Recruit staff from all over to keep you informed
Every risk manager thinks the job is too big for one person, especially as health systems keep heaping on more and more responsibility, so maybe you shouldn't try to do it alone. A better strategy is to recruit unofficial risk managers throughout the hospital, from all departments, to be your eyes and ears and to reinforce your risk management strategies when you can't be there to do it in person.
That's the advice from Denise C. Myers, RN, MS, CNAA, CPHRM, director of risk management at Monongalia Health System in Morgantown, WV, where she has employed that strategy to great effect. She reports that the program has increased incident reporting by 400% in five years.
Myers began the effort in 1998 when she joined Monongalia. At that time she received only about 30 incident reports a month, and she knew there was more going on than that.
"So I went to staff meetings and started telling people that we wanted to hear about everything, not just the one time something really bad happened," she says. "I had to let them know that we wanted them to talk to us, that we were eager to hear from them, and that's where this all started."
Recruiting others to help with risk management offers several benefits, Myers says. First, there is strength in numbers. More people means you can do more work. Plus, they are the ones who are in the trenches at your hospital and know what's going on.
Having people from other departments on your team also lowers the mystique, and the fear, that sometimes surrounds risk management, she says. You also will see increased ownership in the process and more buy-in for corrective actions.
The effort pays off, reports Susan S. Brewer, JD, an attorney with the law firm Steptoe & Johnson in Morgantown, and the health system's general counsel. She says there has been a significant reduction in litigation against the hospital since Myers began her campaign. In previous years, there usually were nine or 10 lawsuits against the hospital open at any time, but currently there are only two.
"You get real results when you include people from the very top to the very bottom of the pay scales and everyone in between," Brewer explains. "The input you get from some of the staff in housekeeping and food service, for instance, can be extremely revealing because these are people who are out on the floors all the time, doing their jobs and seeing everything as it really is on a daily basis, not just when a manager walks down the hall."
Myers and Brewer say frontline staff often already have an interest in patient safety and risk management issues, so you only have to give them a voice. In many cases, you don't have to convince them that they can contribute. You only have to convince them that they are welcome on the risk management team and that their contributions are valued.
"I spent a lot of time out and about, convincing people that I wanted to talk to them, that I wanted to be approached," Myers says. "It takes some work to change that impression that risk management is a department you want to avoid because it means you messed up and there might be a lawsuit."
So what does it mean to recruit risk managers from other departments? It can mean different things for different staff.
For administration, it might mean encouraging top-level executives — your chief executive officer, chief financial officer, vice president of patient care, director of nursing, vice president of medical affairs, and general counsel — to participate directly in risk management activities. For instance, Myers recommends having vice presidents sign off on incident reports so they are aware of what is happening and how you are managing those incidents. They also can participate on the sentinel event response team and the risk management committee.
Myers also recruits members of the health system's board of directors to sit on the risk management committee, and she makes risk management a standard agenda item for the board. She also recruits physicians to participate, both those employed by the health system and those privileged to practice there.
One of the keys to success, however, is to recruit all the way down the line, Myers says. Include staff who aren't usually seen as key players. Look for candidates in transport, housekeeping, dietary, the business office, and maintenance. When educating them about risk management issues, you should be sure to present the material at a level commensurate with their education and ability to understand, Brewer says.
"A lot of what you are educating these people about is basic information anyway," Brewer notes. "You don't have to get into complicated risk management strategies and policies." Sometimes it's as simple as reminding them to wear their name tags so people can see them and to check identification bracelets on patients, she says. "It sounds basic to us, but they don't hear it nearly as much as we do," Brewer says.
Sources
For more information on recruiting assistant risk managers, contact:
- Susan S. Brewer, Steptoe & Johnson, 1085 Van Voorhis Road, Suite 400, P.O. Box 1616, Morgantown, WV 26507-1616. Telephone: (304) 598-8103.
- Denise C. Myers, Director, Risk Management, Monongalia Health System, 1200 J.D. Anderson Drive, Morgantown, WV 26505. Telephone: (304) 598-1404.
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