Risk Management Forever: Because Everything Old Is New Again

A navy blazer with gold buttons, a brilliant white shirt, and tan trousers that break perfectly over shoes shined to a high gloss—is this a piece about fashion or about risk management? From the screen idols of Hollywood’s Golden Age to the models of today’s glossiest publications, everything old is new again. And so it is with managing risk and preventing loss in healthcare. Healthcare risk management operates in environments buffeted by ongoing uncertainty, dynamic change, escalating demand, and consumerism. We meet these forces with knowledge, tools, and behaviors—fundamentals of risk management—that enable us to help our organizations learn, adapt, survive, and thrive.

The Triple Aim set goals for us of increased access to care and improved outcomes for patients with corresponding cost savings because we were doing things correctly the first time (efficiency) and providing appropriate care in the appropriate setting (effectiveness). The evolution from fee-for-service to value-based care and payment underscored these goals and increased the pressure to perform on practitioners and organizations. The effects of this pressure became evident in the increasing numbers of practitioners and staff reporting that they were experiencing burnout. In its most serious manifestation, burnout has driven gifted practitioners and staff out of healthcare, achieving exactly the opposite result the Triple Aim hoped for. In response to this unintended consequence, the Quadruple Aim has been adopted, adding the goal of improving the work life of healthcare providers, including clinicians and staff.

The risk manager walks the narrow path of protecting patients and families, practitioners and staff, and the organization.

The nuts and bolts of risk management revolve around assessment and planning and address the work environment, the people, and the myriad details that demand the risk manager’s attention. How does the work flow? How does information flow? Precision, accuracy and timeliness in receiving, recording and transmitting information—whether on paper or electronically—help to ensure that very little, if anything, falls through the cracks when coordinating patient care. These same qualities of precision, accuracy, and timeliness are crucial in managing patient expectations. The mismatch between expectations and actuality is a key factor contributing to patient dissatisfaction and consequent contemplation of legal action.

The risk manager walks the narrow path of protecting patients and families, practitioners and staff, and the organization. The risk manager’s strategic responses to risk issues most often are responses grounded in relationships of trust and confidence. Particularly in relationship to physicians, this means giving our best risk advice without telling the physician how to practice medicine! The trust and confidence come from patients’, families’, staff’s, and practitioners’ experience of the risk manager:

• Flexibility: Having a varied response repertoire and being able to imagine or understand other people’s points of view are key.

• Expertise: A solid base of knowledge and experience to draw on makes flexibility possible.

• Organizational savvy: Knowing the go-to person, and being able to leverage that knowledge to resolve an issue, is an asset.

• Persistence: Being persistent—courteous, but informed and firm—helps to overcome resistance. Above all, being open, reasonable, and available contributes to an environment that promotes learning and collaboration.

Patients, families, staff, practitioners, and organizational leaders come to understand that the risk manager is committed to always doing the right thing at the right time for the right reason.

A risk manager’s experience and expertise, skill at relationship-building, effectiveness in communication, and keen awareness of the environment come together in a simple approach to evaluating and mitigating risk. The risk manager asks these questions:

• What am I looking at?

• What does it mean?

• What do I have to do about it, if anything?

• Who do I have to get to help?

• How do I have to account for it?

So we circle back to our insight and experience that everything old is new again. This is how we survive and thrive: by recognizing the classics that never go out of style and that undergird and support risk management efforts. Observe acutely and intently. Listen exquisitely. Communicate clearly, consistently, comprehensibly, and constantly. Document clearly, consistently, and comprehensively. Follow up and follow through rigorously and consistently. Persist in the face of inertia, resistance, and denial. Keep a sense of humor and sense of proportion. We all are our greatest assets and our greatest liabilities—it’s called being human. And speaking of humanity, always remember the value and meaning of personal contact with patients and families, staff, clinicians, and all members of the healthcare team. As technology affects how we communicate and interact, our ability to establish and nurture relationships will be our most powerful risk management strategy.

Suggested Readings

Hubbell P. Everything old is new again. The Huffington Post. www.huffingtonpost.com/peter-hubbell/everything-old-is-new-again_b_6646524.html . Accessed December 22, 2016.

Lambert CA. The business case for creating the extraordinary patient experience. November 6, 2014. https://www.capphysicians.com/business-case-for-creating-extraordinary-patient-experience .

Lambert CA, Miller C. The successful physician: transition of care. March 14, 2018. https://www.capphysicians.com/The-Successful-Physician-Transition-of-Care .

Lopez M. What makes a great risk manager: Q&A with Michael Lopez of Booz Allen Hamilton. www.riskmanagementmonitor.com/qa-with-michael-lopez-of-booz-allen-hamilton/ . Accessed September 2, 2016.

Minovitz R, Lambert CA. Risk Management Forever—Because Everything Old is New Again. Association of Dermatology Administrators and Managers Annual Meeting, San Diego, CA, February 2018.

Lopez M, Slepitza M. The Art of Risk Management: Characteristics of Successful Risk Managers. Booz Allen Hamilton, September 2011.

Care Transition Bundle: Seven Essential Intervention Categories. 2/7/2011. White Paper. www.ntocc.org/Portals/0/PDF/Compendium/SevenEssentialElements_NTOCC%20logo.pdf.

Roles and Responsibilities in Risk Management. Marquette University. www.marquette.edu/riskunit/riskmanagement/roles.shtml . Accessed September 2, 2016.

Impact of High Turnover in Healthcare on Quality of Care and Patient Satisfaction. Pegged Software. www.arena.io/papers/Arena%20Impact%20of%20Turnover%20on%20Quality%20of%20Care.pdf.

The Purpose of Risk Management in Healthcare. University of Scranton. http://elearning.scranton.edu/resource/business-leadership/purpose-of-risk-management-in-healthcare . Accessed September 2, 2016.

Webster JS, King HB, Toomey LM, et al. In Henriksen K, Battles JB, Keyes MA, et al., eds. Understanding Quality and Safety Problems in the Ambulatory Environment: Seeking Improvement with Promising Tools and Strategies. Rockville (MD): Agency for Healthcare Research and Quality (US); August 2008. www.ncbi.nlm.nih.gov/books/NBK43683/ .

What Makes a Great Risk Manager? The Active Risk Blog, SWORD Active Risk. www.sword-activerisk.com/what-makes-a-great-risk-manager-3/ . Accessed September 2, 2016.

Zenger J, Folkman J. What great listeners actually do. Harvard Business Review. https://hbr.org/2016/07/what-great-listeners-actually-do July 14, 2016.