Haylee Stachow

HCA 750: Healthcare Quality and Performance Improvement

Module 5

February 26th, 2023

Topic Overview

Risk management and analysis is a creative way to say you need to consider every angle

and outcome. To think outside of the box of all the things that could possibly go wrong or come

out differently than you plan for. It can cover a vast amount of material or be focused in on

something small. Risk analysis is like an insurance policy on your business without the monthly

premium. It helps you prepare for disaster while improving workflow and workplace culture.

It's all about identifying the risks that pertain to you and your business. There is no

standardization in risk management because everyone is expected to operate differently. No need

to prepare a budget for medical errors and biohazard cleanup at a plant nursery because it’s not

needed. If it happens, it would be such an isolated incident that you shouldn’t need to prepare for

it. However, maybe you need to prepare a budget for pesticide, since you had a problem with

mites the year prior. It’s all about perspective and being able to spread that perspective as far as

possible to cover any incident.

Now, how do we figure that out, and where do we start? The most reliable and common

answer would be to take a look at the data collected in the past. Everyone and everything have

data. At this point, data is considered one of the most powerful and valuable assets in the world

(Birch, 2021). It has come to the point that data is framed as “the basis of contemporary

economies” and everyone contributes. The most important and pressing issue with this asset is

that it can sometimes be wrong.

Particularly in medical settings, it is easy for this data to be missing or incorrect. Given

that healthcare workers are exhausted, overworked, and moving quickly, it’s easy for mistakes to

be made within the data, which can skew the outcomes.

 Particularly when it comes to things like medication errors or hospital acquired

infections, that can be grounds for losing a license or shutting the facility down if legal becomes

involved. Hospitals and healthcare facilities alike spend millions in legal fees each year due to

patients suing for various complaints. Malpractice, wrongful death, and other accusations are

common within the healthcare workplace, and can contribute to the fact that healthcare is a

system that has been long overdue for an update. Of course, much has changed over the years,

but it doesn’t mean that all problems are solved.

Unfortunately, no healthcare system will ever be perfect, regardless of what we change.

We can never please every person because every patient is different and requires different

elements of care. Seeing how often we work to standardize healthcare as a whole is just not

going to work. Unfortunately, this would just add more risk to the healthcare system and force

those that need it most out of the equation. Identifying the best method of technical and

professional communication in addition to safe individualized practices can increase the

likelihood of success and patient satisfaction more than a cookie-cutter healthcare appointment

(Schreiber, 2021).

Risk management can be a lot to take on at once, especially as a medical director or the

president of a facility. You are the one that is the primary point of contact when things need to

change. Having the ability to work with and adjust the budget to put it towards things that need

changing can add a lot of pressure to an already demanding job. Being the one that makes the

final decision can be hard, so it’s important to have a trustworthy team to help you make the

right choice. Compartmentalizing the risk analysis into smaller pieces can be beneficial as well.

Giving bits and pieces to your team will make it more achievable and give everyone the ability to

put more time and effort into what they’re working on. Risk analysis takes data and thinking
outside the box to prevent disaster and simple mistakes from being made. Especially considering

those mistakes can cost someone their life or millions of dollars, it is crucial to take the time to

analyze every angle to your full ability.

In addition, having eyes from multiple departments can really help widen the ideas and

experience in the decision. Considering the hierarchy within many healthcare systems, some of

the people making these decisions may never have even stepped foot into the healthcare facility

they are making decisions for (Pascarella, 2021). Taking the opportunity to include those that

work the front lines will give you a better idea of what’s needed, rather than just taking a guess.

Healthcare Application

Healthcare in the United States is built on a system that has become tertiary. For the

average American, it is difficult to have the looming cloud of medical bill debt over your head.

