Health care risk management has been evolving since its inception, so the current changes in the job description are nothing new, says Grena Porto, RN, ARM, DFASHRM, senior director of clinical operations at VHA Inc. in Berwyn, PA, and past president of the American Society for Healthcare Risk Management. She offers this summary of the profession’s evolution:
• 1970s — The Birth of Risk Management
At this point, risk management was closely tied to insurance companies, with an emphasis on professional liability and general liability losses. There was little integration with quality initiatives. Quality measurement consisted mainly of counting incident reports.
• 1980s — The Good Old Days
Risk management has evolved so that it is seen as an independent and important function in the health care system. The risk manager’s role is broadening to include managed care, directors & officers liability, and similar issues. A move toward integrating risk management and quality improvement (QI) initiatives begins. Measurement now includes the trending of incident reports.
• 1990s — Risk Management Under Fire
The distinction between risk management and QI becomes blurred, and QI starts to take on more prominence. Risk managers focus more on regulatory compliance and still don’t focus much on prevention. There is an overemphasis on risk avoidance without any real proof of effectiveness. A soft insurance market encourages complacency. Measurement still consists of trending incident reports.
• 2000 — Risk Management Eclipsed by Patient Safety
The Institute of Medicine’s report To Err is Human focuses attention on medical errors but barely mentions risk management. Some see the report as proof that risk management has failed. Patient safety is not seen as synonymous with risk management, and many "risk managers" are replaced by "patient safety officers."
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