Description
Book SynopsisThis volume comprises the very essential elements of The Risk Management Handbook for Health Care Organizations, Fifth Edition , providing a complete and comprehensive overview of risk management in health care, including all the necessary foundations and applications to start a career or enhance current practice.
Table of ContentsExhibits, Figures, Tables, and, Photos ix
The Contributors xiii
Preface xxvii
About the Book xxix
ONE Development of a Risk Management Program 1
Learning Objectives 1
Risk Management Program Development 3
Key Structural Elements of the Risk Management Program 4
Scope of the Risk Management Program 8
The Risk Management Process 13
Evolution of the Risk Management Program 21
Selecting an Appropriate Risk Management Program Structure 22
Assessing Areas of the Organization That Need Risk Management 23
Key Components for Getting Started 26
Writing a Risk Management Program Plan 27
Achieving Program Acceptance 27
TWO The Health Care Risk Management Professional 31
Learning Objectives 31
The Risk Manager’s Job: Functional Areas of Responsibility 33
Health Care Risk Management across a Spectrum of Settings 53
Required Skills for the Successful Health Care Risk Management Professional 76
Risk Management Ethics 77
A Profile of the Health Care Risk Management Professional 78
Education and Professional Recognition Programs 78
THREE Patient Safety and the Risk Management Professional 87
Learning Objectives 87
The Scope of Medical Errors 89
Seeking Solutions: What Are the Causes of Medical Errors? 91
FOUR Health Care Legal Concepts 115
Learning Objectives 115
Legal Issues Common to All Health Care Providers 116
Legal Issues Related to Specific Health Care Providers 134
FIVE Governance of the Health Care Organization 157
Learning Objectives 157
Essential Responsibilities of the Hospital Board 159
Basic Legal Duties of Health Care Trustees 160
Lessons from the Panel on the Nonprofit Sector 162
Federal Sentencing Guidelines for Organizations 165
The Sarbanes-Oxley Act of 2002 167
The Volunteer Protection Act of 1997 169
Risk Management and the Board 170
The Medical Staff, Risk Management, and the Board 175
SIX Early Warning Systems for the Identification of Organizational Risks 181
Learning Objectives 181
Early Identification of Exposure to Loss 182
Food and Drug Administration 206
Institute for Safe Medication Practices, United States
Pharmacopeia, and National Coordinating Council for Medication Error Reporting and Prevention 208
Medical Event Reporting System—Transfusion Medicine 212
Intensive Care Unit Safety Reporting System 212
Pittsburgh Regional Healthcare Initiative 212
Other Voluntary Programs 212
Standardizing a Patient Safety Taxonomy:
The National Quality Forum 213
Protecting Sensitive Information 213
SEVEN the Risk Management Professional and Medication Safety 219
Learning Objectives 219
Latent and Active Failures 220
Systems Thinking 221
Risk Management: A Prioritizing Approach 252
Eight Ethics in Patient Care 261
Learning Objectives 261
Ethical Principles and Moral Obligations 263
Research 263
Institutional Review Boards 266
Patient Self-Determination Act 275
“Do Not Resuscitate”: Withholding or Withdrawing Treatment 277
NINE Documentation and The Medical Record 287
Learning Objectives 287
Documentation 291
Record Retention 310
Release of Records 310
Ownership of Medical Records 311
Medical Record Audits 312
Documentation and Risk Management 313
Emerging Risk Exposures 320
The Risk Management Professional’s Role 321
TEN Statutes, Standards, and Regulations 327
Learning Objectives 327
Patient Care 328
Medicare Modernization Act 331
Medical Staff 332
Life Safety Code 350
Federal Health Insurance Laws and Regulations 354
Tort Reform 357
Policy and Procedure Manuals 359
Case Law 360
ELEVEN Basic Claims Administration 367
Learning Objectives 367
The Claims Environment 368
The Claims Process 369
The Risk Management Professional’s Responsibilities 371
Regulatory Reporting of Claims 378
TWELVE Introduction to Risk Financing 381
Learning Objectives 381
Risk Financing in the Context of the Risk Management Process 384
Risk Retention 384
THIRTEEN Insurance: Basic Principles and Coverages 395
Learning Objectives 395
Definition of Insurance 396
Specific Types of Insurance for the Health Care Industry 408
FOURTEEN Information Technologies and Risk Management 427
Learning Objectives 427
Risk Management Information Needs 430
Risk Management Information Systems 431
Using Information Systems to Generate Reports 432
Integrating Risk Management, Quality Assurance, and Patient Safety 433
Electronic Mail 434
Internet- and Web-Based Technology 435
Personal Health Record 435
Electronic Health Records and Systems 436
Clinical Information Systems and “Smart” Technologies 437
Infrastructure Technology 440
Point-of-Care Technology 442
Telemedicine 442
Appendix 14.1: IT Glossary for Risk Managers 447
FIFTEEN Risk Management Metrics 451
Learning Objectives 451
Benchmarking Defined 453
Claims 456
Measuring Change 459
Developing New Metrics 461
SIXTEEN Acreditation, Licensure, Certification, and Surveying Bodies 467
Learning Objectives 467
The Consumer Era of Health Care 468
What the Health Care Risk Management Professional Needs to Know 469
Mandatory Surveying Bodies 471
Voluntary Surveying Bodies 475
URAC 489
Appendix 16.1: Accreditation and Licensure Organizations, Surveying Bodies, and Government Agencies 501
SEVENTEEN Emergency Management 503
Learning Objectives 503
The Steps of Emergency Management 505
Prevention 506
Planning and Preparation 511
Implementation and Response 525
Recovery 526
Recommended Web Sites 528
EIGHTEEN Occupational Safety, Health, and Environmental Impairment 529
Learning Objectives 529
Administrative Procedure Act 530
Administrative Enforcement 532
Specific Occupational Safety and Health Issues 535
APPENDIX A A RISK MANAGEMENT PROGRAM (EXAMPLE) 543
APPENDIX B REQUEST FOR RECORDS form (EXAMPLE) 549
APPENDIX C A GUIDE TO MEDICAL TERMINOLOGY 551
GLOSSARY 565
INDEX 623
