Risk inventory points staff in right direction

Make it easy for staff to respond appropriately

Would a member of your hospital's records department know what to do if a subpoena were served on her? If a parent of a patient were suspected of child abuse, would your nurses know whom to alert?

The risk manager at St. Michael Health Care Center in Texarkana, TX, created an inventory of risk management policies, so staff know whom to call. The inventory is a user-friendly chart that lists topics in risk management and the appropriate person to call for each concern, says Toni Lockhart, BS, HCRM, risk manager at St. Michael.

Lockhart prepared the inventory after she found herself answering frequent questions from staff about whom they should call when an incident occurs.

"[The inventory] takes medical-legal, regulatory, and consent-type issues and cross-walks you over to the responsible parties," Lockhart says.

Each topic area is categorized into specific risk management issues for clarification. For example, under "Fire Safety," Lockhart lists functions like identification of potential fire hazards, maintenance of fire protection equipment, and employee orientation.

Using the index of the supervisor's manual she had written for the hospital, Lockhart abstracted all of the risk management concerns. She also reviewed job descriptions of hospital administrators and managers to determine who was in charge of each area. The inventory was then included in every supervisor's manual for easy accessibility.

Following are steps Lockhart suggests for creating a risk management function inventory for your health care facility:

* Follow your own risk management plan as a guide.

Look at your own handbook to see what areas comprise risk management. As an example, Lockhart says the risk manager is not always the one responsible for regulatory standards.

* Make a comprehensive list of the issues.

Once you've compiled a list of risk management functions, "brainstorm" on the full range of potential issues, so staff who refer to the inventory have examples of what kind of incidents arise under each risk management subject, Lockhart suggests.

* Check that you've covered every important risk management function.

Key areas that Lockhart covered include regulatory standards, infection safety, plant technology and safety, legal issues, consents, and patient complaints.

* Confirm responsibilities of all personnel listed in the inventory.

This is a key element in light of the reorganizations many hospitals are undergoing, Lockhart says. She found in her hospital that job titles do not always correlate with job responsibilities.

* Make sure the inventory is accessible.

Lockhart has included the inventory in every supervisor's manual.

* Keep the inventory updated.

An out-of-date inventory is as good as no inventory, Lockhart cautions. Continuously update the chart. Every time the hospital is reorganized or personnel changes occur, confirm that the person holding that title still has the same risk management responsibilities.

The inventory has been a positive experience for staff and for the risk manager. The number of telephone calls Lockhart receives from hospital staff asking whom they should call has dropped dramatically, giving her more time to do her "real" job, Lockhart says.

Minimizing avoidance

The inventory also has smoothed the handling of risk management incidents in the hospital. "Sometimes there was a lot of avoidance," Lockhart explains. "People were embarrassed because they thought they should know whom to call and did not."

The inventory also has improved patients' perceptions of the hospital. "If you fumble around because you don't know whom to call and what to do, the hospital does not look good," Lockhart says. "Most people don't realize how complex hospital risk management is. Now you can take the supervisor's manual and say, 'Let me tell you what to do.' The hospital looks more polished in the complex systems in which we work." *