The differences between health professionals in assessing levels of caregiver burden

This study examined the ways in which 44 different health professionals appraised a series of comments from those relatives who were the main caregivers of people with schizophrenia. The comments reflected different dimensions of caregiver burden, and were used to develop a questionnaire. The respondents were given 60 different quotes from caregivers, and asked to rate the burden severity of each burden quoted, in three different scenarios that could apply: the burden happening once, the burden happening on a regular basis, and the burden happening in conjunction with other problems. The results were analysed in relation to the question as to whether there were differences in the ratings of different demographic groups within the professional sample undertaking the questionnaire. The results showed that there were wide areas of agreement between the different demographic groups in the study. However, there were a number of differences in burden ratings relating to caregivers' concerns over patients' thoughts and behaviours, and also to the caregivers' annoyance with health services. There were also some specific areas of difference between male and female professionals, nursing and non-nursing professionals, and between those with five years experience or less, and those professionals with over five years experience.     

The journey and Journal get better every year

As I enter into my presidency, I have been reflecting on the past and when I first learned of ASHRM and everything the society offered. I think of all the past presidents and how much I admired their knowledge and dedication to the profession of healthcare risk management.     

Spreading the word about the unique and valuable role of healthcare risk managers

Here I am three‐quarters through my year as president of ASHRM and I am still pinching myself that I am where I am! How has your year been? It has been a tough year for everyone in healthcare. With the Affordable Care Act demands on healthcare and the public, concerns about funding, quality initiatives, and overall potential loss of revenue, it's a wonder we are still in healthcare. But would you be doing anything different? I don't think so. I love that I can help make a difference by assisting staff with a difficult patient or situation or help a patient with a care concern that they are totally frustrated with or explain to a fellow risk manager what I would do in the situation they are dealing with. Although we feel like we are being pulled into new healthcare territories for our insight and recommendations, it is an indication of the value we bring to our organizations. We will get through this and there will be more challenges, but as risk management professionals, we can help solve problems and create value in the upcoming changes in healthcare.     

Knowledge management: An innovative risk management strategy

Knowledge management effectively lends itself to the enterprise risk process. The authors introduce the concept of knowledge management as a strategy to drive innovation and support risk management. They align this work with organizational efforts to improve patient safety and quality through the effective sharing of experience and lessons learned. The article closes with suggestions on how to develop a knowledge management initiative at an organization, who should be on the team, and how to sustain this effort and build the culture it requires to drive success.     

Enhance patient safety by identifying and minimizing risk exposures affecting nurse practitioner practice

A study analyzing closed professional liability claims against nurse practitioners over a 5‐year period was completed by CNA and Nurses Service Organization (NSO). Of 200 closed claims, the average total incurred payment per claim was $285 645. The study identifies current liability patterns and trends and provides risk‐control recommendations to enhance patient safety and minimize liability exposure. Study results indicate that while the number of nurse practitioner claims have been relatively stable over the past 5 years (2007–2011), the number of claims resulting in very severe indemnity payment have increased 19% since 2009. The data also show that many claims develop from a failure involving core competencies, such as treatment and care management, and medication prescribing. Allegations related to failure to diagnose and delay in making a correct diagnosis were found most frequently. The claims demonstrate that nurse practitioners are responsible for obtaining and documenting the results of appropriate tests, consultations, and overall need for medical intervention to meet the patient's medical needs.     

Ethics,risk, and patient‐centered care: How collaboration between clinical ethicists and risk management leads to respectful patient care

Patient‐centered care is driven in part by the ethical principle of autonomy and considers patients' cultural traditions, personal preferences, values, family situations, and lifestyles. Patient decision‐making capacity, surrogate decision making with or in the absence of a patient's advance directive, and the right to refuse treatment are three patient‐care issues that are central to the work done by both the risk manager and the clinical ethicist that have strong relevance to patient‐centered care. This article discusses these three issues briefly and offers two challenging case studies involving patient‐centered care that illustrate how a clinical ethics consultation may help to avert the escalation that can lead to a tort claim.     

Communication plays key role in OB patient expectations

Obstetrics is a medical specialty with high profe sional liability exposure. Every aspect of an adverse OB outcome has become an opportunity for a legal review. Common root causes in adverse outcomes include communication failure, poor teamwork, and system failures. Indeed, poor communication is a significant factor in OB‐related malpractice claims. This excerpt from the booklet Risk Management Pearls for Obstetrics highlights those causes (particularly poor communications) and provides strategies to address them.