Risk managers at the crossroads: Take advantage of opportunities

Be careful: The job description changes rapidly

Risk managers have seen their jobs change in myriad ways in recent years, but nothing like what will happen in the next few years, say many leaders in health care risk management.

They believe risk managers are at a crossroads and how you react now will determine the course of your career.

Some risk managers worry that risk managers are becoming extinct, systematically replaced by patient safety officers and other people with titles bearing little resemblance to the risk manager of five or 10 years ago. There may be some truth to it, but some say risk managers are not being pushed out — just pushed to change.

But you might have to change in a big way, says Barbara Youngberg, BSN, MSW, JD, FASHRM, vice president of insurance, risk, quality, and legal services with the University HealthSystem Consortium in Oakbrook, IL. Youngberg worries that many risk managers underestimate how much the health care industry is changing and how much they may need to reinvent themselves to remain valuable. The increasing focus on patient safety, plus the continuing insurance crisis, changed the way health care institutions look at risk managers, she says.

"There is a much greater public awareness of the need for creating safe systems in health care," she says. "Risk managers, historically, have been in more of a reactive discipline, trying to understand what happened and fix it. The whole focus now is to look at what might give rise to failure and prevent it. You’ve got to be able to do that."

And that is not an easy change to make, she says. It is much more than changing your attitude and saying you will focus on prevention and be more proactive. To really change the way you do your job, many risk managers will have to develop new skills, Youngberg says.

"Everything is going to be more data-oriented," she says. "Risk managers have to be able to collect more data and know what they mean. A lot of people collect data but don’t know what to do with it. That won’t be enough in the future."

Some risk managers worry their profession is on the path to extinction, says Grena Porto, RN, ARM, DFASHRM, senior director of clinical operations at VHA Inc. in Berwyn, PA, and past president of the American Society for Healthcare Risk Management. She says she wouldn’t go that far in assessing the problem, but she still worries that risk managers could see themselves pushed out of the picture if they don’t make some changes. 

"It’s because of all of the focus on safety," she says. "Many of the fundamental concepts of a high-reliability organization, which is what defines a safety-driven focus these days, are totally the opposite of what we do in risk management."

Risk managers must abandon the old-style type of risk management in favor of the more proactive, open type of management that is driving the health care industry now, she says. In the past, risk managers have focused on preventing the dissemination of information, which she says is antithetical to a high-reliability organization. That term, "high-reliability organization," defines what health care organizations strive for. It is most commonly defined as "one that functions consistently and reliably over long periods of time without error."

Under that approach, old-style risk management can be a serious hurdle because it focuses on keeping a tight lid on information that might be damaging. As the health care industry continues to evolve, organizations will not have use for risk managers standing at the hospital door to bar anyone who wants information.

"We already don’t have effective risk-auditing systems because we have created burdensome behemoths to protect information," she says. "We’re so scared of something being discoverable that we stifle discussion of risk auditing. We’re so scared about information getting out in the wrong hands that we stifle the learning that should happen."

The emphasis on defending legal claims can be a major cause of the risk manager’s efforts to protect information and avoid liability at all costs, Porto says. The effect, of course, is that a risk manager may successfully defend one claim while missing the opportunity to fully investigate the incident and stop it from happening again.

"Risk managers can’t even agree on what quality is, when the rest of the industry is saying quality is the most important thing. I was speaking one time and used the example of a retained foreign body, and there were risk managers in the audience who said they could defend that case, that it wasn’t necessarily proof of a quality problem," she says. "Why would you defend that? Why would you spend resources trying to explain that a retained foreign body isn’t really a problem? This ultimately will be our undoing if we don’t change our way of thinking."

Risk managers need to evolve, but they will always be around, says Monica Berry, BSN, JD, LLM, DFASHRM, CPHRM, vice president of risk management and loss control for the Rockford (IL) Health System. She also is president of the American Society for Healthcare Risk Management (ASHRM). The role of the risk manager has always varied tremendously from one organization to another, she says, with some taking on more responsibilities than others. So in that way, the next few years shouldn’t be a shock. But the trend is definitely for risk managers to take on more.

