WGU C430 Healthcare Quality Improvement and Risk Management Questions and Answers Already Passed

Risk Management Ans An organized effort to identify, assess, and reduce, where appropriate, risks to patients, visitors, staff, and organization assets. Reduce the incidence of preventable accidents and injuries to minimize the financial loss to the institution should an injury or accident occur. Risk Management Process Ans Investigate: Observe or study by close examination and systematic inquiry. Inform: Present in material form. Influence: Affect or alter by indirect or intangible means. Interpret: Explain or tell the meaning of; present in understandable terms. Integrate: Form or blend into a whole; unite with something else. Risk Classification Ans • Property Risks • Casualty/liability risks • Employee benefit risks Property Risks Ans Involve the possibility of losses associated with the destruction or theft of property. Casualty/Liability Risks Ans Involve professional negligence, worker's comp, directory and officers liability, environmental liability and product liability. Employee Benefit Risks Ans Cost of benefit plans, disability claims, and Employee Retirement and Income Security Act (ERISA) violations. Risk Management Tools Ans • Incident Reporting • Occurrence reporting • Occurrence screening Incident Reporting Ans The identification and reporting of occurrences that could have led, or did lead, to an undesirable outcome. Occurrence Reporting Ans Serves as a database for further investigation Alerts risk management to a potential claim situation. Occurrence Screening Ans Review technique of medical records of current and discharged patients with the goal of identifying events not consistent with routine. Used to identify and correct problems and to prepare for legal defense. Managing Adverse Events Ans Requires extensive analysis and planning to arrive at the best and fairest solution for all involved. Information must get to the upper-level administration and to the clinical chief or chiefs ASAP. It is also important for details of clinical incidents to be chared with clinicians throughout the org to prevent recurrence of adverse events. How do risk and quality management functions overlap? Ans Quality control is doing what you want to do: meeting needs. Risk control is not doing what you do not want to do: preventing errors. Regulatory & Professional Organizations That Influence Quality & Risk Management Ans • Joint Commission • National Committee for Quality Assurance (NCQA) • OSHA • ADA • Drug-Free Workplace Act (DFWA) • HIPAA • EMTALA • MedWatch • EPA National Committee for Quality Assurance (NCQA) Performance Measures Ans • Effectiveness of care • Access/availability of care • Utilization • Risk adjusted utilization • Measures collected using electronic clinical data systems The Joint Commission Benefits of Accreditation Ans • Helps organize and strengthen patient safety efforts. • Strengthens community confidence in the quality and safety of care, treatment and services • Provides a competitive edge in the marketplace • Improves risk management and risk reduction • May reduce liability insurance costs • Provides education to improve business operations • Provides professional advice and counsel, enhancing staff education • Provides a customized, intensive review • Enhances staff recruitment and development • Provides deeming authority for Medicare certification • Recognized by insurers and other third parties • Provides a framework for organizational structure and management • May fulfill regulatory requirements in select states • Provides practical tools to strengthen or maintain performance excellence • Aligns health care organizations with one of the most respected names in health care