Risk management structures and operations may differ from health care organization to organization, even within the same community, city, state or region. While there are certain elements common to most risk management programs, specific functions vary according to the complexity of the organizations and interests of the governing body and chief administrative officer. As the responsibilities defined under various risk management program risk management programs differ, so will the role of the clinical engineer in risk management. All risk management programs are based on patient safety and the preservation of assets, and have risk identification and loss prevention as their fundamental components. ASHRM has suggested that there are six functional areas within a comprehensive risk management program:
● Risk identification and risk treatment through loss prevention and reduction ● Claims management ● Risk financing ● Regulatory and accreditation compliance ● Risk management departmental operations ● Bioethics
Risk Identification
Risk identification is the process through which the engineer becomes aware of the potential for a loss exposure. An exposure can include patient injury, loss of an asset, plaintiff verdicts and malpractice payments, loss of reputation, or governmental fines. Methods often implemented to identify potential and actual risk include incident reporting, generic occurrence screening, patient complaints, patient satisfaction surveys, accreditation survey reports, insurance carrier risk assessment reports, and state licensure surveys. Clinical engineering problem reports, unexpected or unacceptable equipment downtime, and MDR reports could also be used to identify potential or actual adverse events. All too often, risk managers are unaware of these engineering databases and do not integrate them into an organization’s loss prevention reports.
Risk Treatment
Risk treatment refers to the options and choices available to handle a specific risk. Risk can be controlled internally through risk avoidance/prevention or risk reduction/minimization. Risk can be controlled financially through risk acceptance/retention or risk transfer. Risk avoidance is used when the risk is considered significant enough to avoid the risk by avoiding the action that would create exposure to it. For example, an organization in a rural setting may not be able to hire adequate staff for a neonatal intensive care unit. Therefore, the organization would only perform well-baby deliveries and transfer all high-risk deliveries. Risk reduction is the most common risk management treatment. For example, an organization without a neonatal intensive care unit may have emergency equipment such as a radiant warmer, an on-call system for staff with basic neonatal resuscitation training, and a transfer agreement with an NICU in case of high-risk deliveries that an organization can not foresee or avoid. Risk acceptance involves assuming the potential losses associated with a given risk, such as precipitous high-risk deliveries, and making plans to cover the potential financial costs of the risk. In order to cover the cost of a high-risk delivery with complications, an organization may decide to pay for insurance with low deductibles (typically a high-cost option as the insurance company essentially pays almost the first dollar on every loss) or assume high deductibles within the insurance program and pay for many of them out-of-pocket.
Risk transfer means recognizing that medical care can not be provided without assuming some risk. Therefore, and organization may insure for possible misadventures, which transfers the risk to the insurer, or assign responsibility to another service provider (e.g., independent clinic or surgicenter), which transfers the risk to the service provider or its insurer. Evaluation and monitoring of the implemented risk-treatment technique selected is essential to determine the effectiveness of the choice. Evaluation of the treatment should be multidisciplinary whenever possible, as other disciplines bring varying insights into the success or failure associated with the chosen techniques. Benchmarks or thresholds should be established prior to the implementation of a technique so that measurement can be made against defined parameters.