Kaiser permanente risikomanagement executive

Organization Information

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Chef Permanente (KP) is the country’s largest integrated health care delivery system. KP serves seven states and also nine mil members, with an annual working revenue in 2013 of 53. one particular billion. KP is a head in quality improvement work in the healthcare industry through participation in studies performed by the Countrywide Committee about Quality Assurance (NCQA), The Joint Commission (TJC) accreditations, and the implementation of any state of the art electric health information system, which focuses on the use and quality of proper care standardization.

Major of this summary is on KP clinics in the upper California region and will incorporate topics like the purpose of risk and top quality management, risk identification and management, current risks, top quality outcomes, company goals, plus the relationship among risk and quality management. Risk and Quality Administration Purpose


The goal of risk management in health care is simply the process of protecting the assets and lessening financial loss to the firm (Singh & Habeeb Ghatala, 2012).

A comprehensive risk management strategy in a health care firm will include concentrate on continuous top quality improvement (CQI). The purpose of CQI in medical care, according to Sollecito and Johnson (2013), is to offer a “structured company process pertaining to involving personnel in planning and carrying out a continuous stream of advancements to provide top quality health care that meets or exceeds expectations (p. 4). Through connecting the processes of risk management and quality improvement the success of both processes is more likely to be noticed. Kaiser Recurrente

The key concepts for risk and quality management in KP will be commitment to quality, affected person safety, level of privacy protection, and fraud elimination. KP risikomanagement and top quality management courses are central to their mission, values, and culture. Strategies currently employed to support these types of conceptswithin KP are customer surveys, the use of an integrated EHR with evidence based recommendations and clinical decision-making features, stringent sufferer privacy regulations and operations, continuous medical and management staff training programs, and participation in studies focused on standardizing national quality steps (Kaiser Permanente, 2012). Risk Identification and Management


Although KP can be described as leader in health care risk and top quality management there are specific steps this kind of consultant is definitely recommending over a continual basis that will improve risk identification and administration within the organization. 1 . Identify and evaluate loss and exposure

During your time on st. kitts are many methods utilized in the health care sector in the identity and analysis of damage and coverage, the advised methods for KP are the following: a) Incident-reporting analysis

b) Improvement within the current efficiency management procedure for employees to create focus on risk mitigation and quality improvement. c) Quantitative analysis of patient issues and pleasure surveys. d) Review of the organizations previous professional liability and workers compensation reviews. e) Report on surveys accomplished by TJC and NCQA on different hospitals to be able to identify risk areas that KP ought to focus on. (McCaffrey & Hagg-Rickert, 2009)

2 . Research and propose alternate risk tactics

To mitigate hazards that are unavoidable at KP, a combination of alternative risk methods will help decrease situations that may negatively affect the organization. Economic analysis and risk research should be performed in order to conclude the likelihood of utilizing the exposure avoidance approach. This is not a possible option because the financial impact of eliminating companies may out weigh the potential risks involved with continuous them. A loss reduction approach is more likely to be the strategy chosen with this organization. The core elimination activities that needs to be present in losing reduction technique are the following: a. ) Ongoing personnel education

w. ) Current policy and procedure review and revising

c. ) Improvements to the businesses current EHR system in order that the data present in the clinical decision-making and evidence-based clinical guidelines technology is the most current data readily available. According to Chen, ain al (2009), “a growing body of literature verifies the value of electronic digital health data (EHRs) in improving patient safety, improving coordination of care, boosting documentation, and facilitating specialized medical decision making and adherence to evidence-based clinical guidelines (p. 323). a few. Risk management technique selection

This two-part means of risk management approach selection is accomplished through forecasting and application of a continuous measurement method, which will allow KP to investigate the risk managing technique with regards to outcome and cost effectiveness. Included in the measurement method both risk treatment and risk-financing approaches should be tested (McCaffrey & Hagg-Rickert 2009). 4. Apply the selected approaches

