Risk Management ?
All hospitals have "Risk Management" coordinators. As a practicing physician, or department chairman, have you ever wondered just what kind of risk they manage? I used to assume that they assessed the risk to patients of experiencing an adverse outcome during a hospital stay, formulating a possible intervention to mitigate the risk, and then assessing the effectiveness of the intervention after implementing it.
A web search for "hospital risk manager responsibilities" yielded:
"The responsibility of a hospital risk manager is to identify risks to the hospital. He does this by reviewing past incidents and claims, hospital loss and liability reports, and local and national hospital-related incident or risk data and statistics. The risk manager might also monitor the actions of hospital staff or their work environments to check for issues of compliance with existing policies and procedures, or ask hospital department managers to provide risk assessments about staff, patient or visitor safety."
Risk Manager Responsibilities
Identifying risks to the hospital is certainly a worthy activity, but as a patient, I would be concerned about possible risks to myself, not to the hospital. What is my risk of postoperative infection, deep venous thrombosis, catheter-related infection, diabetic complications, etc, etc? In my opinion, analyzing risks to the patient is far more important to physicians and their patients than examining risks to the hospital.
An article in Becker's Hospital CFO Report indicates a particular purpose of hospital risk management:
"Moody's: Risk management now a crucial variable in determining hospital credit strength"
Financial Risk
Well, again, analyzing patient risks is more important than analyzing financial risks to the hospital. This task belongs more in the realm of the business department than the risk manager. I really don't care, as a patient or as a treating physician, what the financial health of the hospital is. I care about my own physical health as a patient, or my patients's physical health as a physician.
Articles in The Journal of Heathcare Risk Management focus on implementation of programs,compliance assessment, and reviews of risks in different hospital settings. Actual
epidemiologic studies that calculate risk, model associations of risk factors to risks, and statistically assess effectiveness of interventions are virtually absent.
Risk Management Journal
One would think that scientific analysis should be better directed to identifying patient risks than identifying hospital compliance risks.
I think you might agree with me that hospital risk managers are primarily compliance monitors and have little impact on actual risk to patients. They monitor incidents (falls, employee injuries, needle sticks, medication errors), which may impact the hospital in terms of accreditation or legal liability.
Do risk managers attempt to answer questions such as:
1. What is the risk (incidence of) VTE in the two-month window after hospital discharge?
2. What factors in our hospital population are associated with post-hospital VTE?
3. Does immunosupression increase the risk of hospital-acquired infection in our patient population?
4. What if any, was the change in level and trend of C. difficile infection incidence after implementation of an antibiotic stewardship program?
Who then, in the hospital setting, are concerned with the scientific assessment of risk to patients?
The medical staff are equipped to evaluate patient risk, but rarely, outside of teaching hospitals, do they organize adequately to evaluate risk and interventions. On virtually any hospital medical staff , you will find diverse scientific expertise. In addition to the scientific education indicated my the MD or DO degree, you will find bachelor's degrees and master's degrees in many scientific and engineering fields, and previous employment in various areas requiring science education and analytical aptitude. The academic medical center has departments of biostatistics, community medicine, public health, and house staff manpower that can be tapped to study local hospital population risk and intervention. Non-academic hospitals, by and large, do not have formal epidemiology committees (but should have) to study their own local problems. Forming an epidemiology committee is the first step to having scientific patient risk assessment.
Do risk managers attempt to answer questions such as:
1. What is the risk (incidence of) VTE in the two-month window after hospital discharge?
2. What factors in our hospital population are associated with post-hospital VTE?
3. Does immunosupression increase the risk of hospital-acquired infection in our patient population?
4. What if any, was the change in level and trend of C. difficile infection incidence after implementation of an antibiotic stewardship program?
Who then, in the hospital setting, are concerned with the scientific assessment of risk to patients?
The medical staff are equipped to evaluate patient risk, but rarely, outside of teaching hospitals, do they organize adequately to evaluate risk and interventions. On virtually any hospital medical staff , you will find diverse scientific expertise. In addition to the scientific education indicated my the MD or DO degree, you will find bachelor's degrees and master's degrees in many scientific and engineering fields, and previous employment in various areas requiring science education and analytical aptitude. The academic medical center has departments of biostatistics, community medicine, public health, and house staff manpower that can be tapped to study local hospital population risk and intervention. Non-academic hospitals, by and large, do not have formal epidemiology committees (but should have) to study their own local problems. Forming an epidemiology committee is the first step to having scientific patient risk assessment.
