C430 WGU QUESTIONS AND ANSWER 100% CORRECT

C430 WGU QUESTIONS AND ANSWER 100% CORRECTCommunication reduces consequences •Altruism the belief in or practice of disinterested and selfless concern for the well-being of others •Rationalization • Accountability •Compensation Hospital Acquired Conditions CMS identified conditions that are not present on admission and could be "reasonably preventable", and therefore hospitals are not allowed to receive additional payment for these conditions that do present. focus on loss but don't TQM system focus Variation on the Pareto Principle •85/15 rule - 85% of problem is related to system failure and 15% is the fault of the people involved •Three premises: •Quality is important and can be measured •People are part of the solution not the problem •Change is fundamental and can be managed Developing a Risk Management Plan Analyze/identify -the possible liability (e.g. patient and employee safety, operational, financial) risks related to medication errors in the hospital. -The team interviews key internal stakeholders, develops a sequenced timeline of the event, analyzes quality assessment studies, accreditation surveys, medication error incidents, and error near-miss reports, and reviews related tasks and medication protocols from the emergency room, pharmacy, and physicians. •Severity to the individual and/or organization •Number of people harmed or potentially harmed •Likelihood or frequency of occurrence Examine/determines -the errors that must be addressed by -analyzing the data gathered in the first step. They determine that the operational management from the involved departments must refine processes. Develop/agreed upon plan (e.g. including stakeholder manager(s) insights) to respond to and mitigate communication, dispensing errors, and improve overall work flow. Implement/education After developing the plan and educating the staff, the operational managers implement the plan in the hospital. Monitor/change-move forward: -the results of the implementation to determine effectiveness of the plan. Quality Tools from in the Industry reduce time and waste •Lean Management focuses on reducing waste and eliminating errors in the processes. •Six Sigma focuses on eliminating causes of defects or errors and minimizing variability in process. Risk Management Tools for Identifying Risk •Incident Reporting System to identify events that are not consistent with the routine operation of a hospital or routine care of patients •Occurrence Reporting A policy listing specific adverse events that MUST be reports •Required by some states and insurers •Can increase identification of adverse events to 40-60% •Occurrence Screening System that identifies deviations from normal procedures or expected outcomes •Uses criteria to identify adverse events but does not rely on staff reporting •Increases identification of adverse events to 80-85% Risk and Quality of Care Maximization of the use of limited resources Elimination of duplication Developing new solutions to problems Facilitation of training programs Improvement of budget process •Today, organizations utilize a more integrated approach, recognizing that many risk management errors are breakdowns in process (quality) rather than individual error. Risk Management - protection of assets •Risk Management - the identification of and proactive decisions to minimize the affects of potential loss situations and developing strategies of avoidance and prevention (identification and analysis) •Risk Control - the conscious effort or decision to act, or not act, that reduces the frequency, severity or unpredictability of a potential loss. (risk acceptance, exposure avoidance, loss prevention, segregation, contractual transfer) decision to act/not act •Loss Control - ability to minimize the actual loss (response to the loss, loss reduction) •Loss Management - proactive activities to return the organization to the pre-existing state. another definition states that risk management is a program designed to reduce the incidence of preventable accidents and injuries to minimize the financial loss to the institution should an injury or accident occur.1 risk management aims to accomplish three major functions: • Reducing the organization's risk of a malpractice suit by maintaining or improving the quality of care • Reducing the probability of a claim being filed after a potentially compensable event (PCE) has occurred • Preserving the institution's assets once a claim has been filed •Incident Identification, Reporting and Tracking •State Mandated Incident Reporting •Incident Review and Evaluation •Take action to prevent recurrence of incidents •Internal Documentation •Credentialing and Privileging •Patient Complaint Programs •Risk Management Education 'Red Flag' Areas to Watch •Treatment Conditions •Patient Relations •Practice Management •Conduct of Staff Physicians agree on three ideal attributes for a professional risk manager: the ability to present facts rather than feelings, the ability to be concise in writing about or stating the situation, and the wherewithal to understand the facts and to respond to critical questions nurses identify three common qualities of a good risk manager: a demonstrated willingness to listen, an understanding of the other person's responsibilities and problems, and a team approach to problem solving that involves asking input from others in forming solutions. RISK MANAGEMENT ACTIVITIES An examination of the eight minimal components of a risk management program, as defined by the American Society of Healthcare Risk Management (ASHRM), engenders a fuller understanding of a risk management program: 1. There must be a designated, trained, and experienced risk manager who must obtain at least eight hours of continuing risk management education annually. 2. Risk managers must have access to all necessary credentialing, management, and medical data. 3. Institutions must commit the necessary resources to risk management through a written policy statement that is adopted by the governing body, medical staff, and administration. 4. Facilities must have a system in place for the identification, review, and analysis of unanticipated adverse outcomes. 5. Organizations must have the means to centralize risk management data and to share and integrate data collection and analysis with other clinical and administrative departments. 6. Periodically—at least annually—risk managers must provide the organization's governing body with a report that reviews and evaluates risk management program activity. 7. Risk managers must ensure that medical-staff and new-employee educational programs on minimizing patients' risks and addressing high-risk clinical areas are provided. 8. Risk managers must forward information on individual practitioners, such as malpractice claim history, knowledge of adverse outcomes, and incident reporting data, to the committees that evaluate the competency of medical staff. Burlando opts for the 5i system, a measured application of five descriptors: • Investigate: observe or study by close examination and systematic inquiry • Inform: present in material form • Influence: affect or alter by indirect or intangible means • Interpret: explain or tell the meaning of; present in understandable terms • Integrate: form or blend into a whole; unite with something else Risk Management Process •Identify Risk •Continuous collection of information to search for the various liability risks such as •Property risks •Casualty/liability risks •Employee benefit risks •Perform Risk Analysis •Evaluating past experience and current exposure to limit the impact of risk, keeping in mind that there are different levels of Risk •Severity to the individual and/or organization •Number of people harmed or potentially harmed •Likelihood or frequency of occurrence •Implement Risk Control/Treatment •Most common function of risk management programs •Risk Management programs should categorize potential liability into 4 categories: •Bodily injury •Liability loss •Property loss •Consequential loss •Risk Acceptance •Exposure Avoidance •Loss Prevention •Loss Reduction •Exposure Segregation •Contractual Transfer •Finance Risk •An organization should have financing available to fund losses and implement risk management activities -Self-insurance -Commercial insurance -Budgetary funds set for activities and/or losses Business Model Risks associated with employment. aligned for best outcomes; •Managers must work to improve the environment, for not only patients, but also employees in order to achieve organizational goals. Not only will this effort improve quality, it will reterm-15duce risks related to healthcare delivery. 1. value to customers- patients term-15 2. inputs- human capital/doc/nurses and raw material/syr/inst; employee 3. processes- surgery, treatment plan; create health/value 4. revenue generation- payment for creation of value Employment-input high/effectiveness •Though most states follow the employment-at-will doctrine, many organizations may unknowingly negate their ability to apply this principle through •Employer policies (i.e. progressive disciplinary policy) •Oral assurances (i.e. looks like you have a bright future ahead of you here) •Industry customs (i.e. after so many years in one position, employees are promoted to the next level) •Employer conduct (i.e. allowing some employees more chances to correct errors than others)