According to the data from the Kaiser Family Foundation analysis of Census Bureau data, the

average US household owes more than $4,600 in medical debt, and totals to more than $111

billion throughout the United States (Himmelstein, 2022). Considering the fear of debt and how

easy it is for it to accumulate in this country, many Americans find a way to cut costs as much as

possible. Unfortunately, medical costs seem to be one of those that often get removed. Especially

when it comes to preventative care, many people decide to skip preventative care measures and

wait until sickness, infection, or other medical problems evolve to the point that the only way

they can get better is to go into a healthcare facility for further care.

While this sounds like a reasonable thing to do cost wise, it is counterintuitive to what

many people are trying to avoid, which is high costs and worsening health. When patients reach

the point of tertiary care, they are harder to treat, require more resources and staff, and often have

worse outcomes. This is where a lot of common medical errors stem from, considering tertiary
care requires more chronic and layered levels of care rather than the preventative and simple one

on one appointments that they may have had with a primary care provider in the beginning. This

results in a large medical bill that may be next to impossible to pay off. Especially in the case

that the patient does not have insurance. A lot of patients in the United States have a severe lack

of health literacy as well, especially in rural areas. There is a profound lack of funding and

knowledge being given to the education system on preventative health and nutrition, which is a

large part of why we have so many unhealthy American citizens.

A very large portion of the population struggles with diseases that are completely

preventative. Heart disease and diabetes being the two prime examples. Proper nutrition and

exercise are preventative ways to avoid these, but due to the lack of education on preventative

measures, there is a higher prevalence of these preventative health problems (Lippi, 2019). Food

deserts, the cost of gyms, and the lack of public health initiatives to help these people are just a

few reasons why we struggle so much with these diseases in the United States. The visual above
highlights the prevalence of death rate from heart disease per the data from the CDC.

Considering how dark certain areas of the map are just goes to show how large of a problem

these diseases are, and it still holds as the number one cause of death in the US today (CDC,

2022).

Prevention of Medical Errors

Risk analysis can prevent millions of dollars in legal fees for medical errors. Seeing as

many medical errors are preventable, its important to run a risk analysis prior to the

implementation of any new project. Common medical errors include medication errors, hospital-

acquired infections, misdiagnosis, and incorrect patient charting. These are all problems that can

be prevented and reduced when a risk analysis is implemented. The following chart is utilized for

risk analysis from a 500-bed hospital in the Midwest. They are a level II trauma hospital in an

urban area that specializes in cardiology and cardiothoracic surgery. A risk analysis was run to

reduce the number of patients being diagnosed with a hospital acquired infection while in the

hospital for a procedure in the cardiology department.

Slightly Harmful Harmful Extremely Harmful

Highly Unlikely Trivial Risk (1) Tolerable Risk (2) Moderate Risk (3)

Unlikely Tolerable Risk (2) Moderate Risk (4) Substantial Risk (6)

Likely Moderate Risk (3) Substantial Risk (6) Intolerable Risk (9)

The graph below highlights which department within the hospital is most often diagnosed

with an infection while undergoing inpatient care. Both the intensive care unit and cardiology

hold higher rates than any other department, so a risk analysis was run.
 Percentage of Hospital Infection Found within Inpatient
Care
0.5
2.6
4.2

1.6

2.2

5.1 1.4

Cardiology General Surgery Gastroenterology

Intensive Care Obstetrics and Gynaecology Pediatrics
Psychiatry

It’s assumed that surgeries and large procedures would generally hold the highest level of

infection given the risks associated, but it has been found within this data that more patients are

suffering from infection while in their hospital beds rather than during a procedure. This could be

for multiple reasons, so it is important to work through what is the most common between the

departments.

First, we work through each policy and where holes may be in the cleanliness and

sanitization rules. How are we disposing of linens? How many staff members are seeing each

patient? Are they washing their hands from room to room? What medications are common on

these units? Any of these questions could help lead us to the reason why our infections are

higher. If it was higher and sustained at this level in all units, you could assume that this was a

hospital-wide issue. Since it is sustained mainly on a few units, we need to look deeper into the

source of the issue and where it stems from. It is not only on paper and in meetings that we run

risk analyses either. We need to go out onto these units and take our own measurements to run

against the already collected data. For example, common strategies to use when preventing
hospital-associated infections are to practice hand hygiene, maintaining a clean and safe

environment, screening patients into cohorts, and public health surveillance (Haque, 2020).

