1. CONTROL & RISK MANAGEMENT STRATEGIC MANAGEMENT IN HEALTHCARE 14 April 2009

2. CONTROL MONITORING POINTS INPUTS - PROSPECTIVE –FEED FORWARD CONTROL PROCESSES - CONCURRENT –SCREENING CONTROL OUTPUTS - RETROSPECTIVE –FEEDBACK CONTROL

3. INPUT CONTROL FOCUSES ON RESOURCES CONSUMED IN A SERVICE INDUSTRY THIS USUALLY MEANS PERSONNEL PHYSICAL RESOURCES SHOULD NOT LIMIT PERSONNEL BUT USUALLY DO

4. PROCESS CONTROL OUTPUTS ARE DETERMINED BY: –AMOUNT & APPROPRIATENESS OF INPUTS –EFFICACY & EFFICIENCY OF PROCESS

5. OUTPUT CONTROL ALSO CALLED FEEDBACK CONTROL QUALITATIVE & QUANTITATIVE REQUIRES STANDARDS OR EXPECTATIONS

6. CQI AND CONTROL PROCESSES CAN BE IMPROVED CONTROL IS DIRECTED AT PROCESSES INPUT CONTROL IS NO SUBSTITUTE FOR PROCESS AND OUTPUT CONTROL

7. CONTROL METHODS BUDGETING COST ALLOCATION RATIO ANALYSIS - % OF EXPECTED FINANCIAL STATEMENTS/ANALYSIS OPERATIONAL ACTIVITY ANALYSIS BENCHMARKING STANDARD SETTING

8. DESIGNING CONTROLS INFORMATION BASED PROSPECTIVE WHEN POSSIBLE REALISTIC & UNDERSTANDABLE ACURATE, TIMELY & RELIABLE IMPORTANT &/OR COST-EFFECTIVE

9. INFORMATION SYSTEMS MANAGERIAL - HUMAN RESOURCES CLINICAL – DOCTOR VISITS MIXED - LABORATORY

10. INFORMATION SYSTEMS ALL THE USUAL PROBLEMS HIGHLY IDIOSYNCRATIC INFORMATION HIGHLY “TECHNICAL” INFORMATION HIPPA

11. ELECTRONIC MEDICAL RECORDS GARBAGE IN – GARBAGE OUT IF A SYSTEM IS NOT FUNCTIONAL, COMPUTERS WILL MAKE IT WORSE INFORMATIONAL NOISE

12. ADVANTAGES OF EMR Access from multiple sites Reduced offline storage costs Improve quality & coherence of process Automated clinical guidelines Support research and quality improvement Easier reporting of all types Portability – disaster response

13. DISADVANTAGES OF EMR Scores of incompatible data sources Duplicate information and effort Obtaining information from physician Physician as clerk/typist Confidentiality No reduction in support staff Transfer to next provider

14. RISK MANAGEMENT PRIMARY, SECONDARY, AND TERTIARY PREVENTION SPECIALTY OF LAWYERS ABOUT STANDARDS ABOUT LOSSES –MONEY –REPUTATION/BUSINESS –FREEDOM

15. RISK MANAGEMENT AVOID OR REDUCE LOSSES/MISTAKES MITIGATE THE DAMAGE FROM LOSSES/MISTAKES INSURE AGAINST LOSSES/MISTAKES OBEY THE LAW

16. STEPS IN RISK MANAGEMENT IDENTIFY EVALUATE REDUCE/ELIMINATE TRANSFER/INSURE

17. WHEN A LOSS OCCURS SECURE THE RECORDS MITIGATE DAMAGES DON’T ADD INSULT TO INJURY BE SMART ABOUT BILLS SUPPORT YOUR PEOPLE

18. SELF-INSURANCE YOU ARE YOUR OWN INSURANCE COMPANY REINSURANCE OR UMBRELLA IS USUALLY NECESSARY DEDUCTIBLE IS A FORM OF SELF- INSURANCE

19. INCIDENT REPORTS MAY BE USED FOR NUMBERS ONLY SERIOUS PROBLEMS NEED A FAST TRACK MUST HAVE A CORRECTIVE ACTION COMPONENT - DON’T JUST DOCUMENT YOUR STUPIDITY!

20. NATIONAL PRACTITIONER DATA BANK MUST REPORT SIGNIFICANT ACTIONS AGAINST A PRACTITIONER MUST QUEARY IT BEFORE TAKING ON A NEW PRACTITIONER AVOIDING REPORTING

21. INDEMNIFY & HOLD HARMLESS USUALLY A STUPID IDEA FOR BOTH PARTIES DON’T EVER SIGN ONE YOURSELF INSURANCE OR A BOND IS THE RIGHT WAY TO DO THIS