in University Clinics

Risk Management in University Clinics Donald A Vogel, AuD, CCC-ADirector, Hunter College Center for Communication Disorders

Bio & Disclosures Vogel Bio:Audiologist,Clinic Director for Hunter College-CUNY, and, member of Metropolitan New York Council of University Clinic Directors in Communication Sciences and Disorders(that’s a mouthful for ya!)Many thanks to my co-authors – Dr. Sue Wortsman, AuD, CCC-A Dr. Paul Cascella, PhD, CCC-SLP

Bio & Disclosures Disclosure I:I am employed by Hunter College-CUNY and will receive travel reimbursement for attending CAPCSD.I am not paid for, nor do I have a vested interest in, promoting any product, software, hardware, or saleable good that may possibly be discussed during this presentation.

Bio & Disclosures Disclosure II: I am not a lawyer, credentialed risk management professional or university administrator.I am a SIMPLE professor employed by the City University of New York who has an interest in sharing what I do as clinic director with this audience.

Bio & Disclosures Learning Objectives: • Define risk management activities in a university clinic • Assess risk issues in their own settings • Coordinate a risk management committee at their clinics

Bio & Disclosures At the conclusion of this session, [I’m hoping] you will have some tools to develop guidelines to create a viable supervisor-faculty-student RMP appropriate to the university clinic setting.

Literature & Survey Basic information – what is risk management? • Risk management in healthcare is the examination and implementation of procedures and policies that will reduce harm to patients and employees

Literature & Survey What does the literature say? • Hospitals and service industry instruct their employees about RM • There is a paucity of research in this topic • We need to train future professionals about why this is important and not rely on the medical community to prepare our own professionals

Literature & Survey We did a survey (thank you for participating!) Our primary goals were: • Determine what RM activities are conducted • Recognize any trends across the country • Determine if professional experience relates to RM • Additionally, we wanted to assess how RM is monitored and used as an educational tool

Literature & Survey Risk management programs (RMP) • High priority in healthcare settings and academic institutions administrations • However, RMP survey of 280 CSD programs showed need for growth in this area of interest (response rate of 35%)

Balancing Acts UniversityCD’sbalancingact: • Administration • Clinical supervision • Enforcement • Mediation • Parenting • Patient care • Research • Service • Teaching

Balancing Acts When performing a balancing act, RM getsdeprioritized!

Balancing Acts What are the barriers?

Balancing Acts Who sits on your RM Committee?

Balancing Acts Risk Management CommitteeHunter College Center for Communication Disorders

Balancing Acts Frequency of RM monitoring activities

Balancing Acts Has your clinic RMP resulted in any of the following?

Balancing Acts With a clear understanding of risk management, CDs can integrate appropriate aspects of it into their clinic’s routine protocols.

Affects on clinic How does RM affect my clinic? “Risk management refers to strategiesthatreduce and minimize the possibility of a loss.”1 • It’sveryclear for healthcare: e.g., bloodbornepathogens = use gloves and ePHI = HIPAA compliancetools • But for us there’s more: Student: safety; FERPA;credentialing Faculty: safety; credentialing Staff: safety; training Accreditation 1Risk Management and Medical Liability, American Academy of Family Physicians, AAFP Reprint No. 281, retrieved 3.31.14 from: http://www.aafp.org/dam/AAFP/documents/medical_education_residency/program_directors/Reprint281_Risk.pdf

Affects on clinic How does RM affect my clinic? • Need – the who, what, where, when and why • Commitment of time and resources • Academicbenefits • Harmreduction • Teachingtool

Affects on clinic What incidents have you recorded?

Affects on clinic University clinic RMP Is it not as important as: • Clinicalduties and service? • Teaching? • Research?

Affects on clinic What drives risk management? • Charge of the risk management committee must be a comprehensive one • University administration looks to avoid adverse events thus reducing harm and liabilities • Financial • Students • Clients • Faculty • Staff • Physical plant

Key elements of RMP Key elements of an RMP include Awareness Action Education Risk Management Program

Key elements of RMP Knowledge of thesetoolsassistsuniversity clinic managers in the initiation of an RMP in a fairlyeffortless, and [somewhat] less time-consumingmanner.

Key elements of RMP Education • Education about risk management helpsreduce harm to clients, students, faculty and staff. • Educatingstudents about risk management philosophy and how it is conductedadds to the pedagogicalelement of clinicaleducation.

