Working together

Communication and openness are watchwords in healthcare risk management. Cynthia DeBord, co-president of the Indiana Society for Healthcare Risk Management, explains to HRMR how these qualities can be promoted by risk management societies.

A s co-president of the Indiana Society for Healthcare Risk Management (ISHRM), Cynthia DeBord is keenly aware of the role that risk management societies can play in promoting communication and openness between their members. These qualities are crucial to the direction healthcare risk management is taking today, but can still be difficult to achieve in a role that is traditionally discreet about disclosing the details of adverse events.

“One of the things we have to do as risk managers is to find ways to communicate with each other, even if we represent competing agencies, healthcare providers or risk management societies,” says DeBord, who works as director of risk management, ambulatory surgery centers and care, Indiana University Health.

“We have to be much more open with each other about what we know, and we have to be more open about the things that we’ve experienced, whether it’s on a litigation side, or the clinical side. If we’ve had an event and found something that works, we’ve got to share it. We need to be able to talk to each other without having fear of upsetting the apple cart.”

DeBord believes that a risk management society such as ISHRM can create a relaxed, friendly environment in which risk managers can discuss the challenges they are facing and the lessons they have learned, improving everybody’s practice as a result.

“It’s essential that we trust each other; that we can share information that allows us to become stronger in not only our defense of litigation but also in protecting patients from harm.”

This move reflects the increased focus on transparency and incident reporting in healthcare, which can be seen in everything from the growth of patient safety organizations (PSOs) to the tendency to be far more open with patients and their families when errors occur.

It all adds up to a seachange in the world of healthcare risk management—and in her time with ISHRM, DeBord has been able to observe this change in action.

“People are definitely becoming more open and feel more at ease in having conversations: the atmosphere of ISHRM seems to have lightened up in the last couple of years,” she says.

“People are having fun, they’re laughing together and that really promotes the trust needed for someone to be able to admit to having a problem and ask how others have dealt with it. They feel it is a safe environment in which to have these conversations.”

A complex task

One of the issues faced by risk managers as they strive to bring about improvements in their organizations is how to comply with the dictates of the Affordable Care Act while also investing a healthy portion of time and effort in creating a safer environment for patient care. 

“Hospital and healthcare provider initiatives are very sensitive to everything that affects reimbursement, but we have to stay strong from a risk management perspective,” DeBord says.

She and ISHRM’s co-president Dorinda Sattler are striving to give ISHRM’s members the tools they need by growing ISHRM’s social media output. The society has three major educational offerings every year but in the quiet times between those, Sattler is working to develop the chapter’s website into an educational resource for risk managers. 

She and DeBord are keeping the output, both online and in its educational sessions, purposefully broad so that anyone whose job relates to healthcare risk management—from attorneys to quality officers and risk managers—can find something of relevance to them.

Looking to the future

High on the American Society for Healthcare Risk Management’s (ASHRM’s) agenda this year is enterprise risk management (ERM), which encourages a system-wide approach to risk management. This is reflected in ISHRM’s educational offerings.

“The ERM approach is important because it emphasises that you have to have the risk people at the table before things happen, rather than bringing us in after something has happened to do a root cause analysis and figure out how to deal with it financially,” says DeBord.

“If risk managers are involved from the start, they can pre-empt a lot of problems—for example by looking at the type of tiles being laid in a hospital doorway to ensure they are slip-proof. I would like to see that type of approach continue to evolve and strengthen.”

Even in smaller, free-standing facilities, DeBord believes the risk manager needs to be at the table during discussions about issues such as medical device selections, the building of a wing or a hospital, or bringing in new technology. 

“Risk managers can help people think through the processes they are considering and make them as safe as possible.”

Championing change

DeBord says risk managers can face resistance when trying to promote a new, forward-thinking view of risk within their organizations, especially as it can be difficult to get people to address risk issues that might happen, as opposed to adverse events that have already happened.

“People have been used to a very reactive approach to healthcare risk. Now we need to get people to see that risk managers can prevent situations by providing help and support in the early phases of change. 

“That is the strongest model of risk management you could possibly build, and it’s a paradigm shift that healthcare folks are really opening up to, but one that also requires that we have more resources devoted to risk, so that we can be both reactive and proactive,” she says. 

“If something has happened in your system, then of course you’ve got to fix that but you’ve also got to have your ear to the ground to hear what else is going on and what other systems are experiencing. Then you can look back at your own system to see if you face the same risks.”

As risk management becomes broader and more forward-thinking, DeBord is certain that societies such as ISHRM can help accelerate the pace of change by nurturing a collaborative, open and educational approach to risk management.

“I’ve had many roles in my career and I finally figured out that being in healthcare risk management is what I was always meant to do,” she says. 

“A lot of healthcare risk managers have a passion for what they do and I’m honoured to be a member of a group that is so good at putting the priorities where they need to be and working together.”