Those working in the healthcare industry are no strangers to constant change. A healthcare risk management program and the right technology can help to effectively monitor risk across specialties and improve patient safety. Origami Risk’s Bill Schwacke spoke to Future of Personal Health about the intersection of risk management and the healthcare industry.
Risk management software is used in various industries. How is it applied to healthcare?
Risk management software is at the center of a healthcare organization’s approach to risk, safety, claims, and insurance. The software can define the provider’s approach to risk by linking, organizing, and distributing data from independent, critical functions to provide an organizational view of risk.
Can you elaborate on the correlation between patient safety and risk management software?
Patient safety and risk management software are often linked due to the nature of the data involved. While they often work independently, there are insights that can be discovered when linked together. These insights can improve quality of care and reduce claims/insurance costs for the organization.
Read the full article in Future of Personal Health.
Workplace burnout has become so common across industries that, as of May 2019, the World Health Organization (WHO) recognizes it as an occupational phenomenon in its International Classification of Diseases Handbook.
In the healthcare industry, burnout is a reality and is described by those on the front line in alarming terms. According to a NEJM Catalyst survey Immunization Against Burnout, “83% of respondents — who are clinicians, clinical leaders, and health care executives — call physician burnout a ‘serious’ or ‘moderate’ problem in their organizations.” Based on survey results like these, a report titled A Crisis in Health Care: A Call to Action on Physician Burnout called physician burnout “a public health crisis.”
Burnout has reached crisis level for many reasons, including its prevalence and its effect on staff turnover. But it’s had unexpected consequences for patient care, as well. A JAMA Internal Medicine study concluded that physician burnout doubled the odds of an adverse patient safety event. According to the report, this includes “unsafe care, unprofessional behaviors, and low patient satisfaction.”
In the first part of a two-part series, we examine the main drivers of hospital staff burnout, its far-reaching consequences for healthcare organizations and patients, and how the right technology can play a key role in reducing its widespread nature.
Understanding burnout and its consequences
The WHO officially defines burnout as “a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:
- feelings of energy depletion or exhaustion;
- increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
- reduced professional efficacy.”
Burnout affects clinicians on an individual level, delivering the mental and physical exhaustion mentioned above. Far from being only a staff issue, burnout has profound effects on hospitals and patients.
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CHICAGO—Origami Risk has been recognized as one of “Chicago’s Best and Brightest Companies to Work For®” by the National Association for Business Resources (NABR). The award marks the fourth consecutive year Origami Risk has been cited by NABR, including national honors and previous awards in Chicago and Atlanta. In gaining this recognition, Origami Risk now has earned over 20 workplace awards in recent years. The honors showcase its commitment to hire and retain the insurance industry’s top talent to provide the highest level of service to its customers.
“We’re honored to be recognized again by the National Association of Business Resources,” said Jon Nichols, chief operating officer, Origami Risk. “Our focus on delivering the highest quality of customer service has always depended on our ability to attract and retain the industry’s most talented people as well as to support them with the environment, tools and culture they need to be successful.”
According to NABR, only companies that distinguish themselves as having the most innovative and thoughtful human resources approach can be bestowed this honor. An independent research firm evaluates each company’s entry, based on key measures in various categories. They include: Compensation, Benefits and Employee Solutions; Employee Enrichment, Engagement and Retention; Employee Education and Development; Recruitment, Selection and Orientation; Employee Achievement and Recognition; Communication and Shared Vision; Diversity and Inclusion; Work-Life Balance; Community Initiatives; and Strategic Company Performance.
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The onboarding process can be challenging for both TPAs and their clients. Migrating data from one claims management system to another is often a difficult, resource-draining part of that process. Wesley White’s article 10 Data Migration Best Practices For Any Organization summarizes the extent of the challenge:
Migrating data to a new information management system from multiple sources is a complex and often headache-inducing undertaking. Data migration is often necessary to keep up with technological advancements and industry standards, but it requires great effort. Data from various storage areas—both onsite and in the cloud—must be evaluated, analyzed, cleaned up and organized before it can be combined and reconciled.