Key elements of RMP Awareness • Individualswalkinginto clinic know the risks, measures and how to avoid them. • Awareness of the riskstakes place on multiple levels and interactions: • Environment • Environment to people • People to people

Key elements of RMP Action RMP takes charge to secure harm reduction • Protocols • Drills • Audits • Inspections Reinforces the commitment by the university clinic to reducing the risks

Key elements of RMP What do wewish to impart on ourstudents, faculty and staff? The elementscreatinga unique risk management program in the universityclinicsetting: • Pedagogicalaspects of client/patient care • Measuresthatreducerisks for clients, students, staff and facultywho attend clinic • Environmental monitoring

Key elements of RMP The otherelementsthatmakeit work • Governance • Risk Assessment • Compliance

Key elements of RMP Governance • Directive from administration that a taskneeds to be performed • Ensuresthat the directive wascompleted • Managingrisks of safety and liability to clients, students, faculty and staff are the goals • Governancewilloftenlendfinancial support to the RMP [if theybringit up first!]

Key elements of RMP Risk Assessment Examines the gravity and control of varioushazardsexposingthoseentering the sphere of the university clinic setting: • Clients • Students • Faculty • Staff

Key elements of RMP Compliance • Mechanism by whichGovernance and Risk Assessmentare adhered • Individualsappointed as complianceofficers are typically the “turn to” person and heldresponsible for ensuring the various goals of risk management program have been met

Create a committee Steps to creating a RM committee • Committee mission • Committee members • Clinical educators • Faculty • Students • Staff • Frequency of meetings • Generatingspecific goals and directives

Create a committee Stepsin running the committee: • Elect/Assigncommittee chair (witheveryfiber of yourbeing, resisttaking command of thisrole) • Allow the new leader to define and delineate the center’srisks • Classify if the risks are in the purview of the committee or somehigherauthority • Allow the new leader to assignresponsibilities to completetasks • Allow the new leader to design activitieswhichwillensurecompliance

Create a committee Leadership: Clinic director assumes theseroles: • Advisor: function as an advisingmember/participant • Mentor: allowotherfacultymembers or staff to serve as leader, because: • CD is releasedfromduty • Advocate for professionaldevelopment of a peer

Create a committee CD guides through important issues (may be overlookedwith the lessexperiencedeye): • Abuse: elder, emotional, physical, sexual • Chemical/Environmental • Documentation and credentials • Hazardouswaste • Infection control • Privacy • Proper identification • Supervision • Training • Transferring patients

Important issues Review issues fromthese perspectives: • Environment • Patient care • Pedagogy

Important issues What areas of RM does committee consider?

Important issues Identifying risk areas is critical: • Privacy and security • Infection control • Safety • Allergens

Important issues Assessing Risk in 5 Steps2 Step 1: Identify the hazards (what can go wrong?) Step 2: Decide who might be harmed and how (what can go wrong? who is exposed to the hazard?) Step 3: Evaluate the risks (how bad? how often?) and decide on the precautions (is there a need for further action?) Step 4: Record your findings, proposed action and identify who will lead on what action. Record the date of implementation. Step 5:Review your assessment and update if necessary 2Health Risk Assessment Made Easy, National Patient Safety Agency (NSPA), 2007, London, UK (http://www.nrls.npsa.nhs.uk/resources/?EntryId45=59825)

Important issues What metric surveys are conducted?

Important issues About EHR EHR and documentation

Important issues Environmental issues • Chemical • Firesafety • Public safety • Structural

Important issues Environment issues Write down RM tasks important to environmental issues

Important issues Patient/Client care issues Write down RM tasks important to client issues

Important issues Student issues • Abuse • Documentation • Food allergies and asthma triggers • Infection control • Privacy • Safe use of wheel chair and walkers • Transferringpatients • Falls • All of the above, and, • Clinicalknowledge and skill • Credentialing(e.g., liabilityinsurance)

Important issues Supervision issues • Abuse • Documentation • Food allergies and asthma triggers • Infection control • Privacy • Falls • Safeuse of wheel chair and walkers • Transferring patients • Clinicalknowledge and skill • Credentialing(e.g., liabilityinsurance) • Same as students and: • FERPA

Pedagogy Pedagogy • Not necessarily a risk (but just in case, youcanget rider on yourliabilityinsurance) • Studentinvolvement is a critical component of this program as it enablesthem to learn about issues oftenleft to learnatexternship or real-world experiences

Pedagogy RM as teaching tool

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