Kaiser Permanente Risk Management Executive Summary Essay Example for Free

Kaiser Permanente Risk way Executive Summary Essay arrangement DescriptionKaiser Permanente (KP) is the nations largest integrated wellness superintend delivery system. KP serves nine states and over nine million members, with an annual operating revenue in 2013 of 53.1 billion. KP is a attraction in tint forward motion efforts in the health awe industry through participation in studies performed by the National committee on Quality Assurance (NCQA), The Joint Commission (TJC) accreditations, and the implementation of a state of the art electronic health records system, which focuses on integration and look of bring off standardization. The focus of this summary is on KP hospitals in the northern California region and ordain complicate topics such as the purpose of gamble and tint focus, happen identification and attention, current bumps, prime(prenominal) exits, systemal goals, and the relationship between take a chance and note counselling. Risk and Qua lity Management PurposeGeneralThe purpose of risk management in health allot is simply the process of protecting the assets and minimizing financial losses to the organization (Singh Habeeb Ghatala, 2012). A comprehensive risk management scheme within a health care organization will include focus on continuous quality overture (CQI). The purpose of CQI in health care, according to Sollecito and Johnson (2013), is to offer a structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations (p. 4). Through linking the processes of risk management and quality improvement the success of both processes is much seeming to be realized. Kaiser PermanenteThe key concepts for risk and quality management at KP are commitment to quality, patient of safety, privacy protection, and fraud prevention. KP risk management and quality management programs are central to their mi ssion, values, and culture. Methods currently apply to support these conceptswithin KP are consumer surveys, the use of an integrated EHR with evidence based guidelines and clinical decision-making functionality, stringent patient privacy regulations and processes, continuous clinical and administrative staff training programs, and participation in studies focused on standardizing national quality measures (Kaiser Permanente, 2012). Risk Identification and ManagementStepsWhile KP is a leader in health care risk and quality management there are specific steps this consultant is recommending on a continual tooshie that will improve risk identification and management within the organization. 1. Identify and analyze loss and exposureWhile there are many methods utilized within the health care industry in the identification and analysis of loss and exposure, the recommended methods for KP are as follows a) Incident-reporting analysisb) Improvement on the current feat management proce ss for employees to hire focus on risk mitigation and quality improvement. c) Quantitative analysis of patient complaints and satisfaction surveys. d) Review of the organizations past superior liability and workers compensation reports. e) Review of surveys completed by TJC and NCQA on other hospitals in order to identify risk areas that KP should focus on. (McCaffrey Hagg-Rickert, 2009)2. Research and propose ersatz risk techniquesTo mitigate risks that are unavoidable at KP, a combination of alternative risk techniques will help reduce situations that might negatively hazard the organization. A financial analysis and risk analysis should be performed in order to ascertain the likelihood of utilizing the exposure avoidance technique. This is not a likely option as the financial impact of eliminating serve may out weigh the risks involved with continuing them. A loss reduction approach is more likely to be the technique chosen for this organization. The core prevention activit ies that must be present in the loss reduction technique are as follows a.) Ongoing staff educationb.) Current policy and procedure review and revisionc.) Updates to the organizations current EHR system to mark off the data present in the clinical decision-making and evidence-based clinical guidelines technology is the to the highest degree current data available. According to Chen, et al (2009), a growing body of literature confirms the value of electronic health records (EHRs) in improving patient safety, improving coordination of care, enhancing documentation, and facilitating clinical decision making and adherence to evidence-based clinical guidelines (p. 323). 3. Risk management technique selectionThis two-part process of risk management technique selection is accomplished through forecasting and application of an ongoing measurement process, which will allow KP to analyze the risk management technique with estimation to outcome and cost effectiveness. Included in the measur ement process both risk sermon and risk-financing techniques should be measured (McCaffrey Hagg-Rickert 2009). 4. Implement the selected techniquesImplementation of the chosen risk management techniques may include decisions on insurance coverage and policy changes, overall department workflow changes to ensure compliance with state and federally mandated regulations and guidelines, and voiding of processes that impede or hinder patient safety. 