Risk Management Handbook for Health Care Organizations, Student Edition This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for…mehr
Risk Management Handbook for Health Care Organizations, Student Edition This comprehensive textbook provides a complete introduction to risk management in health care. Risk Management Handbook, Student Edition, covers general risk management techniques; standards of health care risk management administration; federal, state and local laws; and methods for integrating patient safety and enterprise risk management into a comprehensive risk management program. The Student Edition is applicable to all health care settings including acute care hospital to hospice, and long term care. Written for students and those new to the topic, each chapter highlights key points and learning objectives, lists key terms, and offers questions for discussion. An instructor's supplement with cases and other material is also available. American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association with more than 5,000 members representing health care, insurance, law, and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking, and interactions with leading health care organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, preserving financial resources, and maintaining safe working environments.Hinweis: Dieser Artikel kann nur an eine deutsche Lieferadresse ausgeliefert werden.
ROBERTA CARROLL, ARM, MBA, CPCU, CPHRM, is senior vice president of Aon Healthcare based in Tampa, Florida.
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Exhibits, Figures, Tables, and, Photos ix The Contributors xiii Preface xxvii About the Book xxix ONE Development of a Risk Management Program 1 Learning Objectives 1 Risk Management Program Development 3 Key Structural Elements of the Risk Management Program 4 Scope of the Risk Management Program 8 The Risk Management Process 13 Evolution of the Risk Management Program 21 Selecting an Appropriate Risk Management Program Structure 22 Assessing Areas of the Organization That Need Risk Management 23 Key Components for Getting Started 26 Writing a Risk Management Program Plan 27 Achieving Program Acceptance 27 TWO The Health Care Risk Management Professional 31 Learning Objectives 31 The Risk Manager's Job: Functional Areas of Responsibility 33 Health Care Risk Management across a Spectrum of Settings 53 Required Skills for the Successful Health Care Risk Management Professional 76 Risk Management Ethics 77 A Profile of the Health Care Risk Management Professional 78 Education and Professional Recognition Programs 78 THREE Patient Safety and the Risk Management Professional 87 Learning Objectives 87 The Scope of Medical Errors 89 Seeking Solutions: What Are the Causes of Medical Errors? 91 FOUR Health Care Legal Concepts 115 Learning Objectives 115 Legal Issues Common to All Health Care Providers 116 Legal Issues Related to Specific Health Care Providers 134 FIVE Governance of the Health Care Organization 157 Learning Objectives 157 Essential Responsibilities of the Hospital Board 159 Basic Legal Duties of Health Care Trustees 160 Lessons from the Panel on the Nonprofit Sector 162 Federal Sentencing Guidelines for Organizations 165 The Sarbanes-Oxley Act of 2002 167 The Volunteer Protection Act of 1997 169 Risk Management and the Board 170 The Medical Staff, Risk Management, and the Board 175 SIX Early Warning Systems for the Identification of Organizational Risks 181 Learning Objectives 181 Early Identification of Exposure to Loss 182 Food and Drug Administration 206 Institute for Safe Medication Practices, United States Pharmacopeia, and National Coordinating Council for Medication Error Reporting and Prevention 208 Medical Event Reporting System-Transfusion Medicine 212 Intensive Care Unit Safety Reporting System 212 Pittsburgh Regional Healthcare Initiative 212 Other Voluntary Programs 212 Standardizing a Patient Safety Taxonomy: The National Quality Forum 213 Protecting Sensitive Information 213 SEVEN the Risk Management Professional and Medication Safety 219 Learning Objectives 219 Latent and Active Failures 220 Systems Thinking 221 Risk Management: A Prioritizing Approach 252 Eight Ethics in Patient Care 261 Learning Objectives 261 Ethical Principles and Moral Obligations 263 Research 