Medical error is undoubtedly one of the biggest and most serious risks within the ambulatory surgery center (ASC) industry. Operations or procedures performed on the wrong body part, wrong patient or performed using the wrong implant are all potentially catastrophic events that could mar a center’s reputation, jeopardize its financial stability, and, worst of all, threaten patient safety. Thankfully, from the perspective of an individual surgeon or ASC staff, these events rarely happen. It appears, however, that the uncommon nature of adverse events like these tend to reinforce an organization’s beliefs that it will never experience them. This can lead to complacency and cutting corners when in a hurry, and can create false confidence that an ASC’s safety systems are adequate. A lack of preparation for potential issues and errors can have significant, long-term effects on an ASC’s productivity and success. Neglecting to have comprehensive risk management plans in place can compromise patient care, increase liability risks, and result in significant financial losses. According to the 2011 study “Paid Malpractice Claims for Adverse Events in Inpatient and Outpatient Settings” published in the Journal of the American Medical Association, 43 percent of the 10,739 malpractice claims in 2009 were for events in outpatient settings. This resulted in settlements totaling $1.3 billion. Risk management is a function of an individual or committee bridging a number of disciplines to reduce the incidence of organizational loss. Risk management initiatives can be proactive—attempting to prevent a loss—or reactive (in other words, damage control). To ensure an ASC is doing all it can to proactively avoid and reduce risk of medical error or other operational safety hazards, it is important to develop, implement, and monitor an organization-specific risk mitigation plan based on prior risk assessments. The following are three ways to mitigate risk and encourage safe and smoothly run center operations:
Keep communication open and transparent
Open and transparent communication is key to ensure a culture of patient safety within an ASC. Risk financing solutions company Clarity Group cites poor communication amongst staff and in handoffs as a top reason for medical error within ASCs. In fact, according to JCAHO, communication, particularly related to handoffs and transitions, is a critical, error-prone process in patient care that has been associated with over 80 percent of medical errors as of 2012. ASC employees need to feel comfortable speaking up when they witness concerning activity, behavior, or a center’s policy not being followed. It is important to foster an environment that encourages this kind of dialogue and a greater sense of employee accountability. An integral part of creating this environment is training managers, physician leaders, and administrators to be responsive to employees’ observations. Be sure to follow up on concerns, question inappropriate behavior, and facilitate conversation around constant improvement of safety and quality measures.
Provide access to resources and education
Risk managers must enhance their visibility to patients, staff and physicians alike. In addition to fostering open and transparent communication, risk managers should participate in Quality and Medical Executive Committee meetings to actively encourage a culture of safety and accuracy. Risk managers should also provide educational material on internal risk management issues, how the issues are being addressed, and industry trends regarding these issues. Providing these resources to staff members not only improves their knowledge, but can help motivate them to actively ensure that the center is not putting patients or employees at risk.
Demonstrate value of risk management initiatives
Within an industry hyper-focused on data measurement and benchmarking, it is important that risk management demonstrates its value within an ASC. It can be a challenge to quantify issues that do not occur because they were prevented. Regent’s centers measure the success and value of their risk management activities by benchmarking patient outcomes and cost savings against other Regent centers and national standards. An annual assessment of potential risks is required by ASC accrediting agencies. It should be specific to the ASC and include not only an evaluation of a center’s activity, but also specific policies to implement and goals to strive toward in the following year. Regent provides ongoing risk assessments in all areas of clinical compliance to evaluate operational efficiencies and areas of potential risk throughout the year. The results of these intensive reviews, as well as Regent’s subsequent recommendations, are presented to the ASC’s leadership team who then report the findings to their QAPI, MEC Committees and the Governing Board. The goal for these initiatives is to create and maintain High Reliability Organizations, or centers that are conducting relatively error-free operations. These organizations recognize that complacency itself is a threat to patient and staff safety, and avoid it by consistently making decisions that encourage high quality, reliable operations. To learn more about proactive risk management initiatives, please contact firstname.lastname@example.org.