and I was struck by what a big risk that was, but also by how valuable it is and how wonderful it is for the health of the community that an organization might serve.”

In other words, risk management is not just about eliminating risks; it is about seeing the opportunities in taking well-planned and insured risks.

“It’s a matter of really thinking about the community needs and making sure that we are willing to take risks and cooperate with our insurance companies to make sure we have the freedom to do that. I’ve been fortunate to work in risk for three organizations, all of which have been self-insured and have taken that approach.

“They have all asked what they can do to manage risk so that they can can invest in innovative healthcare and the innovative treatments and opportunities that come along.”

A strong grounding

When Venditti entered healthcare risk management she already had a strong clinical background, with 27 years of experience in nursing. During the 12 years that preceded her transition to risk she worked as staff nurse and frontline manager in an ambulatory surgical center. That specialty was growing in leaps and bounds in the 1980s and 1990s, with a strong focus on safety, efficiency and effectiveness.

“Quality outcomes and patient satisfaction were crucial, but so was the importance of attracting surgeons and patients. When I moved into risk management, the emphasis was on pretty much the same factors. It was a natural fit for me.”

"I learned early on that risk managers have to be team players, developing strong relationships with others throughout the organization in order to successfully reduce or manage risk.”

Venditti’s subsequent risk management career has included stints as director of corporate risk management for Cape Cod Healthcare, director of risk management for Saint Vincent Hospital and senior director (as well as one time staff risk manager) for UMASS Memorial Healthcare. She has also been a volunteer member of the ASHRM board. Most recently, Venditti has stepped into consultancy.

“Last year, after 45 years of working exclusively in hospitals or healthcare systems, I realized it was time for a change. It has reenergized me,” she says.

Systems thinking

Venditti’s mission as a consultant remains to foster implementation of risk management and patient safety strategies that will prevent harm to patients, faculty, staff, and entire organizations. She is especially passionate about human factors principles, an approach that emphasizes a scientific understanding of the factors affecting interactions between humans and other elements of a system, and the use of that understanding to drive better system performance.

“Early on in my risk management career, I heard Dr Lucien Leape, a pioneer in the patient safety movement, speak at a risk management conference. I’ve never forgotten his words and the main point of his presentation, which was that we need to focus on systems in healthcare, applying human factors principles to our work, just as other high risk industries do. Those words became my operating philosophy, my mantra.”

Venditti is skilled in the application of those principles in the healthcare setting and frequently speaks on the subject on a local, national and international level.

Some of her favourite moments in her career relate to being able to influence a team, individual or specific leader—or indeed the whole culture of an organization—to think in terms of human factors principles make them part of that organization’s language.

“It has been my greatest success to hear people tell me I have changed their way of thinking and that they have become systems thinkers. To look at risk from a systems perspective is good for everyone—patients and their families, our healthcare workers, doctors, physicians, nurses and pharmacists as well as the whole organization.”

A team approach

One of the most formative moments in Venditti’s own development as a healthcare risk management leader was learning about the ‘Swiss cheese’ model, as outlined by cognitive psychologist James Reason, an influential leader in systems thinking.

“He uses the Swiss cheese model to show how errors can occur,” she says. “On any given day if you were to line up six slices of Swiss cheese, the holes might not line up—but on occasion they do, and if there are not good systems in place then something can slip through those holes.

“The Swiss cheese model has always been part of my presentations and discussions about safety issues in healthcare. Recently, a healthcare organization leader told me that the Swiss cheese model has permeated the culture of his organization, which made me really proud, but it’s worth remembering that risk managers don’t work alone. I learned early on that risk managers have to be team players, developing strong relationships with others throughout the organization in order to successfully reduce or manage risk.”

Venditti believes that this collaborative, enterprise-wide risk management role has a vital place at the heart of each organization, allowing it to move forward with its eyes open.

“We can’t be paralyzed with fear and avoid all risks. The pitfall can be operating in a void, or hoping to be lucky, rather than striving to identify any potential areas of risk that could exist for a healthcare organization. 

“Having strong risk management, quality management and compliance programs in place, in order to uncover risks across the enterprise, is crucial; we have to be able to rely on these programs.”

She adds that healthcare reform has served to emphasize the importance of risk managers in healthcare. The Affordable Care Act has led to enhanced collaboration between caregivers and hospitals, with care being rendered in different settings, including innovative telemedicine practices. 

“The expanding models of care delivery will present broadened opportunities for risk assessment and management. Risk managers will be focusing on assessing risks across the enterprise in areas of technology, human resources, clinical, and finance. 

“Reimbursement has increasingly been based on quality outcomes and patient satisfaction, areas that have always been of special interest for risk managers.”

ASHRM’s role

Venditti has been involved with the ASHRM team since she stepped from nursing into risk management in 1997, initially joining her local chapter in Massachusetts and then joining ASHRM itself. She sees the society as having a vital role to play in helping risk managers take a positive, proactive and innovative view of risk.

“For me and for most of our members, ASHRM has always meant education and resources, plus networking,” she says. “A risk manager is often a lone practitioner, so ASHRM provides vital support: if you have any questions or need any guidance, ASHRM is always there for its members.”

Besides providing these opportunities through face-to-face meetings and events, ASHRM offers online support and networking through ASHRM Exchange where risk managers can share approaches that have worked, connect with risk managers who have faced similar situations to those they are dealing with and ask other members for help with policies and other challenges.

“The ASHRM Exchange has been a great source of information for me as a member, and it’s a way of networking with my colleagues without having to make a phone call. I would definitely say that education and support I’ve received from my fellow risk managers is the one of the greatest benefits from my ASHRM and state chapter memberships.”

After many years as an ASHRM member, Venditti is well placed to take on the role of president. At the heart of her mission is the need to keep communicating with members and responding to their needs.

“I am so humbled and honored to be elected president of ASHRM. It gives me the opportunity to interact with our members on a new level. It’s a great opportunity to see the wonderful things our members do and really appreciate them.

“I always feel that I am a surrogate for our members when I am sitting on the board acting as president. My main goal is to try to figure out what our members need and implement methods to meet those needs.”

New tools

Venditti adds that she is helped along by an excellent executive team that is committed to making ASHRM members’ working lives easier. The members have told Venditti and her team that what they need is more resources to keep up with changing times, and ASHRM is responding.

Venditti’s term as ASHRM president sees the launch of a patient safety Playbook to add to the society’s existing risk management tools, which include an Enterprise Risk Management (ERM) Playbook and a series of pocket-sized books, called Pearls, giving bite-sized advice on risk management issues. On top of this, ASHRM provides face-to-face risk management education via the annual conference, CPHRM certification, and the recent addition of the annual ASHRM Academy. Webinars and the ASHRM University provide online, any time education.

Also launched this year is a root cause analysis (RCA) toolkit providing ready-to-use tools that can be easily adapted to each risk manager’s organization. These steps forward are all part of ASHRM’s strategic plan.

“I have never before had an opportunity to be so involved in developing a strategic plan and using that strategic plan as a guide,” she says. “Our strategic plan focuses on being the leader in patient safety and ERM and helping our members to achieve their goals and be successful at their work. It also focuses on continuing to grow our membership and having a strong governance model for our organization.”

As she looks to the future, Venditti is aware of the unique position ASHRM occupies in the risk management arena and of its potential to help its members move towards an ERM approach.

“We’re the only professional organization specific to healthcare risk management and our goal is to continue to be the leader in healthcare risk management, supporting our members and everyone in the field whether they are members or not, helping them to become strong enterprise risk managers across their organizations and able to assess and manage risks.” 

ASHRM, Ellen Grady Venditti, US