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Jeannie Sedwick is a risk manager who believes in getting the most out of the resources at hand.

With a staff of four, including herself-one position currently is vacant, though-, Wake Medical Center's director of risk management relies heavily upon the services provided by her broker and insurer to assist with loss control and insurance planning.

And she takes advantage of groups such as the American Society for Healthcare Risk Managment and the Risk & Insurance Management Society Inc. to network and develop more effective loss control programs at the Raleigh, N.C., hospital system.

The medical center's liability insurer, American Continental Insurance Co., provides a risk consultant who visits the hospital and assesses different areas, including the emergency room, operating room and perinatal services. "Those are very special areas that are high-risk within a health care organization, and they know typically where the claims come from in those areas," Ms. Sedwick said of the consultant.

The consultant is able to determine, for example, how the departments perform in accordance with national standards and can recommend improvements. Anesthesiologists, for example, have national standards for the administration of anesthesia and ObGyn physicians observe a national set of practice standards.

If Ms. Sedwick detects a recurring health care delivery problem, she will request a visit by the consultant. "It's really very positive because it's a non-threatening kind of situation. You're not having some regulatory body come in and surveying you, saying, 'If you don't fix this, we're going to close you down.' It's your own insurance company saying, 'You know, you would be a better insured for us if you would look at these areas and improve upon them.'*"

The hospital used American Continental's loss control representative to help operating room personnel keep better tabs on sponges used in surgery. In two cases several years ago at Wake Medical, sponges had been left inside patients.

The representative, who is a nurse, "just observed, quietly watched" the operating procedure and "then she came back with some recommendations," Ms. Sedwick said. Her suggestions led to changes in the count sheet used to account for sponges used in surgery.

In addition, as a result of the consultant's findings, doctors and nurses were discouraged from leaving the operating room during surgery "When they leave the OR, they have to report off to someone else," Ms. Sedwick explained. That leaves open the potential for error as recounts of items in the room are done by a second person.

"And we wanted to make sure the doctors continued to be careful with their own practices," she said, "not closing the patient until the X-ray had been taken" to make sure no foreign bodies were left inside. Compliance with that practice has increased.

There have been no other incidents of sponges left inside patients since the implementation of the procedures, Ms. Sedwick said.

Physicians and others are receptive to these loss control visits because they know the consultant is coming in to help prevent claims and improve service, she said. "The management staff is real anxious to hear those kinds of things. They want them to come in and tell them how they can do things better or give them suggestions."

Another resource, the hospital's broker, is only a phone call away, and Ms. Sedwick frequently dials the number.

She has forged a close working relationship as well as a friendship with Gary W. Buchanan, senior vp at Willis Corroon & Associates Inc. in Chapel Hill, N.C.

"He is an extended member of my team," she said of Mr. Buchanan. "It's like a marriage. Gary and I have been together for a lot of years, and we're working together every week on some project."

The health care facility "is such a dynamic, changing organization" that it takes a vigilant effort to keep up with the shifting nature of risk it faces.

"Who are we insuring? What new entities do we need to add? We're constantly looking at managed care contracts, contractual agreements between physicians, hold-harmless agreements, just a variety of things that health care is into now."

With so many players to deal with, the hospital needs "a sharp eye to look for the exposures that may result," Ms. Sedwick said. "I think your broker is your right hand," and the risk manager is responsible for making sure the intermediary is "as attuned to what's going on in your organization as you are."

"One of the things that I have noticed in my 24 years in the insurance business is that successful risk managers are people who build networks," Mr. Buchanan said. "Jeannie is a great network builder. She's always looking for new ideas."

There are no "open issues for very long" within the risk management department at Wake Medical, he added. When faced with a risk management problem, Ms. Sedwick taps a nationwide network of contacts for the solution. "If there is more than one way to go, she gets information from a variety of sources," he said.

Two of those sources are contacts made through ASHRM and RIMS.

Along with meetings that address risk management concerns, the groups offer the opportunity to network with other risk managers, she said, which provides the chance to "talk about similar problems, insurance issues. ...identifying good practices."

Ms. Sedwick is a frequent attendee and speaker at state and national conferences and in 1996 was president of ASHRM.