263 Institutional Review Boards 266 Patient Self-Determination Act 275 "Do Not Resuscitate": Withholding or Withdrawing Treatment 277 NINE Documentation and The Medical Record 287 Learning Objectives 287 Documentation 291 Record Retention 310 Release of Records 310 Ownership of Medical Records 311 Medical Record Audits 312 Documentation and Risk Management 313 Emerging Risk Exposures 320 The Risk Management Professional's Role 321 TEN Statutes, Standards, and Regulations 327 Learning Objectives 327 Patient Care 328 Medicare Modernization Act 331 Medical Staff 332 Life Safety Code 350 Federal Health Insurance Laws and Regulations 354 Tort Reform 357 Policy and Procedure Manuals 359 Case Law 360 ELEVEN Basic Claims Administration 367 Learning Objectives 367 The Claims Environment 368 The Claims Process 369 The Risk Management Professional's Responsibilities 371 Regulatory Reporting of Claims 378 TWELVE Introduction to Risk Financing 381 Learning Objectives 381 Risk Financing in the Context of the Risk Management Process 384 Risk Retention 384 THIRTEEN Insurance: Basic Principles and Coverages 395 Learning Objectives 395 Definition of Insurance 396 Specific Types of Insurance for the Health Care Industry 408 FOURTEEN Information Technologies and Risk Management 427 Learning Objectives 427 Risk Management Information Needs 430 Risk Management Information Systems 431 Using Information Systems to Generate Reports 432 Integrating Risk Management, Quality Assurance, and Patient Safety 433 Electronic Mail 434 Internet- and Web-Based Technology 435 Personal Health Record 435 Electronic Health Records and Systems 436 Clinical Information Systems and "Smart" Technologies 437 Infrastructure Technology 440 Point-of-Care Technology 442 Telemedicine 442 Appendix 14.1: IT Glossary for Risk Managers 447 FIFTEEN Risk Management Metrics 451 Learning Objectives 451 Benchmarking Defined 453 Claims 456 Measuring Change 459 Developing New Metrics 461 SIXTEEN Acreditation, Licensure, Certification, and Surveying Bodies 467 Learning Objectives 467 The Consumer Era of Health Care 468 What the Health Care Risk Management Professional Needs to Know 469 Mandatory Surveying Bodies 471 Voluntary Surveying Bodies 475 URAC 489 Appendix 16.1: Accreditation and Licensure Organizations, Surveying Bodies, and Government Agencies 501 SEVENTEEN Emergency Management 503 Learning Objectives 503 The Steps of Emergency Management 505 Prevention 506 Planning and Preparation 511 Implementation and Response 525 Recovery 526 Recommended Web Sites 528 EIGHTEEN Occupational Safety, Health, and Environmental Impairment 529 Learning Objectives 529 Administrative Procedure Act 530 Administrative Enforcement 532 Specific Occupational Safety and Health Issues 535 APPENDIX A A RISK MANAGEMENT PROGRAM (EXAMPLE) 543 APPENDIX B REQUEST FOR RECORDS form (EXAMPLE) 549 APPENDIX C A GUIDE TO MEDICAL TERMINOLOGY 551 GLOSSARY 565 INDEX 623
Exhibits, Figures, Tables, and, Photos ix The Contributors xiii Preface xxvii About the Book xxix ONE Development of a Risk Management Program 1 Learning Objectives 1 Risk Management Program Development 3 Key Structural Elements of the Risk Management Program 4 Scope of the Risk Management Program 8 The Risk Management Process 13 Evolution of the Risk Management Program 21 Selecting an Appropriate Risk Management Program Structure 22 Assessing Areas of the Organization That Need Risk Management 23 Key Components for Getting Started 26 Writing a Risk Management Program Plan 27 Achieving Program Acceptance 27 TWO The Health Care Risk Management Professional 31 Learning Objectives 31 The Risk Manager's Job: Functional Areas of Responsibility 33 Health Care Risk Management across a Spectrum of Settings 53 Required Skills for the Successful Health Care Risk Management Professional 76 Risk Management Ethics 77 A Profile of the Health Care Risk Management Professional 78 Education and Professional Recognition Programs 78 THREE Patient Safety and the Risk Management Professional 87 Learning Objectives 87 The Scope of Medical Errors 89 Seeking Solutions: What Are the Causes of Medical Errors? 