The right technology can help to reduce the tremendous burden that data migration places on new clients. It can also transform the onboarding process and showcase the unique insights, savings, and benefits your organization delivers. As White notes, “It doesn’t have to be as hard as you may think to get past these challenges and successfully migrate your data.”
Assisting with the pre-migration phase
Research from the independent research firm Bloor paints an ominous picture of data migration projects. Of these projects, 37% exceed budgets, 67% take longer than expected, and 84% fail to meet expectations. In Why do so many data migration projects end in disaster?, Colin Rickard, a data management director with Experian, is asked to explain the high failure rate. “Often there has just not been enough analysis done at the start, so you end up with a lot of data problems at the end,” he responds.
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When does maintaining an up-to-date library of workers’ compensation state forms become too great of a bureaucratic burden for your claims adjusters or administrative staff? The most straightforward response is this: The more states in which your organization handles workers’ comp claims, the greater the challenge of staying on top of form revisions and additions.
Time and resources could certainly be allocated to more important activities. In the International Risk Management Institute, Inc. (IRMI) article Workers Compensation Bureaucracy Drives Costs, Mark Walls and Kimberly George cite training and education as two such examples:
One of the goals of workers compensation regulations is to ensure that injured workers are paid benefits in a timely manner at the correct rate and that they have access to appropriate medical treatment,” write Walls and George. “There was a time when payers had offices located in most states with adjusters handling only that state. Now, with most payers utilizing multistate adjusters, payers must be constantly training and educating their adjusters to ensure that they understand all of the nuisances of the different states that they handle.
For organizations looking to reduce the bureaucratic burdens their adjusters face, Origami Compliance offers a secure, API-based solution that integrates with any claims management system to provide immediate access to a single-source, up-to-date library of state and federal workers’ comp claim forms. Without leaving the claims system, an adjuster can quickly find the right form based on state or category. And when that form is selected, form fields automatically populate with claim data and a PDF version is generated.
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Risk assessments and heat maps remain central components in most enterprise risk management (ERM) programs. Yet there is considerable debate about their effectiveness and both tools have no shortage of critics. In 2011 Howard Sklar, a Forbes contributor, outlined one of the most popular criticisms regarding companies that viewed risk assessments as a document instead of a risk management process. He noted, “Companies that fail in this way are often trying to check the risk-assessment box on their program. That’s fine, as far as it goes. At first glance, a risk assessment seems like a low-ROI effort. You put in time and potentially money, and you get back a piece of paper laying out what you already know.”
Similarly, others deride heat maps as nothing more than “colorful guesses.” Brian Priezkalns, in the not-too-subtly titled article, Why I hate Heat Maps, says “Heat maps are just a terrible terrible terrible way to understand, communicate about, and decide how to respond to risks. They either mess up what you already knew, or they hide the fact you are too ignorant to make a rational decision. Everything that can be done with heat maps would be done better with actual numbers.”
If the risk assessment and risk heat map have such fierce critics, then why are they still central to most ERM programs? In this article, we’ll examine what drives the limitations, and the key missing ingredient that turns them into powerful assets. … read more
Origami Risk has been named one of Inc. magazine’s Best Workplaces for 2019, the magazine’s fourth annual ranking in the fast-growing private company sector. In gaining this recognition for the second consecutive year, Origami Risk now has earned 19 workplace awards in recent years. The honors showcase its commitment to hire and retain the insurance industry’s top talent to provide the highest level of service to its customers.
Hitting newsstands in the June 2019 issue, and as part of a prominent Inc.com feature, the list is the result of a wide-ranging and comprehensive measurement of private American companies that have created exceptional workplaces through vibrant cultures, deep employee engagement, and stellar benefits. Collecting data on nearly 2,000 submissions, Inc. singled out 346 finalists.
