Journal of healthcare risk management : the journal of the American Society for Healthcare Risk Management最新文献

The United States Department of Labor's Occupational Safety and Health Administration (OSHA) defines workplace violence (WPV) as any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. OSHA recognizes that WPV ranges from threats and verbal abuse to physical assaults and even homicide. There are no OSHA standards specifically related to WPV however the General Duty Clause, Section 5(a)(1) of the OSHA Act of 1970, requires employers to provide a workplace that is free of conditions that could cause death or serious harm to employees. The Joint Commission published standards in 2022 related to WPV. The standards require a proactive analysis of the organization relative to WPV. Monitoring of events and training of staff are also required. This article will explore one hospital's journey to understand the frequency and types of violence experienced by nurses in the facility; implement evidence-based strategies to mitigate violence in the hospital; maintain compliance with regulatory and accrediting bodies; and most importantly, to protect our staff from harm.

It has been estimated that medical errors are the third highest-ranking cause of death in the United States. A patient safety culture has been touted for many years as best practice to reduce medical error. While there is a general agreement of its importance, it has remained elusive for many. This study sought to learn how strengthening leadership skills within a health care organization could catalyze patient safety culture improvement. The research asked the following to gain an appreciation for that question: How does a leader ensure consistency in policies, practices, and protocols to create a patient safety culture? What attitudes, beliefs, and collective efficacy are needed to produce a patient safety culture? What leadership characteristics are needed to create a patient safety culture? The research participants were the employees who make up the patient safety department in a large academic health care system. Information was gathered to capture their view of leadership's role in patient safety culture and to gain knowledge relative to their individual experiences following a medical error.

In the world of health care litigation it has become clear that medical malpractice cases now contain two claims—one on the medicine and one on the electronic health record (EHR). Two years of contentious discovery motions over the production of a complete copy of the EHR and audit trail in a case involving the delivery of a baby recently resulted in a nightmare scenario for a large health care system: sanctions in the form of an order entering judgment of liability in favor of the patient. The order was entered before depositions on the medicine were ever held. The decision in Prieto v. Rush University Medical Center (RUMC), et al. is the premiere example why patients’ lawyers are focused on the audit trail. In this case, they were able to secure a legal victory without even litigating the underlying facts of the case.

Social factors that affect health are called social determinants. Social determinants may also carry risk, known as social risk. Management and patient safety professionals understand health care and enterprise risk. Social risk may add a new dimension for some. Social risks are probably amenable to the strategies patient safety and risk management professionals already employ, such as enterprise risk management, a culture of safety, and just culture. A large body of evidence suggests that social risks, particularly literacy and discrimination, strongly affect patient safety and well-being. This paper examines the relationship between social determinants of health and social risks and considers how health care organizations might address literacy and discrimination from the perspective of patient safety and risk management.

Visitor aggression in pediatrics is a form of workplace violence that has not received much focus across pediatric health care systems. There are many different practices, strategies, and policies implemented across children's hospitals to mitigate visitor aggression on both clinical and organizational levels. To date, there has not been a published review on interventions in pediatrics to de-escalate the intensity of these circumstances in the context of providing care and treatment to children. The goals of this review are to identify and assess the efficacy of each effort implemented across diverse pediatric health care settings. This review also proposes research, organizational, clinical, and policy implications and considerations that could help inform future practice in hospital-based violence prevention. A narrative review of the literature identified eleven peer-reviewed studies that delineated practices, strategies, and educational efforts between 1994 and 2020. All studies were descriptive in nature. There were four cross-sectional studies, three qualitative studies, one mixed-methods study, two prospective studies (one of which also had a group comparison design), and one non-experimental study. The primary measures implemented across children's hospitals involved increasing security and police presence in patient care areas (n = 3), development of multidisciplinary workgroups to review and revise visitation policies (n = 2), crisis response teams (n = 2), and incident reporting systems (n = 2). Hospital risk management, administration, and clinical leadership teams were stakeholders involved in designing interventions across studies. Hospitals varied in allocation of support resources and in defining visitor aggression which contributed to mixed findings across studies.

Health care organizations have struggled to establish par levels of risk management personnel needed to effectively accomplish risk management functions. This study set out to determine whether a par level staffing model could be established utilizing a nonclinical role to enable the clinical risk manager to focus on key risk management core functions, therefore enhancing risk management department efficacy. Utilizing a model published by Howard and Felton, Trinity Health Insurance and Risk Management Services (IRMS) evaluated risk management staffing according to our core functions and workload and determined recommended risk management staffing levels for our organization. Eighteen Risk Managers from 13 acute care hospitals participated in a 2-week time study documenting time spent and estimated time needed to complete core risk management functions. By quantifying the time needed to complete risk management core functions and evaluating which activity could best be completed by specific roles, we have established both a recommended baseline staffing level of one risk manager FTE per 6650 monthly average adjusted patient days (APD), as well as a work distribution model of 70% clinical and 30% nonclinical split of risk management FTEs for our hospitals. Organizations can similarly evaluate their staffing according to their core functions and workload.