Implementation of the chosen risikomanagement techniques might include decisions in insurance coverage and policy changes, overall department workflow changes to ensure conformity with state and government mandated polices and recommendations, and reduction of operations that slow down or impede patient basic safety. 5. Monitor and improve the integrated risk management program In order to continue improving upon the newly executed risk management system a comprehensive monitoring strategy must be employed. In fact , McCaffrey and Hagg-Rickert, (2009) stated, “a multidisciplinary way of evaluating the risk management system ensures that the impact of additional in order to improve the risikomanagement function will be fully explored (p. 21). a. ) Prepare an annual risk management report

b. ) Compare the newest annual survey against before years risk management data (McCaffrey & Hagg-Rickert 2009)

Current Dangers

Three risks that KP is going to take special treatment to avoid happen to be rejection of newly applied risk management and CQI methods by workers, statute and

regulatory changes, and health care associated infections (HAIs). 1 . Being rejected

Change rendering is never an easy task and without special care taken the rate of rejection to improve by clinical and management employees is definitely high. To be able to achieve successful CQI changes the following suggestions and suggestions are offered. a. ) Minimize worker rejection through easily applied and followed CQI types of procedures. b. ) Engage personnel in planning to increase approval.

c. ) Ensure spectrum of ankle linkages inside the organization across specialty departments to improve communication (Sollecito and Johnson, 2013). 2 . Statut and regulatory changes

With the ever-changing landscape in state and federal code and polices surrounding the care market, special attention to this risk location must be considered. In fact , Cohen (2009) stated that “health care is one of the most greatly regulated of most sectors of commerce (p. 328). Failing to abide by state and federal loi and restrictions can bring about adverse financial influences at KP, including but is not limited to; penalties, loss of accreditation and credentialing, and a rise in malpractice law suits, not to mention a decrease in quality of attention. a. ) Risk management and quality improvement officers keep up on, be in the know, keep up to date, be well-informed and involved in statute and regulation adjustments. b. ) Mandate educational goals intended for risk management and quality administration officers with regard to state and federal rules. c. ) Implement monthly employee newsletter within which the risk management expert and top quality improvement official outline regulation changes. Contain processes that employees should expect to see implemented to keep compliance. Will include a signature site with those editions which include changes to plan and ensure almost all employees sign and go back to the human assets department. deb. ) Recurring training for scientific and management employees regarding statute and regulation. Raise the risk management and quality improvement officers will be responsible to utilize the agencies education office to put into practice new training courses as required. e. ) Include these kinds of responsibilities in the performance monitoring strategy for the risk management and quality improvement officers. 3. HAIs

Medical associated infections are a severe risk in hospitals, because noted simply by Sydnor and Perl (2011), in their assertion “HAIs will be the most common complications seen in in the hospital patients (para. 20). Poor prevention can cause increased costs, lengthier hospital stays, and patient loss of life. Additionally , a Condition of Engagement (CoP) (42 CFR 482. 42) simply by CMS mandates hospital infection control programs to adhere to specific requirements. Recommendations happen to be as follows. a. ) Apply a house-keeping checklist to assure proper sanitization of affected person rooms. m. ) Apply a sanitization checklist for clinical staff that will put in force hand cleaning before and after affected person contact. c. ) Develop a committee to examine and revise the KP infection prevention and control program. Alterations should focus on compliance with TJC as well as the Center for Disease Control (CDC) rules. Quality Effects

Internal and external

Three external and internal factors that influence top quality outcomes are organization management of interpersonal relationships among physicians and patients, affected person compliance, and continuity of care. Without correct management of interpersonal relationships between medical doctors and sufferers, the organization will certainly face wreckage in trust and visibility. Patients ought to be involved in every treatment decisions, through proper education on the diagnosis and treatment options. This will likely bring about sufferer engagement through this decision making process. While KP cannot push their people to adhere to treatment suggestions, the exterior influence of patient complying is crucial to quality final results. Programs aimed at thorough teaching and education of patients and loved ones will improve the rate of complying, thus improving the probability of great quality outcomes for patients. Lack of patient compliance will certainly hinder the treatment process and lower the degree of quality results standards for KP. Continuity of attention is another internal influence that could affect quality outcomes. Frequent follow up with people will also boost patient conformity. Without increasing continuity of care, the KP organization will see a reduction in positive quality outcomes and an increased in undesired results (DeHarnais, 2013, chp 5). Goals


1 ) Design fresh regulatory and statute training programs for a lot of clinical and administrative employees. 2 . Assessment and revise the KP infection avoidance and control program three or more. Revise the performance management system to include CQI measurements and risk management procedures as overall performance metrics.

