Design a risk-management program

Q We have decided to start an in-house enrichment
curriculum in risk management. What resources can you recommend? What
topics should we include? Who should attend?

A Everyone — from receptionist to medical director
— can benefit from risk-management training because everyone
plays a role in making it work. Curriculum design will be most
interesting and successful if you address all roles every session. When
the lab team understands the ways in which others’ roles integrate
patient care and safety, building systems that can respond proactively
to potential disaster is easier.

Make sure the right people are chosen as educators
and resources. Some risk-management education can be done by lab staff,
researching and presenting topics; in the Internet age, a wealth of
information is available. Case reports and short articles can 1) form
the basis of a discussion group, independent of class-work, and/or 2) be
used to supplement and enrich didactic material.

Have a “deep bench” of experts who can lecture/advise
on particular topics, and who can answer questions and direct research.
At a minimum, engage an attorney who is well versed in
administrative/malpractice law; a member who understands institutional
risk-management; and a member familiar with human-resources
policies/requirements. These can be from your institution. Involving
them in the planning is the best way to ensure cooperation and success.

Start by defining what risk management is and how it
works through team effort. Recent initiatives in patient safety provide
a wealth of direction. Take a look at The Joint Commission (TJC) site
which focuses on a general system of risk evaluation/ elimination,
especially on mode of failure, effect, and critical analysis (MECA).
Learning to describe lab processes in steps; determining what can go
wrong and what the possible effect(s) is/are; finding what can cause a
failure and how to remedy the possibility of its happening in the first
place … all of this develops a style of thinking that makes risk
management second nature and underscores how many individuals in the
process can change the outcome if a mistake is made. TJC’s site offers a
substantial risk-management bibliography that may be helpful as a

A good general reference for medical law can be found
on the AMA website. While Law for Physicians is for physicians in
practice, most issues have applicability in institutional lab medicine.
This reference is well written and researched, and covers fraud, abuse,
malpractice, discrimination law, and explains litigation in general.

A good reference on employment-discrimination law is
a nice addition to your shelf. A number of overviews published for the
lay reader are available from online booksellers. Aspen Health Law
Compliance Center publishes Employment Discrimination in the Health
Care Industry
, written primarily from the perspective of the
healthcare institution. A good HIPAA reference is needed; a number of
excellent resources come from general outlets; several contain
interactive CD-ROMs, making them even more useful for training purposes.

Look at professional organizations for resources and
training they can provide. The ASCP publishes a good reference on lab
safety, Laboratory Safety: A Self Assessment Workbook, with a
practical easy-to-use format. Contact your local medical society/bar
association for speakers. Find local programs of interest as you move
through your curriculum. Sign up for newsletters and newsgroups to stay
abreast of the latest developments and to get fodder for discussions.

The American Society for Healthcare Risk Management
has varied programs directed at healthcare risk managers and provides
audioconferences on topics like investigation of safety events and fall
prevention. While aimed at risk-management pros, much of the content is
applicable/accessible to the lab pro “in the trenches.”

The list of topics is almost endless. Make an
inventory of issues that have surfaced in your own experience and group
them, if possible, to provide the core of your initial focus:
negligence, employment law, HIPAA, accreditation, and so on.

Once resources are assembled and curriculum topics
defined, plan sessions to combine “book learning” and information
application to real-life situations to drive lessons home. If you decide
to have a MECA session, take a common lab process and work out the
analysis as a group. Encouraging discussion, application, and questions
helps ensure the team gets the most out of the exercise. Ensure that you
address how each lab employee fits into the overall picture. Make sure
whoever is responsible for presenting the program has information and
discussion to engage all the attendees. Most important? Solicit feedback
about the program’s effectiveness from attendees/administrators to make
sure relevant issues were addressed.

This is an interesting challenge! Be flexible as you progress to
facilitate success; adaptability itself communicates an important
risk-management principle.

Barbara Harty-Golder is a pathologist-attorney
consultant in Chattanooga, TN. She maintains a law practice with a
special interest in medical law. She writes and lectures extensively on
healthcare law, risk management, and human resource management.

MLO’s “Liability and the Lab”is intended to
provide risk management and human resource management education; it is
not intended to provide specific legal advice.
If you require legal advice, the services of an attorney should be
sought. Dr. Harty-Golder welcomes your questions, which can be sent to
her at [email protected] . Unless otherwise noted as
“confidential” by readers, all queries will be considered for
publication without further notice to them. Names, institution, city,
and state will be removed before publication.