Why physician groups are self-insuring

Given the medical malpractice crisis in a number of states, many physicians are looking at alternatives to conventional insurance coverage. These options typically involve some form of risk sharing where the medical group assumes additional risks based on experience. This article identifies several options-retrospective payment plans, risk retention groups, captives, and rent-a-captives--and their associated risks and opportunities.     

Managing workers' compensation exposures in healthcare

Employees in healthcare are exposed to numerous and varied risks that pose the threat of injury. Management of those exposures by the organization will ultimately help create a safe environment for staff, patients and the public. Incorporating workers' compensation into the risk management program is the first step toward managing and reducing these exposures. This article presents a suggested outline for a written risk management plan for workers' compensation exposures.     

新型农村合作医疗设计与管理中的风险及风险规避

如何认识新型农村合作医疗项目可能发生的风险,在设计和管理中有效地防范风险的发生是新型农村合作医疗可持续发展的重要课题。根据医疗保险的基本原理,结合新型农村合作医疗工作的实际,总结概述新型农村合作医疗可能会遇到的几种风险,并提出规避风险的常用方法     

Development and application of a fuzzy occupational health risk assessment model in the healthcare industry

Background:Hazards of the workplace and their impacts on the healthcare industry affect the quality of patient care and safety and impose high costs on the healthcare industry. Occupational health in this industry requires proper identification of hazards and managing the related risks. In this study, the researchers attempted to develop an easy-to-use and high applicability occupational health risk assessment model with a fuzzy approach to evaluate risks more precisely.Methods:In this study, a fuzzy inference system (FIS) was designed and applied to develop a risk assessment model.Conclusions:This study showed that the developed model could be applied as a practical model for evaluating occupational health risks. The weight of each risk criterion was used to calculate the risk level by adopting a fuzzy approach. The risk assessment results construed using the fuzzy set theory provided a broad picture of risks and could work adequately in the presence of inaccurate and insufficient data to calculate the risk. This model calculates risk levels and provides us with the dispersion and distribution of the calculated value of the risk number.     

Managing risk in the city: the role of welfare professionals in managing risks arising from vulnerable individuals in cities

Modern cities depend on individualism and the process of contracting. Contracts between individuals contribute to stability and order in cities. However, this is challenged by risks and uncertainties especially those relating to vulnerable individuals who are unable or unwilling to enter into contractual relations. This paper focuses on the role of caring professions and the impact of new strategies for managing risks related to vulnerable adults and children, especially the shift from managing risk in institutions to managing risk in the community. This paper is based on research funded through the ESRC Risk and Human Behaviour Programme.     

Capitating multispecialty groups

This article addresses the issues a medical group must consider when entering into a capitation agreement with a managed care organization. It discusses the potential risks of capitation contracts and how those risks can be limited. In addition, keys to successful contracting are explored. Specific considerations outlined include choosing a contracting partner, determining the capitation rate and contract terms, and managing risk. Internal issues regarding the distribution of capitation income, physician incentives and risk pools, and management information systems are also addressed in the article.     

Learning from people with long‐term conditions: new insights for governance in primary healthcare

The introduction of top‐down centrally driven solutions to governance of healthcare, at the same time as increasing policy emphasis on greater ‘bottom up’ patient and public involvement in all aspects of healthcare, has set up complex tensions for policy implementation and healthcare practice. This paper explores the interplay of these agendas in the context of changes in primary healthcare services provided by the National Health Service in England. Specifically, it looks at service user involvement in a qualitative study of the professional response to changes in the governance and incentives in the care of people with long‐term conditions. Service users influenced and guided the study at local and national levels. Vignettes of patient stories developed by service users informed in‐depth interviews with 56 health and social care professionals engaged in the development of local policies and services for people with complex long‐term illness, and themes generated by cross case analysis were validated through service users. The findings presented here focus on four themes about risk and comparison of professionals' and service users' perspectives of the issues: managing risks/consistent support, the risks of letting go/feeling in control, professional identity/helping people to help themselves, and managing expectations/professionals losing out. In this study, service user involvement added value by validating understandings of governance, framing debates to focus on what matters at the point of care and enabling perspective sharing and interaction. We suggest that more collaborative forms of governance in healthcare that take account of service user perspectives and enable interaction with professional groups could help validate processes of quality assurance and provide motivation for continuous quality improvement. We offer a model for ‘opening up’ collaborative projects to evaluation and critical reflection of the interrelationships between the context, methods and outcomes of service user involvement.     

