Risk Management

COMPETENCIES

7024.1.3 : Legal Aspects of Risk Management and Quality
The graduate evaluates the confluence of quality improvement and risk management practices that support favorable legal outcomes for healthcare organizations.
7024.1.5 : Compliance Programs
The graduate applies compliance requirements identified by government regulations and by accreditation, licensing, and certification agencies to mitigate legal risk to healthcare organizations.
INTRODUCTION

Risk management, quality improvement, and compliance programs have discrete applications within a healthcare organization, yet they have complementary goals. The motive for these programs is to improve all aspects of the patient experience. There are external regulations and requirements imposed on all organizations, and these regulations are controlled by the internal processes designed by each organization.

There is an expectation of care and trust between patients and their healthcare providers. An organization needs to be vigilant in all circumstances, particularly those involving patient safety.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Analyze the attached “Compliance Management Scenario” by doing the following:

1. Describe five health information management (HIM)-related mistakes made in the scenario.
2. Determine whether each of the five mistakes described in part A1 was a violation of organizational compliance, a legal concern, or both.
3. Describe one specific solution the compliance officer and Anika, the manager, should implement to prevent each of the five mistakes described in part A1 and justify how these solutions will prevent reoccurrences of each mistake.

B. Explain how the manager of a HIM department could teach compliance behaviors to the clinic’s staff members in order to mitigate legal risk within a healthcare organization.

1. Explain why it is important for staff to understand patient authorization as it relates to release of information, including how this ensures patient safety and trust.
2. Explain protocols for release of protected health information (PHI) and how these protocols protect patient privacy.

C. Acknowledge sources, using in-text citations and references, for content that is quoted, paraphrased, or summarized.

D. Demonstrate professional communication in the content and presentation of your submission.