Risk Management Handbook for Health Care Organizations, Student Edition (J-B Public Health Health Services Text)

Risk Management Handbook for Health Care Organizations, Student Edition This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for students and those new to the topic, each chapter highlights key points and learning objectives, lists key terms, and offers questions for discussion. An instructor's supplement with cases and other material is also available. American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association with more than 5,000 members representing health care, insurance, law, and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking, and interactions with leading health care organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, preserving financial resources, and maintaining safe working environments. Jossey-Bass Risk Management Handbook for Health Care Organizations, Student Edition 3 CONTENTS 5 EXHIBITS, FIGURES, TABLES, AND, PHOTOS 11 THE CONTRIBUTORS 15 PREFACE 29 ABOUT THIS BOOK 31 CHAPTER 1: DEVELOPMENT OF A RISK MANAGEMENT PROGRAM 33 LEARNING OBJECTIVES 33 RISK MANAGEMENT PROGRAM DEVELOPMENT 35 KEY STRUCTURAL ELEMENTS OF THE RISK MANAGEMENT PROGRAM 36 SCOPE OF THE RISK MANAGEMENT PROGRAM 40 THE RISK MANAGEMENT PROCESS 45 EVOLUTION OF THE RISK MANAGEMENT PROGRAM 53 SELECTING AN APPROPRIATE RISK MANAGEMENT PROGRAM STRUCTURE 54 ASSESSING AREAS OF THE ORGANIZATION THAT NEED RISK MANAGEMENT 55 KEY COMPONENTS FOR GETTING STARTED 58 WRITING A RISK MANAGEMENT PROGRAM PLAN 59 ACHIEVING PROGRAM ACCEPTANCE 59 SUMMARY 60 KEY TERMS 60 ACRONYMS 60 NOTES 61 SUGGESTED READING 62 CHAPTER 2: THE HEALTH CARE RISK MANAGEMENT PROFESSIONAL 63 LEARNING OBJECTIVES 63 THE RISK MANAGER’S JOB: FUNCTIONAL AREAS OF RESPONSIBILITY 65 HEALTH CARE RISK MANAGEMENT ACROSS A SPECTRUM OF SETTINGS 85 REQUIRED SKILLS FOR THE SUCCESSFUL HEALTH CARE RISK MANAGEMENT PROFESSIONAL 108 RISK MANAGEMENT ETHICS 109 A PROFILE OF THE HEALTH CARE RISK MANAGEMENT PROFESSIONAL 110 EDUCATION AND PROFESSIONAL RECOGNITION PROGRAMS 110 SUMMARY 115 KEY TERMS 116 ACRONYMS 117 NOTES 117 SUGGESTED READING 118 CHAPTER 3: PATIENT SAFETY AND THE RISK MANAGEMENT PROFESSIONAL 119 LEARNING OBJECTIVES 119 THE SCOPE OF MEDICAL ERRORS 121 SEEKING SOLUTIONS: WHAT ARE THE CAUSES OF MEDICAL ERRORS? 123 SUMMARY 142 KEY TERMS 142 ACRONYMS 142 NOTES 143 SUGGESTED READINGS 145 CHAPTER 4: HEALTH CARE LEGAL CONCEPTS 147 LEARNING OBJECTIVES 147 LEGAL ISSUES COMMON TO ALL HEALTH CARE PROVIDERS 148 LEGAL ISSUES RELATED TO SPECIFIC HEALTH CARE PROVIDERS 166 SUMMARY 182 KEY TERMS 183 ACRONYMS 183 NOTES 183 CHAPTER 5: GOVERNANCE OF THE HEALTH CARE ORGANIZATION 189 LEARNING OBJECTIVES 189 ESSENTIAL RESPONSIBILITIES OF THE HOSPITAL BOARD 191 BASIC LEGAL DUTIES OF HEALTH CARE TRUSTEES 192 LESSONS FROM THE PANEL ON THE NONPROFIT SECTOR 194 FEDERAL SENTENCING GUIDELINES FOR ORGANIZATIONS 