Risk Management in University Clinics

Report
Bio & Disclosures
Vogel Bio:
Audiologist, Clinic Director for Hunter CollegeCUNY, and, member of Metropolitan New York
Council of University Clinic Directors in
Communication Sciences and Disorders
(that’s a mouthful for ya!)
Many thanks to my co-authors –
Dr. Sue Wortsman, AuD, CCC-A
Dr. Paul Cascella, PhD, CCC-SLP
Bio & Disclosures
Disclosure I:
I am employed by Hunter College-CUNY and
will receive travel reimbursement for
attending CAPCSD.
I am not paid for, nor do I have a vested
interest in, promoting any product, software,
hardware, or saleable good that may possibly
be discussed during this presentation.
Bio & Disclosures
Disclosure II:
I am not a lawyer, credentialed risk
management professional or university
administrator.
I am a SIMPLE professor employed by the
City University of New York who has an
interest in sharing what I do as clinic director
with this audience.
Bio & Disclosures
Learning Objectives:
Define risk management activities in a
university clinic
Assess risk issues in their own settings
Coordinate a risk management
committee at their clinics
Bio & Disclosures
At the conclusion of this session,
[I’m hoping] you will have some
tools to develop guidelines to
create a viable supervisor-facultystudent RMP appropriate to the
university clinic setting.
Literature & Survey
Basic information – what is risk
management?
Risk
management in
healthcare is the examination
and implementation of
procedures and policies that
will reduce harm to patients
and employees
Literature & Survey
What does the literature say?
 Hospitals
and service industry instruct
their employees about RM
 There is a paucity of research in this
topic
 We
need to train future professionals about
why this is important and not rely on the
medical community to prepare our own
professionals
Literature & Survey
We did a survey
(thank you for participating!)
Our primary goals were:
1. Determine what RM activities are
conducted
2. Recognize any trends across the country
3. Determine if professional experience
relates to RM
4. Additionally, we wanted to assess how
RM is monitored and used as an
educational tool
Literature & Survey
Risk management programs (RMP)
 High
priority in healthcare settings and academic
institutions administrations
 However,
RMP survey of 280 CSD programs showed
need for growth in this area of interest (response
rate of 35%)
Balancing Acts
University CD’s balancing act:
 Administration
 Clinical supervision
 Enforcement
 Mediation
 Parenting
 Patient care
 Research
 Service
 Teaching
Balancing Acts
When performing a balancing act,
RM gets deprioritized!
In your clinic, do you have a Risk
Management Committee?
Answer
Yes
No
Response
11
91
%
11%
89%
Balancing Acts
What are the barriers?
Answer
Response
%
My institution's administration includes our department in
their overall risk management activities
31
34%
Lack of personnel to add this task to their work load
31
34%
The need for a risk management committee is unclear
26
29%
Lack of knowledge about risk management
20
22%
Lack of time
19
21%
A Risk Management Committee has never been
considered
19
21%
Insufficient resources to pay for a risk management
committee and its programs
10
11%
Other
9
10%
Balancing Acts
Who sits on your RM Committee?
Answer
Response
%
Clinic director
10
83%
Clerical staff
6
50%
CSD academic faculty
5
42%
Clinical educator(s)
5
42%
Graduate student(s)
3
25%
Other
3
25%
Business manager
2
17%
Associate dean or other college administrator
1
8%
Undergraduate student(s)
1
8%
Representative from your institution's H & S dept.
1
8%
Assistant clinic director
0
0%
Client(s)
0
0%
RM consultant from outside of college/university
0
0%
Balancing Acts
Risk Management Committee
Hunter College Center
for Communication Disorders
Balancing Acts
Frequency of RM monitoring activities
Question
Once a Once a
semester year
Every
other
year
Never
Document audits
46
29
6
20
Fire drill attendance
32
33
0
36
Equipment audits
29
54
1
17
Policy and procedure manual updates
20
70
8
3
Safety drill attendance
19
27
1
54
In-service program attendance
17
41
2
41
Chemical and Material Safety Data Sheet
(MSDS) reviews
8
31
0
62
Balancing Acts
Has your clinic RMP resulted in any
of the following?
Answer
Response
%
We do not have a risk management program.
52
51%
We had one or more incident(s) for which we were
appropriately prepared.
22
22%
Our legal department and/or administration has
utilized clinic's documentation.
17
17%
We have not seen a positive or negative impact from
having a risk management program.
12
12%
We had one or more incident(s) for which we were
unprepared.
2
2%
Balancing Acts
With a clear understanding of risk
management, CDs can integrate
appropriate aspects of it into their
clinic’s routine protocols.
Affects on clinic
How does RM affect my clinic?
“Risk management refers to strategies that
reduce and minimize the possibility of a
loss.”1
 It’s