Long lasting

1 ) Increase faith to state and federal rules and code throughout the KP organization. 2 . Reduce HAIs by 10% throughout KP hospitals in the northern Washington dc region. three or more. Improve CQI measurement and risk management policy adherence over the northern A bunch of states region simply by 20% among clinical workers. Risk and Quality Supervision


Risk management policies

1 ) Quarterly peer review

The Health Treatment Quality Improvement Act (HCQIA) of 1986 “encourages clinics, state license boards, and professional communities to identify and discipline doctors, dentists, and also other health care providers who have, after satisfactory, non-discriminatory peer review, were found to acquire engaged in at fault or not professional conduct (Cohen, 2013 p. 333). Through ongoing screening process of new and current physicians, KP will require responsibility pertaining to offering their particular patients that highest quality of care and reducing the risk of employing negligent clinical personnel. 2 . Actually zero tolerance faith policy for all employees with regard to infection control techniques Part of the CMS CoP (42 CFR 482. 42) rules is the “designation of an infection control officer and development of relevant policies that address the identification and control of attacks and nommable diseases. With no full conformity with all CoPs, KP may face the losing of their Treatment provider arrangement. 3. Weakness analysis graph and or chart and unexpected emergency plan coverage.

According to Rawson and Hammond (2009) “by assessing vulnerabilities and taking ideal preventive actions, loss could be minimized within an emergency(p. 506). Health care establishments should include prevention measures within their emergency strategies that include the risk of terrorist disorders. While terrorist attack risk cannot be completely mitigated, is it doesn’t responsibility from the health care center to be well prepared for such an emergency. Attain additional information upon including risk of terrorist attacks from the Nationwide Institute for Occupational Basic safety and Overall health (NIOSH). Quality management procedures

1 . Faithfulness to evidence-based clinical guidelines

While it has been shown that “clinicians have got customarily appreciated a great deal of autonomy in their practices (Argawal, 2010, para 3), it is essential that doctors follow evidence-based clinical recommendations. If conditions should be built the details of, the patient medical diagnosis and variants should be presented for expert review ahead of altering treatment plans. installment payments on your Minimum score of 88% on customer satisfaction surveys

Doctors must keep an average credit score of no less than 88% on customer satisfaction surveys quarterly. In the current health care market, measurements of quality include consumer satisfaction. In fact , Bernard and Savitz (2009) state that in todays “competitive healthcare environment, customers want and expect better health care services and clinic systems concern maintaining all their overall image (p. 185). Relationship among risk and quality administration

In the past, risk management officers and quality improvement managers worked well autonomously in one another, in reality they usually reported to be able to superiors. Nevertheless , today health care organizations will be realizing that in order to reach quality of care goals and maintain effective risikomanagement programs these types of disciplines need to work together closely. An example of just how risk management work and top quality improvement efforts complement each other is seen in the reduction of medical problems. The risk managing plan need to consider methods to reduce medical errors, as the quality improvement plan will offer you solid methods toward minimizing medical problems (Sollecito and Johnson, 2013). Conclusion

This summary aimed at topics including the purpose of risk and quality management, risk identification and management, current risks, top quality outcomes, company goals, and the relationship among risk and quality management. While KP is the nation’s largest integrated health care delivery systems and leader in CQI standardization, there is always room for improvements. This specialist understands the importance of improvement at KP, thus humbly presents this kind of summary and recommendations for the board of directors.


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