In this new series, we ask medical liability leaders to share their perspectives on emerging risks and key issues shaping the industry.
Suzanne Blundi is president of MMC Risk Consultants, where she supports healthcare clients in achieving superior claim outcomes. An attorney and healthcare risk expert with decades of experience, she has held leadership roles in claims management, legal affairs and healthcare compliance, including serving as vice president of claims for MCIC Vermont and deputy general counsel for NYC Health + Hospitals. Through her work, she helps organizations navigate complex liability challenges from event assessment to resolution to identify, analyze and mitigate risks for positive outcomes.
What’s one misconception people have about the role of a clinical risk manager?
There is often an unfortunate association between the role of a clinical risk manager being limited to litigation. While it is often a part of their job description, the role is much more proactive, focusing on near misses, concerns, overall risk patterns and events. Within the right hospital infrastructure, this role is one of a liaison between practitioners, administrators and legal teams.
From your perspective, what are the biggest clinical risks healthcare organizations are managing today, and how have they changed over the past few years?
In sum, I would say tech and people. Specifically, people development, retention and addressing burnout are fundamental to a successful healthcare organization. These issues are among the most frequently discussed, especially when things don’t go well. Poor retention also affects culture, potentially leading to an uphill battle when it comes to identifying, reporting and investigating events. Whatever risk management systems administrators may put in place, if the workplace culture is not aligned with the mission, as the saying goes, “culture eats strategy for breakfast.” Social capital in healthcare is both its greatest asset and its greatest risk.
Similarly, with electronic records and AI being integrated into daily floor operations, there is both convenience and risk. Risk stems from adequately training staff and gaining team buy-in for new tech. This is where the risk manager can be especially helpful — if they are tuned into the shortcuts providers are trying to create. Recall when sepsis monitoring alerts and beeping systems were first rolled out: at some point, the beeps started getting ignored.
When a serious adverse event occurs, what are the most important steps organizations should take in the first 24 to 48 hours?
Healthcare is about humanity. Acknowledging humanity in the aftermath of an adverse event is most important. This means identifying the impact on staff, the patient and the family, and providing support. Oftentimes, staff are secondary victims of adverse events and can be overlooked by risk investigators as they proceed with their interviews. Providing resources and support for staff during an investigation can only strengthen the culture. Organizations should focus on securing all recordings, defining the perimeter of the investigation and identifying all providers involved and their respective roles. This helps establish the scope of the event and supports a thorough investigation.
What role does organizational culture play in reducing risk, and how can leaders encourage staff to report concerns before they become claims?
In the insurance world, effective carriers who care about building long-term relationships with their clients recognize that attempting to build trust while a big, expensive claim is percolating is ineffective. Instead, the better ones insert themselves into audits, calls and random questions on more run-of-the-mill cases, all to understand how the client operates and to become a known entity to them. Similarly, leadership visibility and frequent engagement — not just around sentinel events, but also near misses and almost-mistakes — are vital.
Are there recurring documentation or communication issues that you continue to see contribute to claims, and what strategies have proven most effective in addressing them?
There are several, but one issue we see often is communication during handoffs and sign-outs. There is no perfect solution other than taking the time needed for a thorough sign-out, but alas, that can be a lot to ask of a tired provider at the end of a shift. Building a buffer around sign-outs or providing dedicated quiet areas where they can occur are certainly effective ways to ensure a smooth flow of communication.
Looking ahead, where do you see the greatest opportunities for healthcare organizations to reduce risk, whether through technology, education, process improvements or interdisciplinary collaboration?
I think the greatest opportunity for reducing risk and improving patient outcomes is medical record interoperability. The easier it is to transfer a patient’s records from one provider or health system to another, the better the receiving provider’s understanding of the patient’s health will be. This is already happening among Epic hospitals and, to some extent, across New York state. For example, if you present to an emergency department five counties away, providers may be able to retrieve your information through the Statewide Health Information Network for New York (SHIN-NY), although that access is limited. Yet, it is a start.
