Little risk in allowing staff to make some decisions

The attorney contact policy at Harborview Medical Center in Seattle might fly in the face of some risk management ideas by allowing frontline staff to handle attorney calls instead of referring all of them to risk management. Nevertheless, there is little risk if the policy is handled well, says Lisa Vincler, JD, assistant attorney general for the state of Washington in Seattle.

Vincler worked with Helen Johnson, RN, risk manager at Harborview, and University of Wash ington officials to develop the policy, making sure it didn’t unduly expose the hospital or infringe on its legal obligations to release information. Vincler says the team considered the risk of putting more responsibility in the staff’s hands but ultimately determined the risk already existed because, for better or worse, the staff already were taking the calls. Risk management was unable to field all the calls, so the best solution was to devise a policy that helped the staff handle them.

"There is a risk that mistakes may occur," she says. "However, the likelihood of mistakes can be greatly reduced through staff education. I am not aware of any disadvantages in having such a policy, provided staff receive some education about the policy and that staff don’t hesitate to call either the risk manager or legal counsel if they need specific advice."

Two points were particularly important to get across to the staff, Vincler says. First, she wanted the policy to emphasize that "subpoenas are not invitations’ and, when properly served, they require a response." She also made sure the policy reminded staff that original medical records should not be removed and taken to court or depositions by anyone other than medical records department staff. Doing so could threaten the integrity of the records.