Kaiser Permanente Risk Management Executive Summary
Kaiser Permanente (KP) is the nation’s largest integrated health care delivery system. KP serves nine states and over nine million members, with an annual operating revenue in 2013 of 53.1 billion. KP is a leader in quality improvement efforts in the health care industry through participation in studies performed by the National Committee on Quality Assurance (NCQA), The Joint Commission (TJC) accreditations, and the implementation of a state of the art electronic health records system, which focuses on integration and quality of care standardization. The focus of this summary is on KP hospitals in the northern California region and will include topics such as the purpose of risk and quality management, risk identification and management, current risks, quality outcomes, organizational goals, and the relationship between risk and quality management. Risk and Quality Management Purpose
The purpose of risk management in health care is simply the process of protecting the assets and minimizing financial losses to the organization (Singh & Habeeb Ghatala, 2012). A comprehensive risk management strategy within a health care organization will include focus on continuous quality improvement (CQI). The purpose of CQI in health care, according to Sollecito and Johnson (2013), is to offer a “structured organizational process for involving personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations” (p. 4). Through linking the processes of risk management and quality improvement the success of both processes is more likely to be realized. Kaiser Permanente
The key concepts for risk and quality management at KP are commitment to quality, patient safety, privacy protection, and fraud prevention. KP risk management and quality management programs are central to their mission, values, and culture. Methods currently utilized to support these concepts within KP are consumer surveys, the use of an integrated EHR with evidence based guidelines and clinical decision-making functionality, stringent patient privacy regulations and processes, continuous clinical and administrative staff training programs, and participation in studies focused on standardizing national quality measures (Kaiser Permanente, 2012). Risk Identification and Management
While KP is a leader in health care risk and quality management there are specific steps this consultant is recommending on a continual basis that will improve risk identification and management within the organization. 1. Identify and analyze loss and exposure
While there are many methods utilized within the health care industry in the identification and analysis of loss and exposure, the recommended methods for KP are as follows: a) Incident-reporting analysis
b) Improvement on the current performance management process for employees to bring focus on risk mitigation and quality improvement. c) Quantitative analysis of patient complaints and satisfaction surveys. d) Review of the organizations past professional liability and workers compensation reports. e) Review of surveys completed by TJC and NCQA on other hospitals in order to identify risk areas that KP should focus on. (McCaffrey & Hagg-Rickert, 2009)
2. Research and propose alternative risk techniques
To mitigate risks that are unavoidable at KP, a combination of alternative risk techniques will help reduce situations that might negatively affect the organization. A financial analysis and risk analysis should be performed in order to ascertain the likelihood of utilizing the exposure avoidance technique. This is not a likely option as the financial impact of eliminating services may out weigh the risks involved with continuing them. A loss reduction approach is more likely to be the technique chosen for this organization. The core...
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Cohen, M. (2009). Statutes, Standards, and Regulations (chp 10) in McCaffrey, J. J., & Hagg-Rickert, S. (2009) Risk Management Handbook (5th ed.). San Francisco, CA: Jossey-Bass.
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Sollecito, W. A. and Johnson, J. K. (2013). McLaughlin and Kaluzny 's Continuous Quality Improvement In Health Care (4th ed.). Jones and Bartlett Publishers.
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