197 THE SARBANES-OXLEY ACT OF 2002 199 THE VOLUNTEER PROTECTION ACT OF 1997 201 RISK MANAGEMENT AND THE BOARD 202 THE MEDICAL STAFF, RISK MANAGEMENT, AND THE BOARD 207 SUMMARY 210 KEY TERMS 211 ACRONYMS 211 NOTES 211 CHAPTER 6: EARLY WARNING SYSTEMS FOR THE IDENTIFICATION OF ORGANIZATIONAL RISKS 213 LEARNING OBJECTIVES 213 EARLY IDENTIFICATION OF EXPOSURE TO LOSS 214 FOOD AND DRUG ADMINISTRATION 238 INSTITUTE FOR SAFE MEDICATION PRACTICES, UNITED STATES PHARMACOPEIA, AND NATIONAL COORDINATING COUNCIL FOR MEDICATION ERROR REPORTING AND PREVENTION 240 MEDICAL EVENT REPORTING SYSTEM—TRANSFUSION MEDICINE 244 INTENSIVE CARE UNIT SAFETY REPORTING SYSTEM 244 PITTSBURGH REGIONAL HEALTHCARE INITIATIVE 244 OTHER VOLUNTARY PROGRAMS 244 STANDARDIZING A PATIENT SAFETY TAXONOMY: THE NATIONAL QUALITY FORUM 245 PROTECTING SENSITIVE INFORMATION 245 SUMMARY 247 KEY TERMS 247 ACRONYMS 248 NOTES 248 CHAPTER 7: THE RISK MANAGEMENT PROFESSIONAL AND MEDICATION SAFETY 251 LEARNING OBJECTIVES 251 LATENT AND ACTIVE FAILURES 252 SYSTEMS THINKING 253 RISK MANAGEMENT: A PRIORITIZING APPROACH 284 SUMMARY 290 KEY TERMS 290 ACRONYMS 290 NOTES 290 CHAPTER 8: ETHICS IN PATIENT CARE 293 LEARNING OBJECTIVES 293 ETHICAL PRINCIPLES AND MORAL OBLIGATIONS 295 RESEARCH 295 INSTITUTIONAL REVIEW BOARDS 298 PATIENT SELF-DETERMINATION ACT 307 "DO NOT RESUSCITATE": WITHHOLDING OR WITHDRAWING TREATMENT 309 SUMMARY 311 KEY TERMS 311 ACRONYMS 312 NOTES 312 SUGGESTED READING AND RECOMMENDED WEB SITES 316 CHAPTER 9: DOCUMENTATION AND THE MEDICAL RECORD 319 LEARNING OBJECTIVES 319 DOCUMENTATION 323 RECORD RETENTION 342 RELEASE OF RECORDS 342 OWNERSHIP OF MEDICAL RECORDS 343 MEDICAL RECORD AUDITS 344 DOCUMENTATION AND RISK MANAGEMENT 345 EMERGING RISK EXPOSURES 352 THE RISK MANAGEMENT PROFESSIONAL’S ROLE 353 SUMMARY 354 KEY TERMS 354 ACRONYMS 355 NOTES 355 SUGGESTED READING AND RECOMMENDED WEB SITES 357 CHAPTER 10: STATUTES, STANDARDS, AND REGULATIONS 359 LEARNING OBJECTIVES 359 PATIENT CARE 360 MEDICARE MODERNIZATION ACT 363 MEDICAL STAFF 364 LIFE SAFETY CODE 382 FEDERAL HEALTH INSURANCE LAWS AND REGULATIONS 386 TORT REFORM 389 POLICY AND PROCEDURE MANUALS 391 CASE LAW 392 SUMMARY 394 KEY TERMS 395 ACRONYMS 395 NOTES 396 CHAPTER 11: BASIC CLAIMS ADMINISTRATION 399 LEARNING OBJECTIVES 399 THE CLAIMS ENVIRONMENT 400 THE CLAIMS PROCESS 401 THE RISK MANAGEMENT PROFESSIONAL’S RESPONSIBILITIES 403 REGULATORY REPORTING OF CLAIMS 410 SUMMARY 410 KEY TERMS 411 ACRONYMS 411 NOTES 411 SUGGESTED READING 411 CHAPTER 12: INTRODUCTION TO RISK FINANCING 413 LEARNING OBJECTIVES 413 RISK FINANCING IN THE CONTEXT OF THE RISK MANAGEMENT PROCESS 416 RISK RETENTION 416 SUMMARY 425 KEY TERMS 425 ACRONYMS 425 SUGGESTED READING 425 CHAPTER 13: INSURANCE: BASIC PRINCIPLES AND COVERAGES 427 LEARNING OBJECTIVES 427 DEFINITION OF INSURANCE 428 SPECIFIC TYPES OF INSURANCE FOR THE HEALTH CARE INDUSTRY 440 SUMMARY 456 KEY