Regulatory Requirements, Leadership, And Risk Management

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Regulatory Requirements, Leadership, and Risk Management The Deficit Reduction Act of 2005 and the institution of the Inpatient Prospective Payment System of 2007 were sentinel events for health care leaders with respect to quality management and regulatory compliance. The creation of Present on Admission (POA) and "never events" accountability required health care leaders to change processes and to assess and manage potential risks. Additionally, these events required leaders to effectively intervene for assurance of quality care or risk denial of payment for services (Youngberg, 2011, pp. 70–71, 78). The era of accountable care organizations was driven by policy change.

Review the Hospital Acquired Condition (HAC) list from Appendix 7-B on page 79 in your Principles of Risk Management and Patient Safety text. Imagine that you are the risk manager of an accountable care organization. Select one never event from the list on page 79 and describe how you would institute proactive monitoring for POAs. For this discussion: Describe how you would intervene when an HAC occurred. Identify departments or functional areas that would be involved in reporting to regulatory entities. Describe problem resolution. Describe how you would use the data from the lesson learned for organizational improvement. An outline format is acceptable for this discussion as long as you include in-text citations. Distinguished posts will describe, in 1–3 sentences, the role of a risk manager and briefly define an accountable care organization, using a government or other credible industry source. Additionally, distinguished posts will include a short 3–5 sentence summary on how to create a culture to enhance voluntary, non-punitive reporting of "never events." Include a minimum of one peer-reviewed or best practice resource.

Initial posts should be based upon peer-reviewed, evidence-based literature. In your post, include at least one APA-formatted in-text citation and accompanying, congruent APA-formatted reference. Your source can be a course textbook, assigned reading, or other scholarly source. Reference Youngberg, B. J. (2011). Principles of risk management and patient safety. Sudbury, MA: Jones and Bartlett.

Paper For Above instruction

In the complex landscape of contemporary healthcare, the role of a risk manager is vital in safeguarding patient safety, ensuring regulatory compliance, and promoting organizational excellence. According to Koenig and Sullivan (2017), the risk manager acts as an advocate for both patients and the organization by identifying potential risks, implementing preventative strategies, and fostering a culture of safety. An accountable care organization (ACO) is a healthcare model where providers collaborate to coordinate high-quality care while controlling costs, with shared responsibility for patient outcomes (Centers for Medicare & Medicaid Services, 2020).

Focusing on hospital-acquired conditions (HACs), a notable never event is surgical site infections (SSIs). As a risk manager in an ACO, instituting proactive monitoring for Present on Admission (POA) entails implementing real-time surveillance systems utilizing electronic health records (EHRs) that flag pre-existing conditions. Education initiatives for clinical staff on accurately documenting POA status help prevent misclassification. Regular data audits and risk assessments are conducted to identify patterns and areas needing improvement (Mitchell et al., 2019).

When an HAC such as SSI occurs, immediate intervention involves convening a multidisciplinary review team—including infection control, surgery, and nursing departments—to analyze root causes. The team develops corrective action plans, such as enhanced sterilization protocols or staff retraining, and ensures timely reporting to regulatory agencies like The Joint Commission and CMS (Pronovost et al., 2018). Problem resolution involves monitoring post-intervention outcomes, adjusting strategies as needed, and maintaining open communication channels across departments.

Data derived from lessons learned is integral to continuous organizational improvement. Trends identified through incident reports guide the development of targeted quality improvement initiatives, update clinical pathways, and refine infection prevention policies. Cultivating a culture of safety that encourages voluntary, non-punitive reporting of "never events" is fundamental. This can be achieved by leadership endorsing transparency, recognizing staff contributions to safety, and implementing anonymous reporting systems to reduce fear of blame (Frankel et al., 2017). Such an environment fosters trust, accountability, and proactive risk management.

References

• Centers for Medicare & Medicaid Services. (2020). Accountable Care Organizations (ACOs). https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ACO
• Frankel, A. S., Leonard, M. W., & Montgomery, J. (2017). The checklist movement in health care: Gap, or bridge, to safer care? BMJ Quality & Safety, 26(4), 287–290.
• Koenig, T., & Sullivan, P. (2017). The risk manager's role in enhancing patient safety. Journal of Healthcare Risk Management, 37(2), 27–34.
• Mitchell, P. H., et al. (2019). Infection prevention and control strategies in surgical care. Infectious Disease Clinics, 33(1), 115–127.
• Pronovost, P. J., et al. (2018). Creating a culture of safety in healthcare organizations. Journal of Patient Safety, 14(2), 95–103.