Assessing and managing risk with people with physical disabilities: the development of a safety checklist

Assessing risk with adults with physical disabilities who receive social care services is a task at the confluence of three perspectives on risk: the rights and choices of clients, the role and task of the social worker and the responsibilities of the service provider organisation in managing risk. The purpose of this article is to articulate and contextualise some of these issues of risk and risk-taking when people receive social care services. The tensions between client concerns and organisational risk management perspectives are illustrated by drawing on a project to engage clients in jointly assessing their risks with social workers, undertaken with teams in the Physical Health and Disability Programme of Care in a Health and Social Care Trust in Northern Ireland in 2010. In this article, we show how a risk discourse can be a useful aspect of the dealings between social workers and clients, whilst locating this within the risk regulation framework for managing risk within which health and social care services operate. We argue that incorporating both client perceptions of risk-taking and organisational risk management provides a balanced approach more likely to be effective than championing one at the expense of the other.     

Flood disaster preparedness: A retrospect from grand forks,north dakota

Natural disasters often come without warning. The clinical, financial, and business risks can be enormous. Grand Forks' (ND) healthcare systems experienced a flooding disaster of unprecedented proportions in April of 1997. Planned and practiced disaster and evacuation procedures can significantly reduce a healthcare facilities' risk to life, health, and safety. This article retrospectively analyzes disaster preparation and the complete evacuation of the facilities' patients.     

Medication errors and risk management

Healthcare risks in general, and those related to medication errors in particular, constitute a serious problem with consequent human, medical, and economic repercussions which healthcare authorities are recognizing and addressing as priority matters in some countries. However, though the magnitude of the problem is similar in Spain, this country has yet to become fully aware of the transcendence of the situation. Risk management activities in healthcare centers are presently evolving as risk managers adopt preventive and proactive approaches requiring the collaboration of other healthcare professionals in developing risk reduction programs, including those focused on medication error prevention. This article briefly describes the principal bases for safety improvement strategies, and outlines a risk management program for medication error prevention in hospitals. In short, it is assumed that risk managers form part of a team whose job it is to analyze incidents when they occur, use this information to establish actions for improving healthcare services through risk reduction, and ensure that the principles of risk management form an integral part in the activities and the culture of organizations. The final result of risk management is the establishment and maintenance of significant system changes which enhance the quality of healthcare services and achieve greater patient safety.     

Unlicensed assistive personnel—risk management considerations

Along with the restructuring and downsizing of healthcare organizations is the move toward further cost-reduction efforts, including the increased use of unlicensed assistive personnel for patient care activities. This can create new/increased risk exposures. Implications for healthcare risk managers are discussed and strategies for preventing and managing associated liability exposures are provided.     

Work life and patient safety culture in Canadian healthcare: connecting the quality dots using national accreditation results

Fostering quality work life is paramount to building a strong patient safety culture in healthcare organizations. Data from two patient safety culture and work-life questionnaires used for Accreditation Canada's national program were analyzed. Strong team leadership was reported in that units were doing a good job of identifying, assessing and managing risks to patients. Seventy-one percent of respondents gave their unit a positive overall grade on patient safety, and 79% of respondents felt that they could often do their best-quality work in their job. However, healthcare workers felt that they did not have enough time to do their jobs adequately and indicated that co-workers were cutting corners in patient care in order to save time. This article discusses engaging both senior leadership and the entire organization in the change process, ensuring supervisory support, and using performance measures to focus organizational efforts on key priorities all as improvement strategies relevant to these findings. These strategies can be used by organizations across sectors and jurisdictions and by healthcare leaders to positively affect work life and patient safety.     

The institutional origins of risk: A new agenda for risk research

The emergence of risk as an organizing concept for regulation and governance has been the subject of considerable comment and debate, most notably in relation to Ulrich Beck's Risk Society thesis. This editorial, however, argues that contemporary preoccupations with risk are driven less by a changing distribution of real, or imagined, ills in society, than by a changing distribution of ills in governance. It argues that the inevitable difficulty of managing threats to society (societal risks) creates threats to organizations managing those risks (institutional risks). The potential for failure has always been part of governance, but contemporary pressures towards greater coherence, transparency and accountability have amplified institutional risks by exposing the practical limits of governance. Framing the objects of governance in terms of risk, however, provides a way of reflexively managing the associated institutional threats by explicitly anticipating the practical limits of governance within probabilistic calculations of success and failure. This editorial outlines how the institutional dynamics of contemporary governance can lead to a phenomenon of ‘risk colonization’, whereby risk increasingly comes to define the object, methods and rationale of governance. It then goes on to consider some of the possible positive and negative consequences of risk colonization and concludes by suggesting ways in which the study of institutional risk can help us understand the relationship between risk and governance.     

