1. SHOPS is funded by the U.S. Agency for International Development. Abt Associates leads the project in collaboration with Banyan Global Jhpiego Marie Stopes International Monitor Group O’Hanlon Health Consulting Business for Health Business Skills for Private Medical Practices Module 10: Risk Management in Your Health Practice

2. A Quick Start Welcome! While you are waiting for the class to begin, please take the Pre-Test and make sure your name is on it before you hand it to the facilitator. While you are waiting for the class to begin, please take the Pre-Test and make sure your name is on it before you hand it to the facilitator. Thank you!. 2Business Skills for Private Medical Practices

3. Agenda Welcome Risk Management Defined Telephone Communication Risks Credentialing Risks Medication Management Risks Privacy and Confidentiality Risks Risk Management Summary and Evaluation Close 3Business Skills for Private Medical Practices

4. Learning Objectives During this session, you will: 1.define risk management; 2.assess the need for telephone protocols; 3.create a credentialing checklist; 4.review the consequences when the “Six Rights” of medication management are not fulfilled; 4Business Skills for Private Medical Practices

5. Learning Objectives 5.describe your privacy and confidentiality practices; 6.propose how to handle risk management issues; 7.discuss the relationship between risk management and quality improvement in a health practice; 8.describe the next step; and 9.state your key take-away from this session. 5Business Skills for Private Medical Practices

6. Introduction You will have 1 minute to introduce yourself: 1.Your name 2.Your position 3.Your business 4. How long you have been in business 6Business Skills for Private Medical Practices

7. Risk Management Defined Business Skills for Private Medical Practices 7

8. Discussion Question Please pop up and stand by your chair if you have an answer to this question: How does risk management apply to human resources, medications, medical supplies, medical records, and facility management? Business Skills for Private Medical Practices8

9. Risk Management Are you: Business Skills for Private Medical Practices9 Proactive?Reactive? Avoiding or preventing risk Minimizing loss or damage after a bad event

10. Telephone Communication Risks Business Skills for Private Medical Practices 10

11. The Need for Telephone Protocols 1.What procedural problems occurred? 2.What are the pros and cons of patients calling a doctor or nurse on their personal cell phones? 3.If doctors or nurses are allowed to give medical advice over their personal phones, what telephone protocols are needed to minimize risks? Business Skills for Private Medical Practices11

12. Telephone Protocol Most Common Problems: 1.Undocumented advice from clinical staff 2.Inappropriate triaging by clinical staff 3.Medical advice from non-clinical staff Business Skills for Private Medical Practices12

13. Sample Phone Message Form Business Skills for Private Medical Practices13

14. Sample Phone Message Form Business Skills for Private Medical Practices14

15. Seven Rules for Medical Office Phone Etiquette Business Skills for Private Medical Practices15

16. Credentialing Risks Business Skills for Private Medical Practices 16

17. First Hand Credentialing Direct qualification confirmation (or “firsthand credentialing) of clinical staff represents another practice risk. Credentialing involves obtaining, reviewing and verifying an applicant care provider’s licensure, certification and references- before hire. Business Skills for Private Medical Practices17

18. First Hand Credentialing Create a credentialing checklist that a practice can use to directly: 1.Verify the credentials of all clinical staff before they start employment 2.Confirm the scope of hospital privileges Business Skills for Private Medical Practices18

19. Credentialing Risk Factors inconsistency poor clinical performance invalid license poor recommendations missing information no privileges unexplained time gaps malpractice claim history disciplinary history Business Skills for Private Medical Practices19 Red Flags to Consider Remember: Any inconsistent information between the application and verification is suspect!

20. Sample Credentialing Checklist Business Skills for Private Medical Practices20

21. Sample Credentialing Checklist Business Skills for Private Medical Practices21

22. Medication Management Risks Business Skills for Private Medical Practices 22

23. Medication Management “Six Rights” 1.The right patient4. The right route 2. The right drug5. The right frequency 3. The right dose6. The right duration Business Skills for Private Medical Practices23

24. Medication Errors Business Skills for Private Medical Practices24 1.What procedural problems occurred? 2.What should have been done to ensure that the “Six Rights” in medication management were fulfilled? 3.What are the lessons in this case related to: a.How doctors order drugs? b.How pharmacists fill orders?

25. When Do Errors Occur? Business Skills for Private Medical Practices25

26. “Medication Errors” At the ordering stage: 1.Illegible handwriting 2.Look-alike, sound-alike drug names 3.Non-standard abbreviations 4.Verbal or telephone orders (which result in transcription mistakes Business Skills for Private Medical Practices26

27. Prevent “Medication Errors” 1.Written standards for drug names and dosing abbreviations 2.Written policy for verbal or telephone orders Business Skills for Private Medical Practices27

28. Sample Medication and Allergy Record Business Skills for Private Medical Practices28

29. Privacy and Confidentiality Risks Business Skills for Private Medical Practices 29

30. Privacy and Confidentiality 1.How do you ensure that other patients cannot overhear conversations when the clinical staff discusses patient information? 2.What are other ways that patient privacy can be violated? 3.How do you sensitive your staff to the issues of privacy and confidentiality? Business Skills for Private Medical Practices30

31. Risk Management Business Skills for Private Medical Practices 31

32. Risk Management Case Dr. Evans Kwendo: 1.Use the Risk Management Assessment Job Aid on page 27; and 2.Identify the major risks that have occurred in Dr. Evans Kwendo’s practice; and 3.Develop an appropriate risk response strategy for each of the identified risks. Business Skills for Private Medical Practices32

33. Risk Management Assessment RiskResponse Strategy Business Skills for Private Medical Practices33

34. Risk Management Assessment RiskResponse Strategy Lack of first-hand credentialing Lack of technical capacity Poor reputation Loss of licensure Poor patient record management Unsafe environment Business Skills for Private Medical Practices34

35. Summary and Evaluation Business Skills for Private Medical Practices 35

36. Risk Management and Quality Improvement 1.Risk management is part of quality improvement. Business Skills for Private Medical Practices36

37. Risk Management and Quality Improvement 1.Risk management is part of quality improvement. Business Skills for Private Medical Practices37

38. Risk Management and Quality Improvement 2.Risk management feeds error data into quality improvement. Business Skills for Private Medical Practices38

39. Risk Management and Quality Improvement 2.Risk management feeds error data into quality improvement. Business Skills for Private Medical Practices39

40. Risk Management and Quality Improvement 3.Quality improvement goes beyond risk management. Business Skills for Private Medical Practices40

41. Risk Management and Quality Improvement 3.Quality improvement goes beyond risk management. Business Skills for Private Medical Practices41

42. Evaluation Sheet 42Business Skills for Private Medical Practices

43. The Next Step Take proactive risk management actions: 1.Identify the three most significant risk management issues that could have negative consequences for your practice. 2.Determine the actions needed to decrease these risks. 3.Define training your staff needs to better manage risk in your practice. 43Business Skills for Private Medical Practices

44. Let’s See How Much You’ve Learned Please take the Post-Test. We will compare it to your Pre-Test to see how much you’ve learned in this session. Thank you. Business Skills for Private Medical Practices44

45. My Key Take-Away 45Business Skills for Private Medical Practices