Kaiser Permanente Risk Management Executive Summary Essay

Organization DescriptionKaiser Permanente (KP) is the nations largest integrated health make do delivery system. KP serves baseb every last(predicate) club farmings and over nine million members, with an annual operating revenue in 2013 of 53.1 billion. KP is a leader in calibre emolument efforts in the health c ar industry through participation in studies performed by the National Committee on Quality Assurance (NCQA), The Joint Commission (TJC) accreditations, and the implementation of a secernate of the art electronic health figures system, which counsellinges on integration and type of assistance standardization. The focus of this succinct is on KP hospitals in the northern California region and leave alone include topics such as the purpose of pretend and prime(prenominal) management, hazard identification and management, current take a chances, quality outcomes, organizational goals, and the relationship amidst riskiness and quality management. Risk and Quali ty Management PurposeGeneralThe purpose of risk management in health vex is simply the do by of protecting the assets and minimizing pecuniary terminationes to the organization (Singh & Habeeb Ghatala, 2012). A comprehensive risk management scheme deep down a health care organization will include focus on continuous quality improvement (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 more likely to be realized. Kaiser PermanenteThe key concepts for risk and quality management at KP are commitment to quality, longanimous safety, privacy protection, and pseud cake. KP risk management and quality management programs are central to thei r mission, values, and culture. Methods currently utilized to support these conceptswithin KP are consumer surveys, the use of an integrated EHR with evidence lay down guidelines and clinical decision- make 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 basis that will improve risk identification and management within the organization. 1. Identify and decompose hurt and exposureWhile there are many methods utilized within the health care industry in the identification and analysis of discharge and exposure, the recommended methods for KP are as follows a) Incident-reporting analysisb) Improvement on the current perfor mance management process for employees to bring focus on risk mitigation and quality improvement. c) Quantitative analysis of patient complaints and satisfaction surveys. d) Review of the organizations past professional liability and workers compensation reports. e) Review of surveys completed by TJC and NCQA on other hospitals in beau monde to identify risk areas that KP should focus on. (McCaffrey & Hagg-Rickert, 2009)2. Research and propose choice risk techniquesTo mitigate risks that are unavoidable at KP, a combination of alternative risk techniques will help reduce situations that might negatively affect the organization. A financial analysis and risk analysis should be performed in order of battle to ascertain the likelihood of utilizing the exposure avoidance technique. This is not a likely option as the financial impact of eliminating services may out urge the risks obscure with continuing them. A loss reduction approach is more likely to be the technique chosen for thi s organization. The core prevention activities that moldiness be present in the loss reduction technique are as follows a.) Ongoing staff preparationb.) authentic policy and procedure examine and alterationc.) Updates to the organizations current EHR system to ensure the data present in the clinical decision-making and evidence-based clinical guidelines technology is the most 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 alliance 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 mensuration process, which will allow KP to analyze the risk management technique with regard to outcome and cost eff ectiveness. intromitd in the measurement process both risk treatment and risk-financing techniques should be measured (McCaffrey & Hagg-Rickert 2009). 4. mechanism the selected techniquesImplementation of the chosen risk management techniques may include decisions on insurance coverage and policy changes, boilersuit department workflow changes to ensure conformity with state and federally mandated regulations and guidelines, and elimination 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 newly 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 new annual report against anterior years risk management data (McCaffrey & Hagg-Rickert 2009)Current RisksThree risks that KP should take special care to avoid are rejection of newly implemented risk management and CQI procedures by employees, statute andregulatory 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 easily 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 regulation s surrounding the health care industry, special attention to this risk area must be taken. In fact, Cohen (2009) stated that health care is one 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 officers 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 periodical 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 fight back compliance. Include a signature pa ge with those editions that include 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. HAIsHealth 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 change magnitude costs, lengthier hospital stays, and even patient death. Additionally, a Condition of Participation (CoP) (42 CFR 482.42) by CMS mandates hospital infection falsify programs to adhere to specific requirements. Recommendations are as follows. a.) Implement a house-keeping checklist to ensure proper sanitization of patient rooms. b.) Implement a sanitization checklist for clinical staff that will enforce hand washing beforehand and after patient contact. c.) Develop a committee to review and revise 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 externalThree 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 engageme nt in this decision making process. While 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 positive 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 another 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 increase 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 co ntrol program 3. Revise the performance 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 professional 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 conduct (Cohen, 2013 p. 333). Through ongoing screening of new and current clinicians, KP will take right for offerin g their patients that highest quality 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 chart 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 polish ups. While terrorist attack risk cannot be completely mitigated, it is the responsibility of the health care facility to be pre pared 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 cut through 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 concerned 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 distinguishable 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 in concert 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, qualit y outcomes, organizational goals, and the relationship 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 wideness 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 Ha ndbook (5th ed.). San Francisco, CA Jossey-Bass. DesHarnais, 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 Manag ement 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.