Each nominated company took part in an employee survey, conducted by Omaha’s Quantum Workplace, on topics including trust, management effectiveness, perks, and confidence in the future. Inc. gathered, analyzed, and audited the data. They then ranked all the employers using a composite score of survey results. This year, 74.2 percent of surveyed employees were engaged by their work—besting last year’s 72.1 percent.
The strongest engagement scores came from companies that prioritize the most human elements of work. These companies are leading the way in employee recognition, performance management, and diversity. It’s a different playbook from a decade ago, when too many firms used the same template: free food, open work environments, and artifacts of “fun.”
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In November 2018, Baylor St. Luke’s Medical Center in Houston made two medical errors, the second of which lead to the death of a 75-year-old patient. After an investigation by the Houston Chronicle and ProPublica, the Centers for Medicare and Medicaid Services issued a report in early 2019 that outlined a pattern of blood labeling errors at the hospital. A ProPublica article on the report states:
Dr. Ashish Jha, an expert in hospital quality, reviewed the government’s findings and said it appeared St. Luke’s was struggling to meet basic care standards. The labeling mistakes, he said, seemed indicative of ‘a broader systemic problem.’… St. Luke’s appeared to miss warning signs in the months prior to the deadly mistake, according to the government report.
The “broader systemic problem” Dr. Jha mentions is, unfortunately, not unique to St. Luke’s. Many hospitals and healthcare systems face organization-wide, process-related issues, especially in a modern healthcare landscape that’s rife with change. Mergers, multiple technology platforms, and changing healthcare policies, to name just a few, contribute to widespread miscommunication and a lack of transparency. This, in turn, jeopardizes the overall quality of care within these organizations.
Hospitals can stem the scope of these issues by implementing a healthcare enterprise risk management (ERM) program. Healthcare ERM establishes a standardized framework for identifying risk across an organization, encourages cross-departmental collaboration, and shifts hospitals from a reactive clinical risk program to a proactive holistic risk management program. A straightforward process, along with the right technology that leverages healthcare analytics, can help to make this shift effective.
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In April, a global network of telescopes/telescope arrays called the Event Horizon Telescope zoomed on the galaxy M87 to create this first-ever picture of a black hole. Further analysis of the image revealed neither the whereabouts nor status of your RMIS support ticket.
When changing business requirements call for adjustments to your risk management information system (RMIS), how does your service team respond? For too many risk managers, the process looks something like this:
- Submit a support ticket.
- Send a follow-up email.
- Call and leave a message.
- Send a follow-up email (cc’ing additional RMIS provider staffers in hopes of escalation).
Trapped in this RMIS service ticket black hole, even the most basic of changes can mean weeks of waiting. Beyond testing one’s patience, delays can negatively impact risk management objectives. If you’re reading this while waiting for a response from your service team, consider switching to technology and an approach to RMIS support that puts you in control by putting your needs first.
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The number of core systems an insurance risk pool uses can have a major impact on the level of service that members receive, as well as the pool’s ability to make the best use of staff resources. Constantly jumping between multiple systems and trying to coax Word and Excel into accomplishing tasks they were never designed to handle is a recipe for performance issues. This can limit a pool’s growth and the types of services it can provide.
Activities most impacted
While the inefficiency of using a patchwork of applications to handle core business functions cuts across a wide variety of routine tasks, several activities performed by risk pool staff are particularly susceptible.
Calculating loss ratios
Assembling the information necessary to calculate loss ratios often involves building multiple spreadsheets and transferring data from several sources via copy/paste. This highly inefficient process is prone to errors. According to the ECRI Institute report, Copy/Paste: Prevalence, Problems, and Best Practices, the familiarity of the copy/paste technique explains why it is used so often. “However,” the report warns, “with several windows open, information can easily be copied into the wrong location. Secondly, copy/paste accelerates propagation of inaccurate information. The ubiquitous use of copy/paste means that, once created, an error can rapidly spread.”
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