Business and Marketing: How to do it... Risk management

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Long-term care is a "risky business" and a little unmanaged risk can cost your facility a lot of money. Risk is the possibility, the potential, that something negative or otherwise undesirable will happen to a resident or facility. Risk is actualized when resident care events or circumstances result in negative outcomes that were either preventable or unavoidable but caused a deterioration in the relationship between the resident/family and the facility, or the facility was unable to successfully demonstrate clinical unavoidability to a surveyor. Actualized risk can result in costly survey deficiencies.

Apparent validation of facility's responsibility for a negative resident outcome by the surveying agency can spur that family to initiate an insurance claim. Plaintiff's counsel will then attempt to use a facility's survey history to establish an alleged pattern of deficient practice as substantiation of the claim. And, your liability insurance carrier may also be using the facility's survey results in establishing your premiums. So here are some tips on how you can position yourself better when it comes to risk management:

1. Adopt the risk management mantra "What If?" The risk of risk being actualized is far greater in facility's whose staff routinely use the "a"word and the "n" word. If you, key department heads or supervisory staff have the words "always" and "never" in their vocabulary, be afraid. Remember, "Always doesn't last forever" ... "Never comes sooner than you think" ... and "what if" will happen!

2. The degree of family dissatisfaction with and lack of trust in the facility is the factor that prompts the hotline call or liability claim, not the severity of the negative resident outcome.

3. Risk management defined ... in English: Strategies that can optimize the quality of resident care and safety. Optimal quality and safety minimizes the potential for negative resident outcomes. Preventing or minimizing negative resident outcomes improves survey results and reduces the likelihood of liability claims. You can't practice good risk management if you don't understand the concept.

4. Risk prevention involves avoiding negative outcomes through the development and implementation of the following: "best practices" policies, procedures and protocols that are based upon current professional practice standards and regulatory requirements; comprehensive, resident-specific risk assessment using tools adequate to accurately and sufficiently identify levels of risk and associated factors; comprehensive care planning; and consistent implementation of care plan interventions by informed and competent staff.

5. Risk control requires prompt identification of and intervention in resident care events that could expose the facility to the risk of survey deficiencies or insurance claims. Implement early detection warning systems such as daily review of units' 24-hour reports, daily review and follow-up of all resident incidents, prompt attention to all potential/actual change in resident condition and immediate communication and resolution of resident/family concerns. Intervene to minimize the extent of negative outcome through timely physician notification, reassessment of clinical risk factors, modification of care plan interventions and observation of staff performance.

6. Damage control strategies are essential. Investigate the facts and circumstances surround the negative outcome. How and why did it occur? Preserve and secure any evidence. Review all related documentation immediately to ensure that entries are present, factual, and do not assume or assign blame. Tell the family the facts, what is being done to and for the resident. Report to the surveying agency as/if required. Insufficient information that leaves a reviewer with unanswered questions will likely trigger a surveyor visit. Implement any required corrective actions before a surveyor inspection and before the negative outcome can repeat itself.

7. Assign a liaison or contact person for the family or surveyor to maximize accessibility and minimize misinformation. Extend acts of kindness and consideration toward the family to assist them in coping with the change in resident condition. Make a comfortable space available for extended visitation or arrange for transportation to the hospital.
In this "risky business" it is good risk management practice to line up your defenses before the attack. Evaluate every negative outcome, i.e. falls with injury, pressure ulcer development, significant weight loss, etc., immediately upon occurrence or discovery. Assume and act as if the negative outcome will be eval