Within this environment, risk and quality managers are doing more, but not always with additional resources. Healthcare leaders recognize that poor-quality care can affect both the organization's bottom line and its reputation and that failure to integrate risk and quality efforts can imperil the organization's success. The federal government also posts publicly available quality data for other healthcare providers, including long-term care facilities, physicians, home health providers, and dialysis facilities. Not only is a healthcare facility's quality-of-care data used to establish reimbursement rates, but it is also posted on the federal government's Hospital Compare website so that patients can use the data to select hospitals. Initiatives include The Leapfrog Group's public hospital reporting initiatives to assist healthcare purchasers, the National Quality Forum's serious reportable events and recommendations of safe practices for healthcare organizations, and the National Committee for Quality Assurance's (NCQA) quality measures (called the Healthcare Effectiveness Data and Information Set, or HEDIS) for managed care. In the private sector, numerous efforts to enhance healthcare quality have required a closer working relationship between risk and quality professionals to improve patient safety across the continuum of care. These payment initiatives include value-based purchasing (i.e., Medicare payment enhancements to hospitals that meet specific quality targets), provisions to no longer pay the costs of certain hospital-acquired conditions, and financial penalties for hospitals with high rates of readmissions within 30 days of a patient's hospital discharge for the treatment of certain conditions. In the public sector, an increasing number of federal payment initiatives linked to healthcare quality have ensured that the combined efforts of risk and quality managers have the attention of healthcare leaders. Joint Commission standards for patient safety, first issued in 2001, along with the organization's sentinel event policy and its ongoing initiatives for performance measurement, spurred organizations to act on IOM's recommendations and build better alliances between risk and quality professionals. Changing systems of care will,' the report said. Soon to follow was IOM's 2001 reportĬrossing the Quality Chasm, which said that healthcare safety and quality will not improve until systems of care are redesigned. The mandate to improve patient safety presented risk managers 'with the opportunity to recreate our roles and also to use our existing skills to direct, mentor and lead the charge to improve patient safety within our organizations,' said one risk manager (Gutman). To Err Is Human: Building a Safer Health System, which underscored the need for healthcare organizations to monitor and learn from patient safety events (IOM Several initiatives in the last 15 years have helped to forge the alliance, starting with the Institute of Medicine's (IOM) 1999 report ** ECRI gratefully acknowledges the input provided by the following individuals in developing this Risk Analysis: Lee Hamilton, JD, MPA, RN, CPHQ, FNAHQ, PCMH CCE, senior consultant, Health APT, Selah, Washington, and Abraham Segres, MHA, CPHRM, FASHRM, vice president, quality and patient safety, Virginia Hospital & Healthcare Association. This Risk Analysis generally uses the terms 'quality professional' and 'quality manager.' * The terms 'quality improvement,' 'quality management,' and 'performance improvement' are used interchangeably in the healthcare literature.

Today, risk management and quality improvement efforts in healthcare organizations are rallying behind patient safety and finding ways to work together more effectively and efficiently to ensure that their organizations deliver safe, high-quality patient care and continue to minimize risks.** In the past, the two functions often operated separately, and individuals responsible for each function had different lines of reporting-an organizational structure that further divided risk management and quality. The roles of healthcare risk and quality professionals* are evolving in healthcare organizations. Healthcare Risk Control Currently selected.Aging Services Risk Quality and Safety Guidance.ECRI Permissions Agreement – Clinical Practice Guidelines.

Healthcare risk manager