2009 Salary Survey Results

Risk managers remain valued players in health arena

Focus on never events, health care reform presents opportunities

With so much focus on health care these days — reform, malpractice, and never events on everyone's mind — risk managers are uniquely situated to influence the debate and display their value to employers.

Career prospects for risk managers remain strong, says Georgene Saliba, RN, HRM, CPHRM, FASHRM, administrator for claims and risk management at Lehigh Valley Hospital & Health Network in Allentown, PA, and 2009 president of the American Society for Healthcare Risk Management (ASHRM) in Chicago.

"With 25 years-plus in risk management and still going strong, I wouldn't still be in this business if I didn't think we had good prospects and a strong future ahead of us," she says. "We still have challenges, similar challenges to those we have faced over the years, and certainly health care reform is opening up plenty of questions and probably some new challenges for us. The continuing focus on never events and nonpayment for never events means risk managers are going to remain at the forefront of the health care field."

Risk managers should continue focusing on developing the processes and procedures that will reduce never events, Saliba says, as this issue clearly will remain an important one for the health care industry, and it is one that risk managers are uniquely qualified to address. Not only are risk managers able to understand the issue and take preventive steps better than other health care administrators, but they also can make the direct connection to the liability costs associated with never events.

In that regard, the intense focus on never events is a great opportunity for risk managers, Saliba says. Another high-profile topic in health care is technology, with health care providers adopting high-tech solutions and using sophisticated computer systems to improve many processes, but Saliba says the growing use of technology can be a double-edged sword for health care providers.

"Technology can mitigate certain risks, as we see when adopting computerized physician order entry for medications. The handwriting issue goes away," she says. "But then we see entirely different risks introduced. Are the systems speaking to one another? Who has access? What information does the system rely on? So, even when you have something positive for the provider, like this technology, the risk manager still has a vital role to play."

Risk managers should position themselves as key players in any technology decisions within the organization, Saliba says. Don't shy away from technological projects because the subject matter is too technical and assume that the IT people will consider all the potential ramifications. The risk manager's role — and it can be an opportunity to position yourself in a high-profile project — is to ferret out any potential problems that could increase liability risks or threaten patient safety.

Involvement in such projects will improve the risk manager's position within the organization, which Saliba says should be an ongoing goal for any risk manager. To further your career and advance the role of risk management in general, it is crucial to be part of the decision-making process at the highest levels and to participate in initiatives and projects that are seen as the domain of the "big players" within the organization, she says.

"That means stepping up and, not just asking to participate, but showing why your skill set is needed and why it is vital that you have input in this project," she says. "You have to get out there, you have to be known. You can't just sit behind your desk."

A risk manager's career prospects can hinge on participation in such projects, Saliba says. Develop a rapport with leaders so that they call on you for input on organizational changes, so that they see you as a resource who contributes value.

Changes in health care usually present risks and challenges for providers, which can be good for a risk manager's career, notes Gregory L. Terrell, MS, CSP, ARM, CPHRM, FASHRM, senior director of patient safety in the clinical quality department with the Tenet Healthcare Corp. in Dallas. With so many changes going on in health care now and more looming on the horizon, risk managers should have good career prospects if they position themselves to take advantage of the opportunities, he says.

"Risk managers have to stay as current as possible, and one of the ways to do that is through their professional organizations like ASHRM and their local chapters," he says. "It is more important than ever to continue with our ongoing educational opportunities and not be stagnant."

Even with budget cuts that restrict travel to conferences and other events, risk managers still should seek out education options locally and online, he says. Terrell also advises risk managers to broaden their skill sets whenever possible, rather than staying in one area of talent.

"We often have one skill set that we are comfortable with and which got us to where we are, but if we want to advance, we will need to broaden that and learn more skills that can be valuable to our employers," he say. "We can't be narrow-minded."

Terrell also sees opportunities in the efforts to enact health care reform. Fortunately, health care providers were not hit as hard as some other industries by the economic recession, and any changes brought by health care reform probably will open up a whole new batch of risk management issues to address, he says.

"I believe health care is a great industry to be in these days," he say. "There are lots of opportunities to blend risk management, patient safety, and quality. We need to continue to foster our relationships and reduce the silos whenever possible."

Risk managers have to realize that their jobs have changed over the years and almost certainly will continue to change, says Ben Gonzalez, CPHRM, PhD, director of risk management with the Montana Health Network in Billings. Thirty years ago, a risk manager's job was much more about managing claims than it is today, he notes. Malpractice claims certainly still are a primary responsibility, but the job has grown to entail much more, partly because risk managers have been successful in reducing the severity of claims in health care.

"We are seeing now that, while the frequency of claims might be up, the severity of claims is down, and there is reason to think that the severity will remain lower than it was in the past," Gonzalez says. "That is because we in the risk management field have our hospitals positioned in the best defensive position before we ever have to get involved in litigation. The challenges that we continue to have are more in the area of new laws and regulations, which require more reporting, record keeping, and standardization."

Career advancement will depend on staying abreast of the new developments and realizing what obligations — and what opportunities — are embedded in them, Gonzalez says.

"As a profession, we have evolved and will continue to evolve," he says. "The risk manager used to be a position that someone, often a nurse, took on because the insurance companies said you had to have one. Now, it is a recognized field, and people come into this field by choice, because it offers a challenge and because providers value what we can do. We have to continue ensuring that we make the most of every possibility to contribute and build our worth to health care organizations."