Following patient safety guidelines should be the standard, but in an environment that is

overworked and exhausted, its more common for staff to cut corners on these policies, causing

infection or other medical errors. Based off the data in the graph above and the results of the risk

analysis ran, the following percentages show how many departments were adhering to the hand

hygiene standards.

In this hospital, the “Clean Hands Policy” requires any staff member to be pulled at any

time by the public health department to get a swab of their palm and fingers to see how much

bacteria are on it. If the staff are at a 95% or higher, they pass. If below, it indicates that they do

not have clean enough hands to treat patients and need to work on their hand hygiene as a

department. See the graph below for the results of this average within each department.

Cardiology Surgery Gastro ICU OBGYN Pediatrics Psych

89% 93% 97% 88% 99% 98% 97%

As we can see, the units reflected in the graph above with higher rates of infection also

have lower percentages of clean hands when tested by the public health department. Since the

risk analysis was implemented, we can prevent further infection in patient care and identify what

the root cause was. Staff were found to be going from one patient room to the next without

washing their hands or using sanitizer in between each one, causing further spread of germs. The

“Clean Hands Policy” tutorial video was sent out to all staff, and checks will be completed more

often to continue educating our staff and maintaining a high level of hand hygiene moving

forward.
Summary

Two take away points I learned from this work are the importance of calculated decisions

in healthcare and the importance of repetitive education. By taking the time to collect data and to

perform risk analysis models, we are saving the hospital money, helping staff feel more

empowered and enabled to do their jobs, and improving patient satisfaction. Hospitals spend

billions each year on preventable medical errors (Carillo, 2018). Patients are the reason we are in

this business in the first place, so it’s important to put them first. Having the ability to do that in

succession with the improvement of staff education and adherence to policy can help bring better

results in multiple avenues.

Repetitive education can help staff feel more comfortable in emergency situations and

give patients peace of mind. Reiterating something as simple as hand hygiene may seem trivial

since most people can handle how to wash their hands, but it can be easy to cut corners when

you’re busy, causing risk for patients and other staff. Working to help patients is counterintuitive

when you are not taking the preventative steps to protect them.

If I were to do anything differently, it would be to take time to work more closely with

staff to make sure their needs are being met. Cutting corners and medical errors generally stem

from the staff wellbeing, so if we can work to prevent that it could save the healthcare system

millions and give patients peace of mind.

References

Birch, K. (2021). Data as an asset? The measurement, governance, and valuation of digital

personal data by big tech. Sage Journals. https://doi.org/10.1177/2053951721101730

Carillo, J. (2018). ASHP guidelines on preventing medication errors in hospitals. American

Journal of Health-System Pharmacy. 75(19). https://doi.org/10.2146/ajhp170811

Centers for Disease Control (n.d.) heart disease in the United States. Centers for Disease Control

and Prevention. https://www.cdc.gov/heartdisease/facts.htm

Haque, M. (2020). Strategies to prevent healthcare-associated infections: A narrative overview.

Risk Management and Healthcare Policy. 13(1).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532064/

Himmelstein, D. (2022). Prevalence and risk factors for medical debt and subsequent changes in

social determinants of health in the US. National Library of Medicine.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9482049/

Lippi, G. (2019). Physical inactivity and cardiovascular disease at the time of coronavirus

disease 2019 (Covid-19). Journal of Preventative Cardiology. 27(9).

https://doi.org/10.1177/2047487320916823

Pascarella, G. (2021). Risk analysis in healthcare organizations: Methodological framework and

critical variables. National Library of Medicine. 14(1).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275831/

Schreiber, J. (2021). Creating a continuous improvement model for sustaining programs in

technical and professional communication. Journal of Technical Writing and

Communication. 49(3). https://doi.org/10.1177/004728161875991