1Risk
very clear for healthcare:
e.g., bloodborne pathogens = use gloves
and ePHI = HIPAA compliance tools
But for us there’s more:
Student: safety; FERPA; credentialing
Faculty: safety; credentialing
Staff: safety; training
Accreditation
Management and Medical Liability, American Academy of Family Physicians, AAFP Reprint No. 281, retrieved 3.31.14
from: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint281_Risk.pdf
Affects on clinic
How does RM affect my clinic?
Need –
the who, what, where, when
and why
Commitment of time and resources
Academic benefits
Harm reduction
Teaching tool
Affects on clinic
What incidents have you recorded?
Answer
None; we did not record any risk
management incidents
Response
36
%
Answer
Response
%
8
8%
Asthma and/or respiratory
allergy problems
7
7%
Lockdown, university wide
5
5%
Abuse (e.g., elder, emotional,
physical, sexual)
5
5%
Other
5
5%
4
4%
3
3%
2
2%
Infection control (e.g., not
cleaning materials, reusing
35%
speculae, not using gloves,
etc.)
Client/patient chart documents
(e.g., missing data, misfiled
36
35%
charts, breach of privacy)
Public safety (e.g., falls in clinic,
23
23%
assault, threats, etc.)
Externship contracts issues
(e.g., sending student to site
17
17%
with expired or no contract)
Credentialing documentation
(e.g., expired license,
14
14%
certification, liability insurance)
Privacy (e.g., breach of HIPAA
14
14%
and privacy rules)
Fire safety (e.g., any type of fire
12
12%
incident)
Patient satisfaction (e.g.,
9
9%
unresolved complaint)
Other: Workman’s comp; altered mental status; falls
Food allergies (e.g., reaction to
food exposure)
Chemical (e.g., expiration,
spills, etc.)
Lockdown, in clinic only
Affects on clinic
University clinic RMP
Is it not as important as:
Clinical duties and service?
Teaching?
Research?
Affects on clinic
What drives risk management?
 Charge of the risk management committee
must be a comprehensive one
 University administration looks to avoid
adverse events thus reducing harm and
liabilities
 Financial
 Students
 Clients
 Faculty
 Staff
 Physical plant
Key elements of RMP
Key elements of an RMP include
Awareness
Action
Education
Risk Management
Program
Key elements of RMP
Knowledge of these tools assists
university clinic managers in the
initiation of an RMP in a fairly
effortless, and [somewhat] less
time-consuming manner.
Key elements of RMP
Education
Education about risk management
helps reduce harm to clients, students,
faculty and staff.
Educating students about risk
management philosophy and how it is
conducted adds to the pedagogical
element of clinical education.
Key elements of RMP
Awareness
Individuals walking into clinic know the
risks, measures and how to avoid them.
Awareness of the risks takes place on
multiple levels and interactions:
Environment
Environment to people
People to people
Key elements of RMP
Action
RMP takes charge to secure harm
reduction
Protocols
Drills
Audits
Inspections
Reinforces the commitment by the
university clinic to reducing the risks
Key elements of RMP
What do we wish to impart on our
students, faculty and staff?
The elements creating a unique risk
management program in the university
clinic setting:
Pedagogical aspects of client/patient
care
Measures that reduce risks for clients,
students, staff and faculty who attend
clinic
Environmental monitoring
Key elements of RMP
The other elements that make it
work
Governance
Risk Assessment
Compliance
Key elements of RMP
Governance
 Directive from administration that a task
needs to be performed
 Ensures
that the directive was completed
 Managing
risks of safety and liability to
clients, students, faculty and staff are the
goals
 Governance
will often lend financial support
to the RMP [if they bring it up first!]
Key elements of RMP
Risk Assessment
Examines the gravity and control of
various hazards exposing those entering
the sphere of the university clinic setting:
Clients
Students
Faculty
Staff
Key elements of RMP
Compliance
Mechanism by which Governance and
Risk Assessment are adhered
Individuals appointed as compliance
officers are typically the “turn to” person
and held responsible for ensuring the
various goals of risk management
program have been met
Create a committee
Steps to creating a RM committee
1.
2.
3.
4.
Committee mission
Committee members
Clinical educators
Faculty
Students
Staff
Frequency of meetings
Generating specific goals and
directives
Create a committee
Steps in running the committee:
1.
Elect/Assign committee chair (with every fiber of
your being, resist taking command of this role)
2.
3.
4.