"In some organizations, the risk manager is directly involved with the purchase of insurance; and in others, the risk manager gets nowhere near that and the CFO [chief financial officer] does that part of the job," Berry says. "At one point, we saw evolution of the chief risk officer. That role still exists, but it’s not yet embraced in health care. Things have always been changing, and now we’re seeing a trend toward more responsibility and patient safety."

But Berry points out that risk managers have been involved in patient safety since the beginning. The important point now is that different methodology is preferred for protecting patients, visitors, and employees. That means you need to acquire those skills, but the fundamental role of the risk manager will remain.

"I see the role of the risk manager as always being at the table. We’re never going to get away from those fundamentals, but it’s a matter of what’s the soup du jour. What’s the name we’re giving it this year?" Berry says. "I don’t see risk managers or their function morphing into nonexistence. That just won’t happen. We play too much of a key role in the organization."

On to senior leadership

Youngberg agrees that the fundamentals of risk management always will have a place in health care, but she says they won’t be enough for your career to thrive. The driving forces behind the changes are the focus on medical errors and the hard insurance market, but she says the profession must take some responsibility for the failure — in some areas — of traditional risk management approaches. Health care organizations have seen the way risk managers addressed issues in the past, and most of them are saying that approach won’t be sufficient in the future.

That’s not to say, however, that the health care community is pushing risk managers aside or easing them out of the system. To the contrary, health care providers are looking to risk managers to take on more responsibility and more leadership roles within the institution, Youngberg says. But you have to seize that opportunity now or watch your position wither away.

"Risk managers are not usually seen as senior leaders. They’re seen more as middle managers," she says. "Organizations are looking for the risk managers now to rise to a higher level of leadership because that’s what the new focus requires. In organizations that have embraced a safety paradigm, risk managers are being given safety departments to manage and are rising to meet the added challenge. I’m afraid your choice is to either do that or be phased out and marginalized."

In essence, the risk manager’s field is becoming a larger expense and a more important focus for health care organizations. That means employers will hold the risk manager to a higher standard and elevate the risk manager’s role.

"But it could elevate the risk manager’s role to a point where the current risk manager it not seen as capable of the job. That’s a real concern," Young-berg says. "The ones that have positioned themselves well, becoming more data-savvy and business-oriented, might be viewed as the right person to manage this. But I suspect that some risk managers may not."

The good news, Youngberg says, is that risk managers can reap tremendous benefits if they seize the opportunity now to improve their skills. The role of the risk manager may be quite different five years from now, but that doesn’t mean it has to be worse, she says. Risk managers who acquire the right skills can find they are taking on leadership roles previously unattainable, she says.

"You have to be more strategic and get a place at the table where the important decisions take place," she says. "But you don’t get invited to that table with the senior leaders unless you develop some additional skills. You have to have something to offer."

Berry and Youngberg’s advice might sound dismaying, but they say risk managers should just accept that their careers are evolving and take advantage of the opportunities to excel. There is no need to change to a different career — even if your title changes. Rather, they just advise keeping up with the changes in your chosen career.

"I don’t want people to worry about career opportunities. In fact, this is going to open the door for us," Berry says. "The shift to patient safety gives us the opportunity to tout that this is what risk management as always been about. Here’s an opportunity to showcase what the profession of risk management is all about. We’re not going anywhere."

Youngberg advises health care risk managers to pursue educational opportunities with the goal of enhancing their skills in ways that will satisfy the changing needs of health care institutions. That means studying data collection, statistics, quality improvement, insurance, finance, and other "top-tier" business skills. And she offers this specific advice: Don’t shy away from the financial topics. Many risk managers have had only cursory involvement with risk financing and insurance purchasing, for instance, but Youngberg says that is likely to change. Any manager who has financial skills is more likely to become a leader in the organization, she says.

Educational opportunities can be found through many professional organizations and universities, Youngberg says. Don’t waste time getting started, she advises.

"I don’t think the risk manager will be doing the same work in five years," she says. "If they are, they’re going to be in a marginal position in the organization."