CCMC Glossary of Terms Related to Risk Management
Insurance Risk Management: A comprehensive program of activities to identify, evaluate, and take corrective action against risks that may lead to patient or staff injury with resulting financial loss or legal liability. This program aims at minimizing losses.
Root Cause Analysis: A process used by healthcare providers and administrators to identify the basic or causal factors that contribute to variation in performance and outcomes or underlie the occurrence of a sentinel event.
- Identifying risk or potential risk
- Calculating the probability of an adverse effect from the risk
- Estimating the impact of the adverse effect
- Control of the risk
Proactive risk management helps to improve the quality of patient care, reduce the probability of an adverse outcome and decrease the likelihood of a malpractice claim. Reactive risk management looks into claims that have occurred for issues that need intervention. The goal of risk management is to reduce adverse events, decrease malpractice claims and minimize financial loss.
Case Management Malpractice Risk Management
The plaintiff, person bringing forth the claim, has the burden of proving two points. The first is that the case manager was negligent. The second is that injury resulted from the negligence.
There are several steps a case manager can take to reduce the risk of a malpractice suit:
- offer the patient several choices of providers
- use only credentialed providers
- communicate with the patient and address concerns
- document all communications with the patient and others involved in care and decision making
- do not alter records
- be consistent in decision making
- document compliance or lack of compliance with treatment plan
- be aware of and comply with professional standards and regulations