Risk Assessments in a Healthcare Context

Risk Management

When creating a risk management plan for a government program a number of important (even crucial) steps must be taken. In this paper a review of those steps is presented. Also, interventions which are important for improving healthcare are presented. Hence, this paper should serve as a five page report to the city council.

Needs Assessment

The simple, straightforward definition of needs assessment is as follows: project leaders and developers must know in advance what resources are necessary -- are vital -- for the completion and success of the program. In other words, needs assessment relates to that time, what financial commitment, what staff and what other tools and resources will be necessary in order to have a program that is functional and purposeful.

Because needs assessment and project management go hand in hand, the project managers working on a new program have a practical goal of making the objectives of a project (identified by a needs assessment) into "a reality…[and a way] to provide a basis to estimate a budget needed" (CIO).

There are several steps that are normally taken when a needs assessment is being prepared, according to CIO in Australia, a magazine for chief information officers and other executives. The steps that should be taken when undertaking the preparation of a needs assessment include: a) gathering all available pertinent information about what will be needed -- and discussing with staff and key employees (whose expertise is pivotal) as to what tools and other resources will be needed to fully carry out tasks; b) a second step is to thoroughly zero in on the problem to be addressed, or the program to be launched, and "prioritize the processes to undertake in creating a resolution"; this could have linkage with the project management side of the launch; c) step number three is to determine "what solutions may be required if any unexpected situations arise"; it's never possible to foresee "unexpected situations" but smart, alert planners and developers should be able to make preparation in that regard; and d) the fourth step involves arriving at a consensus with senior leadership and "key stakeholders" (CIO).

Advisory or Planning Committee

The risk management part of the program must have a manager that reports to the chief executive officer (CEO) or executive director. The risk management manager establishes communication and interfaces with "administration, staff & #8230; provides and other professionals"; and that manager also has the authority to "cross organizational lines" so that the goals of the new program may be met (ECRI Institute). The risk manager meets with a committee established to "…facilitate the sharing of risk management knowledge and practices across multiple disciplines" (ECRI). The risk management committee has a duty to "optimize the use of key findings" from the initial research (which was conducted during the needs assessment); moreover, the committee has a task to review all risk management activities on a regular basis (ECRI). In turn the committee reports its findings to the governing board on a regular basis; the data a planning committee is obligated to report includes "…event trends, claims analysis, frequency and severity data, credentialing activity, relevant provider and staff education," along with the activities of the risk management team (ECRI).

Program Mission Statement

A risk management mission statement should be a "broad statement" that points out who the group is, what the organization stands for, what the goals are and how the risk management effort "ties into the corporate [or community] mission" (Praxiom risk management, 2012). The mission statement should also include some of the important priorities of the risk management program, and it should be remembered that people wanting to know and understand what the risk management effort is directed towards will likely look first at the mission statement. Hence, the mission statement should be important enough to the risk management committee and the manager to be a cogent yet significant explanation of what the motivation and the ultimate goal is -- and why this goal is being sought.

Plan an Intervention / Evaluate Interventions

In the Journal of the American Pharmaceutical Association, the authors suggest that a lot of the information relating to the effectiveness of risk management interventions as far as actually reducing risk is "anecdotal" (Andrews, et al., 2004). Given that interventions are intended to make changes or reduce risk, in a healthcare situation an intervention would logically be intended to "…achieve the ultimate goal of reducing risks to patients," while at the same time creating therapies and solutions to health-related problems (Andrews, p. 1).

In the case of a healthcare-related intervention into a healthcare risk management program, Andrews explains that for interventions to be successful, "…they must effect change in physician prescribing, pharmacist dispensing, and patient adherence"; but when interventions are "overly burdensome to patients and to the professionals and the community, the desired outcome -- and the mission statement -- are unlikely to succeed (Andrews).

Meanwhile the Agency for Healthcare Research and Quality (AHRQ), a federal government agency, explains that various state Medicaid agencies have tried "…combinations of more than 15 types of interventions to improve member health" (AHRQ). Many states are now putting in place programs with a more "holistic approach," rather than pointing towards specific diseases; but moreover, interventions tend to fall into a pair of different categories: provider interventions and member interventions (AHRQ).

For this community, a provider intervention is recommended. This will change the way health care providers treat their patients, and typically a doctor education session is held with regards to cholesterol, a problem that many citizens experience. In this case, doctors are given training on how important it is to screen for high-density lipoprotein (HDL) and low-density lipoprotein. This is in fact an intervention that helps physicians administer quick and effective screening procedures for people as to whether they have cholesterol problems or not.

Select and Evaluate Interventions

The state of Indiana held collaborative and helpful learning sessions "…that introduced teams of three (physician, nurse, and office manager)" to learn new practices as intervention models. They approached the need for intervention for chronic care patients and the intervention included improvements to healthcare sites, which could be used in this community as well. Measurements are used to evaluate how well the goals were met (AHRQ).

As to practice site improvement, which is recommended for this model, the care manager (mentioned earlier) works with physicians to find ways to improve care for patients with chronic conditions. Rarely do Medicaid agencies offer this kind of service "because it can prove labor intensive and some physicians might find it invasive," AHRQ explains. But in North Carolina care managers are able to prompt healthcare providers when they do not for whatever reason follow the necessary and the specific practices.

It is no surprise for folks leading interventions to find out that some doctors are unwilling to attend training sessions for holistic care managers; it isn't necessarily out of arrogance on the doctors' part, but there is a history of reluctance. Part of the intervention that needs to take place to benefit patients and be able to move them seamlessly through the screening process and other innovative healthcare procedures is that doctors are often reluctant to use electronic health records (EHR).

Evaluate the Results of the Intervention

Electronic health records are known to prevent the loss of paper records that can be simply lost, put in the wrong place, or are sometimes hard to read because they're old and haven't been preserved. The intervention that is discussed in this section could be helpful to the healthcare risk management program; risking a person's ability to be served properly by doctors and nurses by resisting the use of electronic health records is unacceptable.