Risky Business: A Look at Risk Management & LTC (Episode 39)

August 8, 2018

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Darcy Grabenstein: Hello from SmartLinx Solutions. In today’s podcast, we’ll talk with Marcia Hopkins, who serves as the Leader of the Risk Management Division for American Healthcare Management Group, or AHMG. Marcia has delivered risk management services for healthcare clients for 12 years, including aging services for continuing care retirement communities, skilled nursing, and assisted living facilities, as well as home health agencies. Her professional designations include Associate in Risk Management, Florida Department of Financial Services, Independent All Lines Adjusting license, Board Certification in Workers’ Compensation, and Board of Director of Florida Workers’ Compensation Claim Professionals. Welcome Marcia, thank you for joining us today.

Marcia Hopkins: My pleasure, Darcy. Thank you.

DG: With the current staffing shortage in long-term care and high turnover rates, our main focus today will be on employees, ways to mitigate risk and improve retention. AHMG offers leadership and staff training to senior living organizations. Marcia, can you give us some details on that for us?

MH: Absolutely. Employees is my very favourite topic, near and dear to my heart. Our team at American Healthcare Management Group has decades of experience working with and inside long-term care and senior living communities, so we know what challenges the staff face on the day to day, those employees every day know what they’re doing. And by using our personalized strategy, our leadership and staff training provides the tools that will not only make their job more efficient, but an overall better place to work. As you know, satisfied employees provide better care, quality care directly relates to satisfied residents, patients, and consumers, which in turn control many types of risks associated with healthcare.

DG: Marcia could you tell us a few of those risks?

MH: Some of those risks in healthcare for employees as well as the industry as a whole, healthcare certainly has different exposures such as communicable diseases that employees are exposed to, and that is an inherent risk of healthcare, and we have controls in place for that. But some employees have to first understand what those exposures are, how they control the environment around them so they are not at risk. That would be an example.

DG: Thank you. In terms of risk management, under the category of investigation and loss prevention, AHMG helps clients with employment practices. So what role does risk management play here, Marcia? And would you say there are many major differences in employment practices for long-term care as opposed to other industries?

MH: Yes, there’s some differences, but first let me address your question about investigation and loss prevention and employment practices, and the role that risk management plays it is significant. And it is risk management’s responsibility to control risk and preserve their assets, that is a basic function. Employment practices liability and emerging exposures that we’re seeing here due to social media and to the #metoo movement, they’re all on the rise. Like other aspects of a dysfunctional work culture—for example, sexual harassment, hostile work environment, bullying—all create a toxic work environment and adversely affects employee health, and by extension the patient’s care and safety. All the empirical data shows the direct link between disruptive behaviours and sexual harassment to adverse patient outcomes, medication errors, and distraction from clinical tasks. By implementing organization-wide feedback and monitoring systems for the employees, or like a compliance hotline for example, provide an outlet where allegations and violations of policies and complaints can be heard, investigated, and remediated without a fear of retaliation, thus deescalating the potential action. Another risk control technique is to ensure a workplace violence prevention program. Keyword prevention program that is formalized, it has a robust policy, procedure, and a reporting mechanism—again, a feedback system for these employees to put out there or get it off their chest, whatever it might be, so risk management can check it out on their behalf and cut off any other adverse actions that might happen. And this is how risk management plays a significant role in administering these types of programs.

DG: Got it. You mentioned social media, we actually did another podcast on crisis management and how to deal with negative comments on social media. So that’s a very important thing. I want to get back to the second part of the question. Would you say there is any major differences in employment practices across the board?

MH: Mainly yes, because if there’s a situation going on with that employee for healthcare, it relates to patient care. If you’re frazzled and stressed out, you’re going to not perform the important role of taking care of that resident or patient or whatever it may be in healthcare. So I think because of the human component there, that’s why it’s much more significant in healthcare.

