In this new series, we ask medical liability leaders to share their perspectives on emerging risks and key issues shaping the industry.
Gina Kittek, system director of risk management and corporate compliance at United Health Services, oversees enterprise risk management, corporate compliance, insurance programs and claims management across the health system. With more than 30 years of healthcare experience, she is a recognized leader in healthcare risk management and compliance and is actively involved in advancing the profession through state and national organizations.
What’s one misconception people have about the role of a clinical risk manager?
That we always say “no.” We tend to ask a lot of clarifying questions when individuals contact us with questions or concerns. Not every situation is the same, so we must perform a risk assessment for each individual situation. While we have policies and procedures, there are times we may bend the rules based on that assessment. We’re not the bad guys; our goal is to protect the organization and support our staff.
From your perspective, what are the biggest clinical risks healthcare organizations are managing today, and how have they changed over the past few years?
Delays in diagnosis, failures to follow up on tests and treatments, and communication breakdowns. The severity of outcomes has increased.
When a serious adverse event occurs, what are the most important steps organizations should take in the first 24 to 48 hours?
First, make sure the patient is stabilized. Next, notify risk management and complete an incident report. Before speaking with the patient or family, coordinate with risk management. Then, the primary provider should have a conversation with the patient and family about what is known — just the facts. Finally, begin the RCA or ACA process.
What role does organizational culture play in reducing risk, and how can leaders encourage staff to report concerns before they become claims?
A culture of transparency is key. Healthcare leaders need to encourage and promote incident reporting and demonstrate that reporting leads to meaningful improvements. Following up with individual reporters is equally important. A culture of safety and emphasis on zero harm is critical as well. Leaders must walk the walk and talk the talk, leading by example.
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?
We’ve noticed failures to follow up on routine testing by our primary care providers. In some cases, the importance of completing recommended screening tests was not sufficiently emphasized to patients, which contributed to claims. To address this, we worked with a risk consultant from our malpractice carrier to develop a tip sheet for our medical staff. We distributed the tip sheet and reinforced the message with a follow-up article from our risk manager in the physician newsletter. In addition, every two years our medical group providers are required to complete courses that are tied to their incentive. The courses focus on high-risk areas identified by our risk and quality departments.
Looking ahead, where do you see the greatest opportunities for healthcare organizations to reduce risk, whether through technology, education, process improvements or interdisciplinary collaboration?
Reducing risk is an ongoing process, and a combination of technology, education, process improvements and interdisciplinary collaboration is the only way to tackle the problem. There must be collaboration, continuing education and reinforcement by all leadership in risk-related areas. We need to continue the discussions, keep sharing safety stories and lessons learned, and communicate important information through a variety of channels and media sources. We should implement proven AI solutions to help check our work and identify potential risks. At the same time, organizations need strong governance and ongoing monitoring of both IT and AI activities. These tools can be effective in reducing risk, but they must be used with caution and governance.
