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ASHRM: RISK MANAGEMENT BY THE NUMBERS

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ATLANTA-A savvy risk manager can tap a broad variety of information collected throughout an organization like a hospital to help that organization save money.

Data on injuries and falls, complaints, legal costs, reserves, indemnity payments and budget information on the cost of running various departments are all of great potential use to a risk manager, according to Margaret R. Douglass, director of hospital risk management programs at Florida Physicians Insurance Co. in Jacksonville, Fla.

Information could include origins of losses, injury severity, information on the largest indemnities or measures of improvement or failure.

Event frequency data "is especially helpful in tracking the effects of interventions," Ms. Douglass said last month at the American Society for Healthcare Risk Management's conference in Atlanta.

"We want to establish what is and is not a risk," Ms. Douglass said. "What can we realistically impact."

Determining which problems to tackle "can be an interesting exercise," she said. To make those decisions, among the things a risk manager needs to understand are what answers are needed and what data will provide them, who has the data and how to get it, and what other resources are available.

"Get to know keepers of information in your hospitals," she advised.

Data sources can include hospital incident reports and claims data from the hospital, the hospital system and insurers. "Ask your insurer for data on hospitals of similar size," Ms. Douglass said.

"Customer satisfaction surveys will give you a lot of data," Ms. Douglass said. Billing data "can be very helpful in knowing the volume of services consumed."

In collecting data, the risk manager will gather both quantitative data-that which is "purely counting widgets" with no interpretation involved-and qualitative data, which provides "the depth to that flat (qualitative) information" by analyzing indicators and representing functions and processes, Ms. Douglass said.

Both are necessary to a risk manager. "Just numbers don't tell us enough," Ms. Douglass said, noting that numerical data alone is insufficient to determine what changes should be made.

It's also important to present data in a way that allows analysis. For example, a report of the rate of patient falls-the number per 1,000 patients, for example-per quarter conveys more useful information than a report simply comparing the number of patient falls per quarter. "That rate information is really a better indicator of performance," Ms. Douglass said.

Adding more information, such as injuries incurred in those falls, how the injuries fit against any fall prevention protocol the facility might have, staffing levels when the injuries occurred or medication taken by the fall victims, can make the data even more useful in the effort to reduce losses.

In examining information to measure quality vs. cost, Ms. Douglass told the risk managers it's important to "strive for a balance."

"Overutilization and underutilization of resources are unacceptable," she said.

In making those analyses, she said, it's important to focus on large numbers of patient encounters. "When you're doing these profiles, you need a large volume," Ms. Douglass said.

She noted that clinical pathways are being used increasingly to streamline care but need risk management input to be most effective.

Their purpose is to guide care from admission to discharge, and they provide information on when to expect certain activities or outcomes, what to expect from patient assessments, tests or outcomes, and to identify critical decisions and actions during the course of care.

"They can be important case management tools and give us very good information about how patients are being cared for," Ms. Douglass said. "If things aren't going well, it can be a risk exposure for you. If a patient isn't following the pathway, what's wrong?"

Clinical pathways require multidisciplinary review, she said. "The risk manager will want to know: Were critical decisions made? Were actions performed at the schedule put forth. The data will tell you."

She suggested that pathways might be reviewed quarterly. Occasionally, she suggested: "Skip a quarter. Implement some interventions. Then see if you've really made a difference. You'll see your quality of care increase and your risks decline."