Allow the new leader to define and delineate
the center’s risks
 Classify if the risks are in the purview of the
committee or some higher authority
Allow the new leader to assign responsibilities
to complete tasks
Allow the new leader to design activities which
will ensure compliance
Create a committee
Leadership: Clinic director assumes
these roles:
Advisor: function as an advising
member/participant
Mentor: allow other faculty members or
staff to serve as leader, because:
CD is released from duty
Advocate for professional development
of a peer
Create a committee
CD guides through important issues
(may be overlooked with the less experienced eye):
 Abuse:
elder, emotional, physical, sexual
 Chemical/Environmental
 Documentation and credentials
 Hazardous waste
 Infection control
 Privacy
 Proper identification
 Supervision
 Training
 Transferring patients
Important issues
Review issues from these perspectives:
Environment
Patient care
Pedagogy
Important issues
What areas of RM does committee consider?
Compliance to Privacy Policy
11
92%
Client/patient documentation (e.g., charts, notes, raw data, etc.)
10
83%
Fire safety plans
10
83%
Patient privacy (HIPAA)
10
83%
Public safety plan (emergency preparedness)
Credentialing documentation (e.g., license, certification, liability insurance,
etc.)
Infection control protocols
10
83%
9
75%
9
75%
Chemicals (e.g., cleaning solutions)
7
58%
Equipment calibration
7
58%
Patient satisfaction
7
58%
Abuse issues (e.g., elder, emotional, physical, sexual)
6
50%
Externship contracts
Transfer for patients (e.g., walker to stationary chair, wheelchair to
washroom, etc.)
Asthma and respiratory allergies
6
50%
5
42%
4
33%
Food allergies
3
25%
Other
0
0%
Important issues
Identifying risk areas is critical:
 Privacy
and security
 Infection control
 Safety
 Allergens
Important issues
Assessing Risk in 5 Steps2
Step 1: Identify the hazards (what can go wrong?)
Step 2: Decide who might be harmed and how (what
can go wrong? who is exposed to the hazard?)
Step 3: Evaluate the risks (how bad? how often?) and
decide on the precautions (is there a need for
further action?)
Step 4: Record your findings, proposed action and
identify who will lead on what action. Record
the date of implementation.
Step 5: Review your assessment and update if
necessary
2Health
Risk Assessment Made Easy, National Patient Safety Agency (NSPA), 2007, London, UK
(http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59825)
Important issues
What metric surveys are conducted?
Answer
Response
%
Credentialing review (e.g., valid insurance, license renewal, etc.
9
75%
Chart audits
8
67%
Patient satisfaction survey
8
67%
Equipment calibration (e.g., biologic monitoring, electro-acoustic
calibrations, etc.)
8
67%
Monitoring of cleaning (e.g., toys, ear probes, counter tops, etc.)
8
67%
Externship contract validity
7
58%
Fire drills (frequency and attendance)
6
50%
3
25%
2
17%
1
8%
Chemical expiration date monitors (e.g., ultrasonic cleaning solutions,
ear mold materials, etc.)
Other
Safety drills (frequency and attendance)
Majority of these tasks are done by different personnel in our department and not
conducted as a part of a formal Risk Management Committee; None of the above are
completed by myself as coordinator of clinical services, not as part of the risk
management team.
Important issues
About EHR
Answer
Response
%
We do not maintain electronic health records at this time
and have no plans to move towards electronic health
records within the next 12 months.
51
50%
We do not maintain electronic health records at this time
but we do plan to move towards electronic health records
within the next 12 months.
35
34%
We currently maintain electronic health records.
16
16%
EHR and documentation
Answer
Response
%
Documentation and privacy risks remain unaffected.
9
56%
Documentation risks have decreased.
4
25%
Additional privacy and documentation risks have
resulted.
3
19%
Important issues
Environmental
issues
Chemical
Fire safety
Public safety
Structural
Important issues
Environment issues
Write down RM tasks important to environmental
issues
Chemical
Fire Safety
Public Safety
Carbon Monoxide
Exit signs
Locking doors
Cleaning solutions
Fire extinguishers
Adequate exits
Allergens
Fire drills
Signs to contact
security
MSDS sheets
Flammable
materials
Safety drills
Gloves
Fire hazards - closets Toys as weapons
Insect/rodent
droppings
Fire hazards –
hoarding
IT security
Important issues
Patient/Client care issues
Write down RM tasks important to client
issues
Patient Care
Patient Care
Abuse
Privacy
Documentation
