Today, leading-edge organizations systematically share internal control knowledge across their organization, departments and functions to promote best practices and to minimize loss. Healthcare organizations, especially larger systems with multiple hospitals, clinics, freestanding outpatient surgery centers and urgent care units, are leading the way with this new approach using risk champions. “Risk Champions” help to create and maintain a system-wide risk management culture in all of their activities and departments using an embedded risk management framework to promote decisions that align with their overall risk tolerance strategy. Institutions such as the University of California and New York University have implemented such a program under their enterprise risk management programs and published their successes.1,2
The goal for creating such a system-wide risk-aware culture from a multidisciplinary system-wide staff is to identify, assess, and control risk, and then review the controls that are in place. The objectives are also to prevent and reduce loss, improve quality of care, maximize patient safety, reduce liability, and highlight risk management strategies.
Formation of a risk champion steering committee, consisting of loss control/risk managers, is critical to a risk awareness culture. The steering committee encourages risk management strategies to be shared throughout their healthcare system with the participation of facility-based risk managers and facility-based risk champions – the existing personnel/staff of each department. Embedded unit risk champions become the “boots on the ground” as well as the “eyes and ears” for the facility risk manager and the steering committee. A risk-aware culture can also help nurture a pool of potential future risk managers from existing facility staff.
Program creation process
The process of creating such an awareness culture initially should come from leaders at the highest level who incorporate the program into clearly defined annual goals. The risk champion steering committee should define the charter for the risk champion program. The charter should include the mission of the program, as well as the roles of the steering committee, facility-based risk managers and unit-based risk champion staff.
The steering committee oversees the strategy, tactics and logistics of creating and maintaining a risk management culture, proposes risk initiatives to implement, and monitors a metric tool for program assessment. Additionally, the steering committee creates a common language for managing loss and reducing risk.
Once the charter and general strategy of the implementation phase is well-defined, the steering committee members communicate this information to the respective facility risk managers. By doing so, the culture of system-wide risk awareness and management is communicated from the top down.
The goal for risk managers of each facility within a large healthcare system is to create a network of risk champions from the existing staff in every unit/department, including the emergency department, operating room, medical and surgical units, pharmacy, respiratory, etc. Risk managers would advocate for risk initiatives, communicate and educate champions, and encourage risk issues to be communicated from the specific units/departments.
Risk champion staff members can be volunteers or nominees within each unit/department who are interested in taking on the role of a risk management/loss control advocate. They are not experts in the field of risk management, but should be influential and respected staff members within the departments they represent. They should possess teamwork skills, effective communication skills, be allotted time to devote to the function and the ability to take actions to implement solutions. A good champion is a communication channel between the department staff, the facility risk manager and the steering committee.
Risk champions in action
One large healthcare system embraced the risk champion program by defining and ratifying their charter. Once strategy and logistics were defined in concept, the program was implemented in a pilot study with identified risk managers who, in turn, created a network of risk champions. The risk managers met with the group of champions for initial training, and maintained the program to create a system-wide culture of risk awareness. For this healthcare system, that meant the unit/department risk champions recognized unsafe or risky practices and took steps with the facility risk manager to reduce the risk/potential loss.
An example of risk awareness in the new program involved the dispensing of medications via the Pyxis system. A risk champion observed that two similar medication bottles were stored in sections right next to each other by brand names, potentially leading to a mix-up and medication error. The risk champion worked with pharmacy staff to rearrange bottles by their generic names. Thus, the similar looking bottles were no longer kept next to each other, reducing the possibility of medication errors.
Other areas of potential risk and loss, as defined by the Centers for Medicare & Medicaid Services, sparked initiatives for this healthcare system. Some of these included prevention of pressure ulcers, nosocomial infections, medication errors and falls.
The success for the program was assessed using a survey tool, the number of event reports generated monthly, and a decrease in the number of complaints or claims generated monthly. A pre- and post-risk champion Initiative questionnaire measured the change in the general staff’s awareness of risk and how they could be a part of minimizing loss. By proactively addressing risk issues and taking loss prevention measures before an event occurred, the facility hoped to increase quality of care through the participation of engaged risk champions.
Pamela E. Freiling, RN, BSN, LNC, Professional Liability Sr. Nurse Consultant
References
- Enterprise Risk Management: University of California. http://www.ucop.edu/enterprise-risk-management
- Enterprise Risk Management: New York University. https://www.nyu.edu/employees/resources-and-services/financelink/insurance-and-risk/enterprise-risk-management.html