TERMS 457 ACRONYMS 457 NOTE 458 SUGGESTED READING 458 CHAPTER 14: INFORMATION TECHNOLOGIES AND RISK MANAGEMENT 459 LEARNING OBJECTIVES 459 RISK MANAGEMENT INFORMATION NEEDS 462 RISK MANAGEMENT INFORMATION SYSTEMS 463 USING INFORMATION SYSTEMS TO GENERATE REPORTS 464 INTEGRATING RISK MANAGEMENT, QUALITY ASSURANCE, AND PATIENT SAFETY 465 ELECTRONIC MAIL 466 INTERNET- AND WEB-BASED TECHNOLOGY 467 PERSONAL HEALTH RECORD 467 ELECTRONIC HEALTH RECORDS AND SYSTEMS 468 CLINICAL INFORMATION SYSTEMS AND “SMART” TECHNOLOGIES 469 INFRASTRUCTURE TECHNOLOGY 472 POINT-OF-CARE TECHNOLOGY 474 TELEMEDICINE 474 SUMMARY 475 KEY TERMS 476 ACRONYMS 476 NOTES 476 SUGGESTED READING 477 APPENDIX 14.1 IT GLOSSARY FOR RISK MANAGERS 479 CHAPTER 15: RISK MANAGEMENT METRICS 483 LEARNING OBJECTIVES 483 BENCHMARKING DEFINED 485 CLAIMS 488 MEASURING CHANGE 491 DEVELOPING NEW METRICS 493 SUMMARY 496 KEY TERMS 497 ACRONYMS 497 NOTES 497 SUGGESTED READING 498 CHAPTER 16: ACCREDITATION, LICENSURE, CERTIFICATION, AND SURVEYING BODIES 499 LEARNING OBJECTIVES 499 THE CONSUMER ERA OF HEALTH CARE 500 WHAT THE HEALTH CARE RISK MANAGEMENT PROFESSIONAL NEEDS TO KNOW 501 MANDATORY SURVEYING BODIES 503 VOLUNTARY SURVEYING BODIES 507 URAC 521 SUMMARY 529 KEY TERMS 530 ACRONYMS 531 NOTES 531 SUGGESTED READING 532 APPENDIX 16.1 ACCREDITATION AND LICENSURE ORGANIZATIONS, SURVEYING BODIES, AND GOVERNMENT AGENCIES 533 CHAPTER 17: EMERGENCY MANAGEMENT 535 LEARNING OBJECTIVES 535 THE STEPS OF EMERGENCY MANAGEMENT 537 PREVENTION 538 PLANNING AND PREPARATION 543 IMPLEMENTATION AND RESPONSE 557 RECOVERY 558 SUMMARY 558 ACRONYMS 559 KEY TERMS 559 NOTES 559 RECOMMENDED WEB SITES 560 CHAPTER 18: OCCUPATIONAL SAFETY, HEALTH, AND ENVIRONMENTAL IMPAIRMENT 561 LEARNING OBJECTIVES 561 ADMINISTRATIVE PROCEDURE ACT 562 ADMINISTRATIVE ENFORCEMENT 564 SPECIFIC OCCUPATIONAL SAFETY AND HEALTH ISSUES 567 SUMMARY 571 KEY TERMS 571 ACRONYMS 572 NOTES 572 APPENDIX A: A RISK MANAGEMENT PROGRAM (EXAMPLE) 575 POLICY 575 PURPOSE 575 AUTHORITY 575 SCOPE 576 PROGRAM ELEMENTS 576 OBJECTIVES 576 PROGRAM PLAN 577 INTEGRATION WITH KEY ASPECTS OF OPERATIONS 578 CONFIDENTIALITY 579 EVALUATION OF THE RISK MANAGEMENT PROGRAM 579 APPENDIX B: REQUEST FOR RECORDS FORM (EXAMPLE) 581 APPENDIX C: A GUIDE TO MEDICAL TERMINOLOGY 583 LEARNING OBJECTIVES 583 HISTORY 584 STRUCTURE OF MEDICAL TERMS 584 SUFFIXES 585 PREFIXES 586 ROOT WORDS 587 SINGULAR AND PLURAL FORMS 593 ABBREVIATIONS AND ACRONYMS 594 CONCLUSION 595 GLOSSARY 597 INDEX 655 ISBN-13:,9780470300176

carroll, A Risk Management Consultant, Presents Guidance For Health Care Risk Managers In This Official Handbook Of The American Society For Healthcare Risk Management. This Fourth Edition Is Updated To Reflect Current Changes In The Health Care Environment, Offering Regulatory And Legal Updates, New Insights On Areas Such As Patient Safety And Bioterrorism, And New Treatment Of The Concept Of Enterprise Risk Management, Which Encourages The Evaluation Of All Risk Exposures Confronting An Organization. Useful For Both New And Seasoned Risk Managers, The Book Takes A Practical, User-friendly Approach, With Much Of The Material In An Informal Outline Format With Bulleted Lists And Numerous Headings And Subheadings. Annotation ©2004 Book News, Inc., Portland, Or