91 FOUR Health Care Legal Concepts 115 Learning Objectives 115 Legal Issues Common to All Health Care Providers 116 Legal Issues Related to Specific Health Care Providers 134 FIVE Governance of the Health Care Organization 157 Learning Objectives 157 Essential Responsibilities of the Hospital Board 159 Basic Legal Duties of Health Care Trustees 160 Lessons from the Panel on the Nonprofit Sector 162 Federal Sentencing Guidelines for Organizations 165 The Sarbanes-Oxley Act of 2002 167 The Volunteer Protection Act of 1997 169 Risk Management and the Board 170 The Medical Staff, Risk Management, and the Board 175 SIX Early Warning Systems for the Identification of Organizational Risks 181 Learning Objectives 181 Early Identification of Exposure to Loss 182 Food and Drug Administration 206 Institute for Safe Medication Practices, United States Pharmacopeia, and National Coordinating Council for Medication Error Reporting and Prevention 208 Medical Event Reporting System-Transfusion Medicine 212 Intensive Care Unit Safety Reporting System 212 Pittsburgh Regional Healthcare Initiative 212 Other Voluntary Programs 212 Standardizing a Patient Safety Taxonomy: The National Quality Forum 213 Protecting Sensitive Information 213 SEVEN the Risk Management Professional and Medication Safety 219 Learning Objectives 219 Latent and Active Failures 220 Systems Thinking 221 Risk Management: A Prioritizing Approach 252 Eight Ethics in Patient Care 261 Learning Objectives 261 Ethical Principles and Moral Obligations 263 Research 263 Institutional Review Boards 266 Patient Self-Determination Act 275 "Do Not Resuscitate": Withholding or Withdrawing Treatment 277 NINE Documentation and The Medical Record 287 Learning Objectives 287 Documentation 291 Record Retention 310 Release of Records 310 Ownership of Medical Records 311 Medical Record Audits 312 Documentation and Risk Management 313 Emerging Risk Exposures 320 The Risk Management Professional's Role 321 TEN Statutes, Standards, and Regulations 327 Learning Objectives 327 Patient Care 328 Medicare Modernization Act 331 Medical Staff 332 Life Safety Code 350 Federal Health Insurance Laws and Regulations 354 Tort Reform 357 Policy and Procedure Manuals 359 Case Law 360 ELEVEN Basic Claims Administration 367 Learning Objectives 367 The Claims Environment 368 The Claims Process 369 The Risk Management Professional's Responsibilities 371 Regulatory Reporting of Claims 378 TWELVE Introduction to Risk Financing 381 Learning Objectives 381 Risk Financing in the Context of the Risk Management Process 384 Risk Retention 384 THIRTEEN Insurance: Basic Principles and Coverages 395 Learning Objectives 395 Definition of Insurance 396 Specific Types of Insurance for the Health Care Industry 408 FOURTEEN Information Technologies and Risk Management 427 Learning Objectives 427 Risk Management Information Needs 430 Risk Management Information Systems 431 Using Information Systems to Generate Reports 432 Integrating Risk Management, Quality Assurance, and Patient Safety 433 Electronic Mail 434 Internet- and Web-Based Technology 435 Personal Health Record 435 Electronic Health Records and Systems 436 Clinical Information Systems and "Smart" Technologies 437 Infrastructure Technology 440 Point-of-Care Technology 442 Telemedicine 442 Appendix 14.1: IT Glossary for Risk Managers 447 FIFTEEN Risk Management Metrics 451 Learning Objectives 451 Benchmarking Defined 453 Claims 456 Measuring Change 459 Developing New Metrics 461 SIXTEEN Acreditation, Licensure, Certification, and Surveying Bodies 467 Learning Objectives 467 The Consumer Era of Health Care 468 What the Health Care Risk Management Professional Needs to Know 469 Mandatory Surveying Bodies 471 Voluntary Surveying Bodies 475 URAC 489 Appendix 16.1: Accreditation and Licensure Organizations, Surveying Bodies, and Government Agencies 501 SEVENTEEN Emergency Management 503 Learning Objectives 503 The Steps of Emergency Management 505 Prevention 506 Planning and Preparation 511 Implementation and Response 525 Recovery 526 Recommended Web Sites 528 EIGHTEEN Occupational Safety, Health, and Environmental Impairment 529 Learning Objectives 529 Administrative Procedure Act 530 Administrative Enforcement 532 Specific Occupational Safety and Health Issues 535 APPENDIX A A RISK MANAGEMENT PROGRAM (EXAMPLE) 543 APPENDIX B REQUEST FOR RECORDS form (EXAMPLE) 549 APPENDIX C A GUIDE TO MEDICAL TERMINOLOGY 551 GLOSSARY 565 INDEX 623
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