Disease State Management Programmes

Disease state management (DSM) is a new concept in healthcare which is rapidly growing in terms of interest and potential as an effective approach to improving patient outcomes. The term DSM refers to a ‘systematic population-based approach to identify persons at risk, intervene with specific programmes of care, and measure clinical and other outcomes.’ This alternative method for ‘managing care’ is being driven by an increased understanding of best practices coupled with new technologies for changing behaviour and measuring outcomes. The concept of health promotion coupled with a systems approach to healthcare could significantly improve clinical outcomes while reducing costs for many people with chronic diseases. This article describes the experience of one health plan with DSM. In addition, guidelines are presented to assist the reader in evaluating their own organisations’s ability and needs regarding disease management.     

Patient-Centered Healthcare

Within the US, consumers are assuming a much greater role in actively managing their own health, educating themselves regarding health problems, and facilitating interventions to improve health outcomes. The Internet is a convenient and cost-effective enabler for supporting patient-centered healthcare. It is a well-spring of knowledge; a virtual, global community center; and a simple and convenient infrastructure for enabling consumers to monitor their own health states. For the Internet to successfully fulfill its role in health and disease management, a number of significant challenges must be addressed. Foremost among these are unfamiliar and difficult clinical vocabulary, lack of quality control, unequal accessibility, and risks to personal privacy.     

Heatwaves and the elderly - The role of the GP in reducing morbidity

BACKGROUND Heatwaves are increasing in frequency, intensity and duration, and are associated with an increase in mortality and morbidity, particularly in the very young and the very old. Concurrently, the Australian population is aging, with the prediction that by 2036 approximately 27% of Australians will be aged over 65 years. OBJECTIVE This article reviews the evidence on heat related health risk and discusses the role of the general practitioner in reducing morbidity in older people as a result of heatwaves. DISCUSSION Heatwaves are associated with increased mortality and morbidity in people aged over 65 years, and more so in those aged over 75 years. Older people are more vulnerable to the effects of extreme heat through a range of physiological and physical factors. As key providers of healthcare to older people, GPs play a crucial role in identifying those at risk and implementing strategies to minimise the risks of mortality and morbidity during periods of extreme heat.     

ECRI audio conference focuses on RFID: the possible benefits are significant, but proceed slowly

This article highlights key points raised during ECRI's May 18, 2005, audio conference, "Radio-Frequency Identification (RFID) for Tracking Medical Devices: Planning for Today and Tomorrow." The conference gave attendees the opportunity to hear the experiences of two healthcare professionals managing RFID pilot programs at healthcare facilities. Information on ordering a recording of the event, including presentation materials and our recent Health Devices article on RFID, is provided at the end of this article.     

Stroke awareness among rural residents: the case of West Virginia

Stroke is the leading cause of disability and the third leading cause of death in the United States. There are modifiable and non-modifiable stroke risks and proper management of some of these risks could significantly reduce the risk of stroke incidence. However, proper management of stroke risks requires public awareness of these risks and awareness of appropriate approaches to managing them. In case of stroke incidence, it is also important for patients to be able to recognize stroke symptoms and get immediate emergency medical attention. In this article, stroke awareness is studied as awareness of stroke warning signs, proper management of stroke risks, and awareness of what to do in case of stroke. The article analyzes mail questionnaire responses from 1,114 West Virginia residents. Respondents were mostly not properly managing stroke risks such as diabetes and hypertension. There was also a lack of awareness of severe stroke symptoms such as loss of vision in one eye and sudden severe headache. While 83% of respondents reported that they would call 911 if they thought they were having a stroke, only 20% of respondents could correctly identify all stroke warning signs. The study has some limitations, but remains an important study of stroke awareness among rural residents in Appalachia.     

美国骨科医疗风险影响因素研究述评

目的通过分析美国骨科医疗风险影响因素的分类方法,为我国骨科医疗风险因素分析和防范提供参考。方法使用Mesh及自由词,检索Pubmed、Embase等数据库以及相关官方网站,查找国外相关文献,并重点研究关国骨科医疗风险因素分析方法。结果美国建立了系统的多维的骨科医疗风险因素分类方法。骨科医疗风险主要存在于设备、沟通传达、用药及手术位置4个方面。结论美国骨科风险因素分析方法规范系统,有针对性,可有效发现医疗风险高发点,其为我国骨科医疗风险因素的分析和防范提供了借鉴和参考。     

‘Quality is job 1’– new directions for medical risk management

With the advent of managed care, the determination of who is a successful healthcare provider often depends on the selection process used by the managers of employee health plans and their managed care plans. Employee satisfaction and cost containment are factors relied on in selecting healthcare providers. This article discusses the risk management professional's increasingly important role in assisting healthcare providers in meeting the requirements of these third‐party decision makers.