Creating and Reviewing Your Overall Risk Management Plan

Overview

In healthcare, every member of the team is key to the effective operation of a practice or clinic. From physicians and clinicians, allied health professionals, to office staff members – everyone plays a critical role in keeping patients safe and managing the processes that mitigate risk.

This resource is intended as a guide to help you construct an overall plan for your organization’s risk management, covering many of the main areas of concern – and to help you find more detailed information throughout our Risk Management Resource Library.

Employment

  • Hiring and credentialing: Doing your due diligence before hiring healthcare professionals (e.g., confirming that they are properly licensed and credentialed and that their experience fits your needs) is a key building block to help reduce risk. Get started with the following resources:
  • Employee job descriptions, training and evaluations: Creating and maintaining accurate job descriptions and conducting regular employee evaluations are excellent ways to ensure that both the employer and employee have a shared understanding of the expectations of their work functions. It will also help to ensure that performance is sufficient to safeguard patient care. In addition, practice leaders can look at the job descriptions and recognize potential gaps in training and supervision. Get started with the following resource:
  • Professional and ethical behavior: It’s necessary to have high standards of professionalism for all team members, including clinicians and staff alike. From handling disruptive behavior to physician ethical responsibilities to sexual misconduct prevention training, it’s important to have clear standards and ensure they are well understood throughout the team. Get started with the following resources:
  • Allied health professionals: Develop a thorough process for providing supervision and oversight of allied health professionals and fully understand their role and scope of practice. Get started with the following resource:

Medical records

  • Documentation best practices: Know and follow documentation best practices for accuracy, thoroughness and timeliness. Be sure to know how to handle documentation of off-hours interactions and information received electronically. Get started with the following resources:
  • Medical record release: The rules for release of patients’ medical records can be complicated so it’s well worth reviewing your processes and your local regulations on a regular basis. Get started with the following resource:
  • Electronic medical records: Be aware of the unique challenges of electronic medical records, and develop a plan for what to do during system downtime. Get started with the following resources:
  • Medical record security: Implement key medical record security protocols to avoid system risks large and small. It’s also important to be cognizant of risk mitigation strategies for cyber breaches and what actions to take if a breach occurs. Get started with the following resources:

Appointments, consults and test tracking

  • Tracking and follow-up: It is critically important that every medical practice has robust systems to track the progress of crucial elements of patient care, and to follow up with patients or other healthcare professionals when necessary. Get started with the following resources:

Medication management

  • Management of medication: Best practices for medication management and security should be followed. In addition, it’s imperative to construct effective policies for the management of controlled substances and other high-risk medications. Get started with the following resources:

Patient interactions

  • Code of conduct: It can be helpful to set the scene for your interactions with patients by putting mutual expectations down in writing. A patient code of conduct can be an important tool for you and your practice. Get started with the following resource from the American Society for Healthcare Risk Management (ASHRM):
  • Communication: Keep communication strategies with patients top of mind through appropriate training and effective processes. Get started with the following resources:
  • Informed consent and refusal: Knowing how to conduct and document consent and refusal discussions can help to reduce your risk and empower your patients in following their care plan. Get started with the following resource:
  • Ending the physician-patient relationship: It’s important to have a clear understanding of the requirements and process for ending the physician-patient relationship. Get started with the following resource:

Quality improvement

  • Learning and improvement: Improve your practice by promoting a culture of continuous improvement and learning in your organization. Get started with the following resources:
  • Unexpected outcomes: Every organization should have a plan for handling unanticipated outcomes or near misses in order to ensure that patients and subsequent treaters have the information they need to make informed decisions and avoid potential safety events moving forward. Get started with the following resource:

Emergency preparedness

  • Emergency planning: Emergencies can occur at any time, so it’s important to organize your response to these scenarios ahead of time. Take steps to also address the possibility of violence in the workplace. Get started with the following resources:

Leaving or closing a practice

  • Closing a practice: Whether you’re moving from one practice to another or closing your practice altogether, you’ll need to tie up important details to ensure a smooth handoff of patients and reduce risk. Get started with the following resource:

Medicolegal considerations

  • Handling care of minors: The rules vary greatly for whether underage patients can be treated on their own or if they require the presence of an adult or parent. Make it a priority to be aware of these rules and how they apply to your practice. Get started with the following resource:
  • Reporting requirements: It’s important to recognize the signs of abuse, trafficking and other sensitive situations, and know the laws and best practices for reporting possible cases, including any mandatory reporting requirements you must follow. Have a process for handling these situations when they arise. Get started with the following resources:

Additional risk categories to consider