Transferring patients
Food allergies
Falls
Asthma triggers
Safe use of wheel
chairs and walkers
Infection control
Important issues
Student issues
 Abuse
 Documentation
 Food
allergies and
asthma triggers
 Infection control
 Privacy
 Safe
use of wheel chair
and walkers
 Transferring patients
 Falls
All of the above, and,
• Clinical knowledge and skill
• Credentialing (e.g., liability insurance)
Important issues
Supervision issues
 Abuse
 Documentation
 Food
allergies and
asthma triggers
 Infection control
 Privacy
 Falls
 Safe
use of wheel
chair and walkers
 Transferring patients
 Clinical knowledge
and skill
 Credentialing (e.g.,
liability insurance)
Same as students and:
• FERPA
Pedagogy
Pedagogy
Not
necessarily a risk (but just in case,
you can get rider on your liability
insurance)
Student involvement is a critical
component of this program as it enables
them to learn about issues often left to
learn at externship or real-world
experiences
Pedagogy
RM as teaching tool
Answer
Response
%
Risk management is embedded in at least one course in our
63
62%
curriculum.
We discuss risk management subjects during student meetings
38
38%
outside regular classes.
We require students to attend risk management program
35
35%
activities.
Risk management is not embedded in any form in our
19
19%
curriculum.
Other
8
8%
Students have the option to attend risk management program
2
2%
activities.
Orientation are required and include risk management information; Students
sign confidentiality agreements that incorporate HIPAA regulations; Only
HIPAA - BBP training; risk management issues are addressed in student
orientation and student meetings; on--line training; HIPAA in-service training is
conducted yearly at student orientation
Pedagogy
How do you confirm your students’
knowledge of RM issues?
Answer
Response
%
Students' knowledge is confirmed via assessment tool.
52
51%
Students’ knowledge is not confirmed via assessment tool.
40
40%
Students perform self-evaluation of risk management
knowledge.
7
7%
Other
6
6%
There are multiple assessment tools; Assessment is done via multiple class
exams and vis web-based certificate course; Certificates given for above;
Some items confirmed via assessment
RMP activities
Risk Management Program Activities
Document risk management activities thus
ensuring the mission of the committee is
accomplished
Activities are:
 Active
 Passive
 Combined
Doing so crosschecks for compliance
RMP activities
Active Activities
Risk Management Day
Audits
Drills
Inspections
RMP activities
Educational activities in your RMP:
Answer
Response
%
Fire drills
Signage
In-service programs
Safety/evacuation drills
Web-page information
We offer no activities
Educational brochures
Other
Approved Continuing Education (CE) events
Risk Management Day (i.e., a designated time of activities
dedicated to risk management awareness)
50
46
40
35
31
20
16
10
9
50%
46%
40%
35%
31%
20%
16%
10%
9%
8
8%
Computer based learning modules; Department Clinical Staff, Faculty and Practicum
Students take web-based HIPAA certificate course; Safety manual on Blackboard for
Students; HIPAA training provided by the UH General Counsel Office; E-mail updates;
Orientation sessions; Formal course on Moodle that University administers; Addressed in
professional issues courses
RMP activities
Passive Activities
Educational brochures
Signs
Webpage updates
Tools to help
Tools to help you
National Institutes of Health (NIH)
 Listserve: https://list.nih.gov/


OCR-Privacy listserve
Lots of other information
Department of Health and Human Services
 Security Risk Assessment Tool



NIH: Patient Safety and Quality


Download iPad App (search for HSS SRA)
Windows tool: www.healthit.gov/providersprofessionals/security-risk-assessment
http://www.ncbi.nlm.nih.gov/books/NBK2651/
NHS – National Health Service (UK)

http://www.nrls.npsa.nhs.uk/resources/?EntryId45=5982
5
What can go wrong, will
What can go wrong, will!
What can go wrong, will
What can go wrong, will
What can go wrong, will!
What can go wrong, will
What can go wrong, will
What can go wrong, will
Conclusion
Conclusion
A clinic director is responsible for so many
areas of her or his facility’s function, inclusive
of safety and risk.
Managing risk through committee will
inevitably ease the director’s various work
tasks, improve quality of care for clients,
reduce financial and safety risks, while
teaching students management, organization
and clinical skills not often discussed in the
classroom.
Risk Management Resources:

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