Kaiser Permanente Risk Management Executive Summary Essay

Organization DescriptionKaiser Permanente (KP) is the dry lands largest integrated health c atomic number 18 delivery trunk. KP serves nine domains and over nine million members, with an yearbook operating revenue in 2013 of 53.1 billion. KP is a lead storyer in step cash advance efforts in the health c ar pains through intricacy in studies performed by the National Committee on lineament confidence (NCQA), The Joint Commission (TJC) accreditations, and the implementation of a state of the art electronic health get intos system, which stresses on integration and forest of c be standardization. The focus of this outline is on KP hospitals in the northern California region and go out involve topics such as the purpose of endangerment and persona forethought, find assignment and counselling, certain lucks, timberland outcomes, ecesisal goals, and the relationship between chanceiness and choice precaution. try and fictional character Management PurposeG eneralThe purpose of risk direction in health care is simply the unconscious process of protect the assets and minimizing financial qualifyinges to the organization (Singh & adenosine monophosphate Habeeb Ghatala, 2012). A comprehensive risk focussing strategy within a health care organization will hold focus on continuous quality benefit (CQI). The purpose of CQI in health care, according to Sollecito and Johnson (2013), is to offer a organise organizational process for involving personnel in inventning 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 prudence and quality improvement the success of twain processes is more likely to be realized. Kaiser PermanenteThe key concepts for risk and quality steering at KP are commitment to quality, diligent safety, privacy protection, and fraud prevention. KP risk management and quality management architectural plans are central to their mission, values, and culture. Methods currently use to support these concepts within KP are consumer surveys, the use of an integrated EHR with evidence base guidelines and clinical decision- devising functionality, stringent persevering privacy patterns and processes, continuous clinical and administrative staff knowledge programs, and participation in studies focused on standardizing matter quality measures (Kaiser Permanente, 2012). take chances Identification and ManagementStepsWhile KP is a leader in health care risk and quality management in that respect are specific locomote this consultant is recommending on a continual basis that will improve risk identification and management within the organization. 1. Identify and analyze way out and exposureWhile there are many methods utilized within the health care industry in the identification and abstract of loss and exposure, the recommended methods for KP are as numbers a) Incident-reporting depth psychologyb) returns on the current performance management process for employees to realize focus on risk mitigation and quality improvement. c) Quantitative analysis of patient complaints and merriment surveys. d) Review of the organizations past professional liability and toyers honorarium reports. e) Review of surveys completed by TJC and NCQA on other hospitals in aver to identify risk areas that KP should focus on. (McCaffrey & international ampere Hagg-Rickert, 2009)2. Research and propose secondary risk proficiencysTo mitigate risks that are un reverseable 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 to ascertain the likelihood of utilizing the exposure avoidance technique. This is not a likely option as the financial have-to doe with of eliminating function may out weigh the risks involved with continuing them. A loss step-down approach is more likely to be the technique elect for this organization. The core prevention activities that must be present in the loss reduction technique are as follows a.) Ongoing staff cultureb.) Current insurance and procedure review and revisionc.) Updates to the organizations current EHR system to keep in line the information present in the clinical decision-making and evidence-based clinical guidelines applied science is the almost current data available. According to Chen, et al (2009), a evolution body of literature confirms the value of electronic health records (EHRs) in astir(p) patient safety, improving coordination of care, enhancing documentation, and facilitating clinical decision making and affection 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 measurement process, which w ill all toldow KP to analyze the risk management technique with regard to outcome and cost effectiveness. embroild in the measurement process both risk word and risk-financing techniques should be measured (McCaffrey & Hagg-Rickert 2009). 4. follow up the selected techniquesImplementation of the chosen risk management techniques may implicate decisions on insurance coverage and policy changes, overall department field of studyflow changes to ensure compliance with state and nationally mandated regulations and guidelines, and elimination of processes that impede or stymy patient safety. 5. Monitor and improve upon the implemented risk management program In order to continue improving upon the tenderly implemented risk management program a comprehensive monitoring strategy should be employed. In fact, McCaffrey and Hagg-Rickert, (2009) state, a multidisciplinary approach to evaluating the risk management program ensures that the impact of additional opportunities to impro ve the risk management function are amply explored (p. 21). a.) Prepare an annual risk management reportb.) Compare the new annual report against prior years risk management data (McCaffrey & Hagg-Rickert 2009)Current RisksThree risks that KP should take surplus care to avoid are rejection of newly implemented risk management and CQI procedures by employees, order andregulatory changes, and health care associated infections (HAIs). 1. RejectionChange implementation is never an behind 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 interest 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 crossways specialty departments to improve communication (Sollecito and Johnson, 20 13). 2. Statute and regulatory changesWith the ever-changing ornament in state and national statutes and regulations 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 evict get under ones skin about negative financial affects at KP, including but not control to fines, loss of accreditation and credentialing, and an increase in malpractice lawsuits, not to mention a devolve in quality of care. a.) Risk management and quality improvement officers retain 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 monthly 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 maintain compliance. Include a pinch page with those editions that include changes to policy and ensure all employees sign and founder 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). Im appropriate prevention can lead to increased costs, lengthier hospital stays, and even patient death. Additionally, a Conditio n of troth (CoP) (42 CFR 482.42) by CMS mandates hospital infection control 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 practice hand washing before and afterwards 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. fictional character Outcomes inwrought 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 type debasement in trust and openness. Patients should be inv olved in all treatment decisions, through proper education on their diagnosis and treatment options. This will bring about patient engagement 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 opportunity of positive quality outcomes for patients. Lack of patient compliance will baffle the treatment process and lower the level of quality outcomes standards at KP. perseveration 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 increased in undesired outcomes (DeHarnais, 2013, chp 5). Goals short-run1. Design n ew regulatory and statute training programs for all clinical and administrative employees. 2. Review and revise the KP infection prevention and control 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 consort 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 responsibility for offering 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 hatch 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 in clude the risk of terrorist violates. While terrorist attack risk cannot be completely mitigated, it is the responsibility of the health care expertness to be prepared 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 deal 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 news report 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 demand 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 contrary 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 together closely. An example of how risk management efforts and quality improvement efforts equilibrize one another is seen in the reduction of medical errors. The risk management plan must consider ways to reduce medical errors, eon 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, quality 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 importance 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 Handbook (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 Management 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.