DG: Right. So when it comes to risk management and Workers’ Comp, one area that you address is employee health and wellness. Would you say this is more of a preventive, a proactive strategy as opposed to a reactive one? And what are some Workers’ Comp issues that are unique to long-term care?

MH: Again, you’re getting into my employee favourite here, and Workers' Comp. But it’s gone way beyond that, Darcy, and yes it’s proactive. We have to address the entire person. And health and wellness programs, absolutely one of the key things that you can do in healthcare and really pretty much any industry. But health and wellness programs contribute to a more healthy employee, which equates as you know to more hardy employee both physically and mentally, which equates again to sustained quality care. So if you have an employee and you provide a customized path to wellness for this employee to get back to work after an industrial or occupational injury, it’s not just Workers' Comp occupational industry, whether you’re in a car accident or that employee has been out for any other type of treatment, maybe they’ve been sick for a long long time, whether it’s short term or long term disability, if a holistic approach is taken, and that employee is provided with a path to wellness, and transitioned back to work, it really is an approach that I think we have to move towards and not just single out Workers' Comp. I will say that there are some issues that are unique to long-term care for Workers' Comp however, and there are some things from a risk management standpoint that we can do. Most organizational safety programs have pretty good proven components that reduce injury rates, and that’s what we’re looking at with Workers' Comp is mainly injury rates, who’s got good ones, who doesn’t. And some of those components are management commitment, rewards, communication, feedback, selection, planning and participation all contribute to a safe work environment. So if we look at the degree to which management safety practices are incrementally more effective and differentiate organizations with low injury rates, the proactive measures for accident prevention.

So again, prevention, some of the most effective steps that employers have used are up-front remedies, or up-front measures that employers take. Then first one most important are the employees that experience low injury rates, upfront with the hiring, the educating, assessing the employee and training that employee and ensure that they’re committed to their own health and wellness. And then the second measure is not as traditional as it has been in the past, lower injury rates for healthcare providers that have an oversight of their risk management strategies and programs that are accountable to and held by positions within the organization that are classified as management level. And a lot of organizations do use their human resources department, and there’s nothing wrong with that because again that holistic approach, usually they have that knowledge with regard to long-term disabilities, short-term disabilities and that is fine, except that risk management or that person, that level that is oversight for the program should be a management level person.

DG: In terms of Workers' Comp, especially in long-term care, I would think that one of the main claims would be back injury from nursing staff and aids moving patients. Have you seen that in your practice?

MH: Oh yes. Resident handling or patient handling is a biggie. A lot of that has been engineered out. And the trends for example for nurses coming in now is all mechanical assistance. So it’s varied. I will say that the healthcare industry has a higher incident rate than even a construction company. The OSHA occupational incident rate in the healthcare industry is the highest.

DG: Wow. So I see Marcia that one of your partners is PointClickCare, which is one of SmartLinx’s partners as well. How do your services integrate with PCC’s?

MH: I love PointClickCare, it’s a great program. It’s been used by American Healthcare, we bring them in in several different types of communities. We have a good working relationship with them. They do a great job and it’s a true testament to the work that they do. My favourite part of their software and their health records is the risk management and compliance content, specifically that content with regard to documentation standards. There’s a module within there that really helps the user with documentation, and in risk management, healthcare, documentation is a huge exposure. So that really reduces exposures associated with documentation and to prove the opportunities for primary care intervention that can be seen by for example the director of nurses, so that they’ve seen the documentation, or a doctor, your medical director in there. So they can quickly provide the interventions that are needed. So yes, PointClickCare is very popular. I’m glad they’re one of your strategic partners as well.

DG: They are. I wanted to ask you, do you find that most senior care organizations already have a risk management program in place? And if not, how do you help them develop and implement one?