dena Ellis Belfiore

this Book Describes The Key Elements Of A Risk Management Program. It Is Designed For An Entry-level Risk Manager Or Other Health Professional Seeking Information Or Understanding Of A Risk Management Program. The Examples In The Book Are Most Applicable To The Acute Care Setting, Although The Concepts Could Be Extrapolated To Outpatient And Other Less Traditional Patient Care Settings. This Book Features Examples Of The Basic Tools Of A Risk Management Program: Job Descriptions, Board Reports, Sample Policies And Procedures, And Congratulatory And Rejection Letters. This Book Thoroughly Covers The Basics Of A Risk Management Program. The Strategies Have Been Proven Effective In Well-managed Programs. In Part Three, On Techniques Of Risk Management, The Examples Are Concise And Help The Reader Actualize The Concepts. I Was Impressed By The Expansive List Of References. The Chapter On Data Management Advances In Computer Technologies Will Increasingly Change The Shape Of Risk Management Programs And Will Be The Focal Point For The Program. Topics Of Interest To Risk Managers Not Covered In This Book Are Computerized Documentation Systems And Compliance With Cobra Legislation.

Development of a risk management program / Jane J. McCaffrey, Sheila Hagg-Rickert The health care risk management professional / Jeannie Sedwick Patient safety and the risk management professional : new challenges and opportunities / Denise M. Murphy, Katrina Shannon, Gina Pugliese Health care legal concepts / Peter Hoffman Governance of the health care organization / John Horty, Monica Hansolvan Early warning systems for the identification of organizational risks / Roberta L. Carroll The risk management professional and medication safety / Hedy Cohen, Nancy Tuohy Ethics in patient care / Sheila Cohen Zimmet Documentation and the medical record / Sandra K. Johnson, Leilani Kicklighter, Pamela Para Statutes, standards, and regulations / Mark Cohen Basic claims administration / Ellen L. Barton Introduction to risk financing / Dominic A. Colaizzo Insurance : basic principles and coverages / Kimberly Willis, Judy Hart Information technologies and risk management / Ronni P. Solomon, Madelyn S. Quattrone Risk management metrics / Judith Napier, Trista Johnson Accreditation, licensure, certification, and surveying bodies / Frederick Robinson Emergency management / Michael L. Rawson, Harlan Y. Hammond Occupational safety, health, and environmental impairment : a brief overview / John C. West.