5. Monitor and improve upon the implemented risk management program In order to continue improving upon the freshly implemented risk management program a comprehensive monitoring strategy should be employed. In fact, McCaffrey and Hagg-Rickert, (2009) stated, a multidisciplinary approach to evaluating the risk management program ensures that the impact of additional opportunities to improve the risk management function are fully explored (p. 21). a.) Prepare an annual risk management reportb.) Compare the hot annual report against prior years risk management data (McCaffrey Hagg-Rickert 2009)Current RisksThree risks that KP should take special care to avoid are rejection of fresh implemented risk management and CQI procedures by employees, statute(predicate) and regulative changes, and health care associated infections (HAIs). 1. RejectionChange implementation is never an easy task and without special care taken the rate of rejection to change by clinical and administrative employees is high. In order to achieve successful CQI changes the following guidelines and recommendations are presented. a.) Minimize employee rejection through substantially implemented and followed CQI procedures. b.) Engage employees in planning to increase acceptance.c.) Ensure lateral linkages within the organization across specialty departments to improve communication (Sollecito and Johnson, 2013). 2. Statute and regulatory changesWith the ever-changing landscape in state and federal statutes and regulations surrounding the health ca re industry, special attention to this risk area must be taken. In fact, Cohen (2009) stated that health care is i of the most heavily regulated of all sectors of commerce (p. 328). Failure to comply with state and federal statutes and regulations can bring about negative financial affects at KP, including but not limited to fines, loss of accreditation and credentialing, and an increase in malpractice lawsuits, not to mention a decrease in quality of care. a.) Risk management and quality improvement policemans stay current and involved in statute and regulation changes. b.) Mandate educational goals for risk management and quality management officers with regard to state and federal regulations. c.) Implement a monthly employee newsletter within which the risk management officer and quality improvement officer outline regulation changes. Include processes that employees should expect to see implemented to maintain compliance. Include a signature page with those editions that inclu de changes to policy and ensure all employees sign and return to the human resources department. d.) Ongoing training for clinical and administrative employees with regards to statute and regulation. The risk management and quality improvement officers will be responsible to work with the organizations education department to implement new workshops as needed. e.) Include these responsibilities in the performance monitoring strategy for the risk management and quality improvement officers. 3. HAIswellness care associated infections are a serious risk in hospitals, as noted by Sydnor and Perl (2011), in their statement HAIs are the most common complication seen in hospitalized patients (para. 20). Improper prevention can lead to increased costs, lengthier hospital stays, and even patient death. Additionally, a Condition of Participation (CoP) (42 CFR 482.42) by CMS mandates hospital infection control programs to adhere to specific requirements. Recommendations are as follows. a.) Imp lement a house-keeping checklist to ensure proper sanitization of patient rooms. b.) Implement a sanitization checklist for clinical staff that will enforce hand washing before and after patient contact. c.) Develop a committee to review and decree the KP infection prevention and control program. Revisions should focus on compliance with TJC and the Center for Disease Control (CDC) regulations. Quality OutcomesInternal and out-of-doorThree internal and external factors that influence quality outcomes are organization management of interpersonal relationships between physicians and patients, patient compliance, and continuity of care. Without proper management of interpersonal relationships between physicians and patients, the organization will face degradation in trust and openness. Patients should be involved in all treatment decisions, through proper education on their diagnosis and treatment options. This will bring about patient engagement in this decision making process. Whil e KP cannot force their patients to comply with treatment guidelines, the external influence of patient compliance is crucial to quality outcomes. Programs focused on thorough training and education of patients and family members will improve the rate of compliance, thus improving the probability of validating quality outcomes for patients. Lack of patient compliance will hinder the treatment process and lower the level of quality outcomes standards at KP. Continuity of care is other internal influence that can affect quality outcomes. Regular follow up with patients will also increase patient compliance. Without improving continuity of care, the KP organization will see a reduction in positive quality outcomes and an increased in undesired outcomes (DeHarnais, 2013, chp 5). GoalsShort-Term1. Design new regulatory and statute training programs for all clinical and administrative employees. 2. Review and revise the KP infection prevention and control program 3. Revise the performan ce management system to include CQI measurements and risk management procedures as performance metrics.Long-Term1. Increase adherence to state and federal regulations and statutes throughout the KP organization. 2. Reduce HAIs by 10% throughout KP hospitals in the northern California region. 