MH: Oh yes, most healthcare organizations do have some type of risk management or safety program in place for sure. As you know, healthcare is pretty heavily regulated. So from a licensure standpoint, there’s got to be some type of risk management component present just for compliance. I will tell you though, many are dated and some may not address some of these emerging exposures we previously talked about, and one of those for example is cyber liability. So you know the short version to your question really is prevention, prevention, prevention. There’s no doubt about it. And if our policies or the risk management program is not all about those words—prevention, prevention, prevention—that’s good place to start. I did a white paper on what is risk management. A lot of people were asking, what exactly is that, Marcia. And I just provide a ten-step process to identify some vulnerabilities that I put in that paper. You know, ask yourself, does your program, do your executive and senior leadership, do you have their commitment, are the right resources and accountability at all levels, does that exist. Do an assessment, assess what already exists, enhance and develop what’s working, starve what is not, implement, train, and practice the plan, measure improvements and outcomes, and celebrate those successful outcomes, reinvest those successes back into your program, and then reward your participants.

DG: Sounds like a plan.

MH: Yes it is a plan.

DG: The goals of senior living, long-term, and post-acute care organizations are improved outcomes and quality care. So how would you say that risk management directly ties into this?

MH: Yes, outcomes in quality care. Risk management programs involve all aspects of work, production, and interaction within an organization. And successful risk management programs contribute to care that is free of mistakes, that certainly makes a clear contribution to quality. But organizations who look beyond just the clinical outcomes and link their risk management programs with other quality initiatives develop an integrated approach to quality improvement. So an effective enterprise risk management assessment addresses the six dimensions, because there are a lot of definition when it comes around to what is quality care, but six dimension of quality care are effectiveness, efficiency, appropriateness, acceptability, access, and equity. And then you have your whole enterprise risk management assessment done, ready to go, and that’s how risk management ties in.

DG: That’s the first time I’ve heard quality care broken down into six distinct attributes, so that’s really good, thank you. What kind of shift, if any, have you seen in attitudes and/or practices in risk management for senior care organizations over the years?

MH: There’s a continued shift. It’s been shifting of course but there’s a continued shift towards top-down organization-wide culture that embraces transparency, and again provides feedback systems for stakeholders, patients, and residents, consumers, and the community also, to mitigate adverse outcomes and voice those concerns. That feedback system is so important. The use of a CRP or a communication and resolution program as a risk management practice reduces angst with people, stress, and the possibility for litigation. Talk about it, let’s resolve it, and lots of times that’s all that’s needed. And it reduces overall risk for the organization.

DG: It almost sounds like mediation to me.

MH: Yes it is, and you know there’s been a lot of discussion with arbitration agreements and so forth. But those feedback systems, I think it is real important to demonstrate transparency.

DG: Definitely. So I’ve got one more question for you, Marcia. Where do you see the industry headed?

MH: Well again, increased government and leadership responsibility. The trend that we’re seeing, again, with the Cybersecurity Act—I referenced that earlier as an emerging risk and emerging exposure—it’s supported by the fact that our government in Health and Human Services developed the Health Care Industry Cybersecurity Task Force. And that task force were charged with providing a recommendation. Due to the data from back in 2016, the healthcare sector experienced more cyber incidents resulting in data breaches than any of the other 15 critical sectors across the country. And mainly, I hate to point fingers, but the findings did demonstrate that the healthcare industry has a lack of information system preparedness planning and budgetary support to IT across the sector. So the task force directive was to improve cyber security to the healthcare industry. They released their report in June of 2017, and what do you think the number one imperative was? To define and streamline leadership governance and expectations for healthcare industry cyber security. That imperative focuses on leadership and accountability for cybersecurity in corporate governance structures, industry organizations, and government at all levels. So the increased focus provides an opportunity for healthcare industry to respond responsibly with transparency and improve. So I think we can definitely say that the trend is for increased governance and transparency in leadership.

DG: Much needed. Thank you Marcia. Thank you so much for sharing your insights with us today. And to all our listeners, thank you for taking the time to tune in. If you’d like to learn more about American Healthcare Management Group, visit AHMG365.com. And if you’d like to learn more about SmartLinx and our fully integrated suite of workforce management solutions, visit us online at SmartLinxSolutions.com.

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