Staffing risk management per bed size is difficult

Question: Our hospital recently merged with several smaller facilities, and now our risk management department is responsible for overseeing the entire organization. We are trying to determine what would be an appropriate staff size for our department. Is there a rule of thumb regarding how many full-time equivalents (FTEs) per number of beds is best for the risk management department? How does it differ if you put risk management, quality assurance, and corporate compliance under one umbrella?

Answer: There is no simple way to make such a calculation, says Grena Porto, RN, ARM, DFASHRM, director of clinical risk management and loss prevention services at VHA Inc. in Berwyn, PA, and past president of the American Society for Healthcare Risk Management. It is possible to develop a bed size/FTE ratio for other positions or departments in the hospital, but Porto says staffing for the risk management department is too complicated for such a simple formula.

To determine the proper staffing for a risk management department, Porto says you will have to look at a long list of factors and determine how your organization uses the department. The role of health care risk managers has changed so much in recent years that no single job description fits, she says. From one institution to another, the role of risk manager may entail very different work.

"Your staffing depends on things like what your department is doing, your risk financing mechanism, and how big the institution is," she says. "Those are the big drivers, so you have to know a lot more about the facility than just how many beds there are or some single number like that."

For instance, a commercially insured organization will not need as much risk management staffing as a self-insured trust, Porto says. The self-insured organization will need more risk managers to handle the in-house insurance concerns that otherwise would be handled by a vendor. Likewise, a streamlined risk management department that does only clinical risk management will be able to get by with fewer staff. But if the same department also is responsible for managing workers’ compensation claims, for instance, that added workload will require more staff.

It is safe to say the department’s staff size should increase as you include more functions under the risk management umbrella. A major task such as corporate compliance, for instance, will take time that a risk manager otherwise might spend on clinical risk management.

"Unfortunately, it’s always a difficult decision to make," Porto says. "You can make comparisons to other organizations in your community and adjust for size differences, but you also have to adjust for all the other differences. It seems no two organizations are ever alike when you look at all these factors."