3. Improve CQI measurement and risk management policy adherence throughout the northern California region by 20% among clinical employees. Risk and Quality ManagementRecommendationsRisk management policies1. Quarterly peer reviewThe Health Care Quality Improvement Act (HCQIA) of 1986 encourages hospitals, state licensing boards, and pro societies to identify and discipline physicians, dentists, and other health care providers who, after adequate, nondiscriminatory peer review, were found to have engaged in negligent or unprofessional take over (Cohen, 2013 p. 333). Through ongoing screening of new and current clinicians, KP will take responsibility for offering their patients that highest qual ity of care and reducing the risk of employing negligent clinical employees. 2. Zero tolerance adherence policy for all employees with regard to infection control procedures Part of the CMS CoP (42 CFR 482.42) regulation is the designation of an infection control officer and development of relevant policies that address the identification and control of infections and communicable diseases. Without full compliance with all CoPs, KP could face the loss of their Medicare provider agreement. 3. Vulnerability analysis graph and emergency plan policy.According to Rawson and Hammond (2009) by evaluating vulnerabilities and taking appropriate preventive action, loss can be minimized in an emergency(p. 506). Health care facilities should include prevention measures in their emergency plans that include the risk of terrorist attacks. While terrorist attack risk cannot be completely mitigated, it is the responsibility of the health care expertness to be prepared for such an emergency. Obtain additional information on including risk of terrorist attacks from the National Institute for Occupational Safety and Health (NIOSH). Quality management policies1. Adherence to evidence-based clinical guidelinesWhile it has been shown that clinicians have customarily enjoyed a great deal of autonomy in their practices (Argawal, 2010, para 3), it is imperative that clinicians follow evidence-based clinical guidelines. If exceptions should be made the details of, the patient diagnosis and variations should be presented for peer review prior to altering treatment plans. 2. Minimum score of 88% on customer satisfaction surveysClinicians must maintain an average score of no less than 88% on customer satisfaction surveys quarterly. In todays health care market, measurements of quality include consumer satisfaction. In fact, Bernard and Savitz (2009) state that in todays competitive health care environment, consumers want and expect better health care services and hospital systems are co ncerned about maintaining their overall image (p. 185). Relationship between risk and quality managementIn the past, risk management officers and quality improvement managers worked autonomously from one another, in fact they most often reported to different superiors. However, today healthcare organizations are realizing that in order to reach quality of care goals and maintain effective risk management programs these disciplines must work together closely. An example of how risk management efforts and quality improvement efforts complement one another is seen in the reduction of medical errors. The risk management plan must consider ways to reduce medical errors, while the quality improvement plan will offer solid steps toward minimizing medical errors (Sollecito and Johnson, 2013). ConclusionThis summary focused on topics such as the purpose of risk and quality management, risk identification and management, current risks, quality outcomes, organizational goals, and the relations hip between risk and quality management. While KP is the nations largest integrated health care delivery systems and leader in CQI standardization, there is always room for improvements. This consultant understands the importance of improvement at KP, thus humbly presents this summary and recommendations to the board of directors.ReferencesAgarwal, R. (2010, May). A Guideline for Quality Accreditation in Hospitals. Quality Digest, (), 1-4. Retrieved from http//www.qualitydigest.com/inside/twitter-ed/guideline-quality-accreditation-hospitals.html Chen, C., Garrido, T., Chock, D., Okawa, G., Liang, L. (2009). The Kaiser Permanente electronic health record Transforming and streamlining modalities of care. Health Affairs, 28(2), 323-33. Retrieved from http//search.proquest.com/docview/204522974?accountid=458 Cohen, M. (2009). Statutes, Standards, and Regulations (chp 10) in McCaffrey, J. J., Hagg-Rickert, S. (2009) Risk Management Handbook (5th ed.). San Francisco, CA Jossey-Bass. Des Harnais, S. I. (2013). The outcome model of quality (chp 5) in Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluznys Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers. Emily R. M. Sydnor, Trish M. Perl (2011, January). Clin Microbiol, 24(1) 141173. Retrieved from http//www.ncbi.nlm.nih.gov/pmc/articles/PMC3021207/ Kaiser Permanente. (2014). Kaiser Permanente, Retrieved from http//share.kaiserpermanente.org/article/history-of-kaiser-permanente/ McCaffrey, J. J., Hagg-Rickert, S. (2009, Chp 1) Developing of a Risk Management Program in Risk Management Handbook (5th ed.). San Francisco, CA Jossey-Bass. Rawson, M. L. and Hammond, H. Y,. (2009) Emergency Management in McCaffrey, J. J., Hagg-Rickert, S. (2009, Chp 7) Developing of a Risk Management Program in Risk Management Handbook (5th ed.). San Francisco, CA Jossey-Bass. Singh, B., Habeeb Ghatala, M. (2012, August). Risk Management in Hospitals. International Journal of Innovation, Management andTechnology, 3(4). Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluznys Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers.