2008 Salary Survey Results

Risk management still offers great opportunities

Seek close alliance with upper management

Risk management continues to be an exciting career opportunity that offers new challenges all the time, says Georgene Saliba, RN, HRM, CPHRM, FASHRM, administrator for claims and risk management at Lehigh Valley Hospital & Health Network in Allentown, PA, and president of the American Society for Healthcare Risk Management (ASHRM) in Chicago.

Saliba has been in the field for 25 years, and she acknowledges that most people, herself included, didn't set out from the start to pursue a career in health care risk management. But however you end up in the position, it offers substantial opportunities for those willing to position themselves well and work hard, she says.

"I always told myself that if I woke up in the morning and it wasn't something I wanted to do, I would move on. But I haven't gotten there yet," Saliba says. "Do I still see opportunities and possibilities to advance in your career? Yes, I absolutely do. As we focus more and more on medical errors and keeping our patients safe, risk managers can be at the forefront to help identify those areas that have a potential for harm to our patients."

Risk managers are best positioned to be proactive in preventing medical errors, she says. One of the best ways to prevent errors in the future is to encourage near-miss reporting now, she says. If you can identify the processes that almost harmed a patient but didn't this time, you can prevent much more serious incidents later, she says.

But to do that kind of proactive work and make the most of your career, you must be positioned to have the ear of senior management, Saliba says.

"You have to promote that culture of open, honest communication; transparency in everything you do," she says. "But you can't do that alone, and that means you must put yourself in a position where you can go to senior management and they will listen when you explain why that kind of culture is important or why a particular initiative is necessary."

Seek to improve risk manager's image

Saliba says one of her goals as a leader in health care risk management is to not only elevate the profession to a position of more respect and authority in health care, but also among the general public. Too often, she says, risk managers still are thought of as the adversaries of patients and families - sometimes even staff - or the folks who come in to protect the hospital after something goes wrong. That is the old image of risk managers - not at all in line with the way most risk managers think of their jobs these days - but Saliba says the negative image still persists.

"When Dennis Quaid was on '60 Minutes' talking about how his twins got an overdose while in the hospital, he was describing who greeted him at the door; and when he said the risk manager was there, he dropped his voice like it was something negative," she says. "My goal is for everyone to be able to talk about risk managers without dropping their voice."

Risk managers have been gaining more respect in recent years, Saliba says, beginning with the way health care organizations more readily recognize the value that a risk manager can bring. Many still do not employ enough risk managers, trying instead to just heap more work on one risk manager or a few, she notes.

Saliba says she does see reason for optimism about how the health care field is treating risk managers now. More risk managers are treated as upper management, with direct access to the top tiers of administration, she says. Allying closely with quality can help with that goal by tearing down silos and getting your voice heard at the top with fewer obstacles.

"We're not the naysayers anymore. We're not just the people who say no to everything," Saliba says. "More organizations are recognizing that our goal is to facilitate care to the patient and improve outcomes for the organization, not to be the designated bad guy in the system who says, 'No.'"

Saliba urges risk managers to be as visible as possible within their organizations, from the lowest levels right up to the boardroom.

"Make sure everyone knows you and what you contribute, what you do for patients, and what you do for the organization," she says. "Don't leave it up to them to draw their own conclusions."

Economy will have effect

The economy is on the minds of everyone these days, including risk managers, says Douglas J. Borg, MHA, ARM, CPHRM, director of insurance for Duke Health System in Durham, NC, and immediate past president of ASHRM. Health care organizations are affected just like most other employers, so risk managers can expect to see budget cuts, he says. The depth of those cuts will differ from one employer to another, but at a minimum, Borg says, you can expect to see cuts in nonessential expenses such as travel.

"We also may see staff positions frozen. There's no room for error right now, and until the economy turns around, we may see our own programs pressured to show their value," Borg says. "We can't afford for risk management to be seen as a luxury, because luxuries are the first thing to be cut."

That means you must continue to emphasize your role in what really matters to the organization - the key components of risk management, such as patient safety and reducing liability expenses.

"We've got a terrific opportunity right now with the CMS never-events. Instead of waiting for someone to come and ask what that means to us, take the initiative and find out what it means to your organization, what the financial impact will be, and take that forward," Borg points out. "We can look for ways to save our organizations' money, because that is what is on everyone's mind right now. We want to be seen as leaders and team players, because if we are seen in roles of supporting everyone else, we are less likely to be seen as expendable."

Borg also recommends improving your credentials by pursuing more certification and education when possible. Even improving your speaking and presentation skills can make a big difference in advancing in your career, he says.

"We need to be honest about ourselves and assess where we need some improvement in things like making presentations to a group or speaking to others. Good skills in these areas can go a long way to advancing your career, and they don't necessarily come easily to everyone," Borg says. "You more often notice when they're bad than when they're good. So, if you know you're not good at those skills, it's worth taking the time to improve."