At many hospitals and health systems, risk managers and claims managers rely on different safety data sets and generally keep their focus on distinct, different work streams.
But an effort to align the two departments at UMass Memorial Health Care in Worcester is yielding positive results, according to a study published in the Journal of Healthcare Risk Management.
“Traditionally claims managers and clinical risk managers have lived in totally separate worlds within our health care entities. Each role owns vast information and knowledge, which historically have not been shared and cross-pollinated,” says Dana Siegal R.N., Director of Patient Safety for CRICO Strategies and a co-author of the study.
The insights gleaned from claims files, which may include clinical records, depositions, expert analyses and court documents, can significantly augment the sources of information typically used by risk management staff: adverse event reports (mandatory, voluntary, near miss, etc.) and results from Root Cause Analyses and Failure Mode and Effects Analyses.
“Having been a medical malpractice defense attorney, I understand what’s happening on the claims side,” says Janell Forget, R.N., B.S.N., J.D., Senior Director of Risk Management at UMass Memorial Health Care, and a co-author of the study with Siegal and Tim Slowick, M.B.A., who is the Director of Claims Management at UMass Memorial.
Since assuming her leadership role in 2015, Forget has made it a priority to collaborate with her colleagues in claims management to reduce risk and improve patient safety. Forget says the hospital also has increased the number of risk managers and embedded them in departments where ongoing, daily involvement means they can develop relationships, become part of the team and avoid being perceived by other managers and clinicians as people who show up only when something bad happens.