The term risk management has become one of the buzzwords of all corporate communities. Practitioners of the healing arts should never forget that the only real risk is to the life and well-being of the patient and that risk management should really mean controlling the variables with regard to medical practice so as to maximize the patient's chances of a satisfactory outcome. To view risk management as any more or any less is to remove it from the traditional duties placed on physicians from the time of Galen. Doing what is in the best interest of the patient is generally in the short-term and long-term best interests of the healthcare professionals and the institutions they represent.
Traditionally, risk managers have used incident reports, patient complaints, and reported poor outcomes as the impetus for them to begin to “manage risk.” In its more traditional form, risk management is reactive and not proactive. It has been the division of the hospital where “bad outcomes” or “bad practice” were mitigated, if not repaired, on an after-the-fact basis. The risk was always viewed as the risk to the assets of the institution and not to the life of the patient. In the past, it was the rare institution that combined its risk management and quality assurance functions in such a way that true changes were triggered.
The newer trends in risk management take a different view of risk. The intelligent risk manager knows that his or her job is proactive, not reactive. The circle of policy formation requires input from risk management on a regular basis.
Organizing Systems to Mitigate Risk
Before risk can be approached in any meaningful way, several concepts must be internalized. The number one plank in the platform of risk management is that good things happen only when they are planned and bad things can happen all by themselves. Institutions have spent too much time providing the latest bit of equipment and not enough time actually analyzing the physical journey of the patient through the maze found in the usual healthcare institution. Studying this sojourn through the medical system from the patient's perspective is key to understanding where things go wrong.
The second major principle of risk management is taken from the quality assurance literature: that is, to emphasize the fact that 85% of the problems are system based and not based on the incompetent or malevolent actions of workers themselves. Few healthcare workers want anything for the patient but the patient's rapid return to health. Precious little time is spent in coordinating the activities of the various departments through which a patient must pass. Miscommunications between the emergency department (ED) and radiology, poor follow-up by on-call physicians, failure to properly relay information between the nurses and physicians—these are the types of system failures that frequently characterize risk management disasters in the healthcare system.