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Vogel Bio: Audiologist, Clinic Director for Hunter College- CUNY, and, member of Metropolitan New York Council of University Clinic Directors in Communication.

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Presentation on theme: "Vogel Bio: Audiologist, Clinic Director for Hunter College- CUNY, and, member of Metropolitan New York Council of University Clinic Directors in Communication."— Presentation transcript:


2 Vogel Bio: Audiologist, Clinic Director for Hunter College- CUNY, and, member of Metropolitan New York Council of University Clinic Directors in Communication Sciences and Disorders (thats a mouthful for ya!) Many thanks to my co-authors – Dr. Sue Wortsman, AuD, CCC-A Dr. Paul Cascella, PhD, CCC-SLP Bio & Disclosures

3 Disclosure I: I am employed by Hunter College-CUNY and will receive travel reimbursement for attending CAPCSD. I am not paid for, nor do I have a vested interest in, promoting any product, software, hardware, or saleable good that may possibly be discussed during this presentation. Bio & Disclosures

4 Disclosure II: I am not a lawyer, credentialed risk management professional or university administrator. I am a SIMPLE professor employed by the City University of New York who has an interest in sharing what I do as clinic director with this audience. Bio & Disclosures

5 Learning Objectives: Define risk management activities in a university clinic Assess risk issues in their own settings Coordinate a risk management committee at their clinics Bio & Disclosures

6 At the conclusion of this session, [Im hoping] you will have some tools to develop guidelines to create a viable supervisor-faculty- student RMP appropriate to the university clinic setting. Bio & Disclosures

7 Basic information – what is risk management? Risk management in healthcare is the examination and implementation of procedures and policies that will reduce harm to patients and employees Literature & Survey

8 What does the literature say? Hospitals and service industry instruct their employees about RM There is a paucity of research in this topic We need to train future professionals about why this is important and not rely on the medical community to prepare our own professional s Literature & Survey

9 We did a survey (thank you for participating!) Our primary goals were: 1. Determine what RM activities are conducted 2. Recognize any trends across the country 3. Determine if professional experience relates to RM 4. Additionally, we wanted to assess how RM is monitored and used as an educational tool Literature & Survey

10 Risk management programs (RMP) High priority in healthcare settings and academic institutions administrations However, RMP survey of 280 CSD programs showed need for growth in this area of interest (response rate of 35%) Literature & Survey

11 Administration Clinical supervision Enforcement Mediation Parenting Patient care Research Service Teaching Balancing Acts University CDs balancing act:

12 When performing a balancing act, RM gets deprioritized! In your clinic, do you have a Risk Management Committee? AnswerResponse% Yes1111% No9189% Balancing Acts

13 AnswerResponse% My institution's administration includes our department in their overall risk management activities 3134% Lack of personnel to add this task to their work load 3134% The need for a risk management committee is unclear 2629% Lack of knowledge about risk management 2022% Lack of time 1921% A Risk Management Committee has never been considered 1921% Insufficient resources to pay for a risk management committee and its programs 1011% Other 910% What are the barriers? Balancing Acts

14 Who sits on your RM Committee? AnswerResponse% Clinic director1083% Clerical staff650% CSD academic faculty542% Clinical educator(s)542% Graduate student(s)325% Other325% Business manager217% Associate dean or other college administrator18% Undergraduate student(s)18% Representative from your institution's H & S dept.18% Assistant clinic director00% Client(s)00% RM consultant from outside of college/university00% Balancing Acts

15 Risk Management Committee Hunter College Center for Communication Disorders Balancing Acts

16 Frequency of RM monitoring activities Question Once a semester Once a year Every other year Never Document audits4629620 Fire drill attendance3233036 Equipment audits2954117 Policy and procedure manual updates207083 Safety drill attendance1927154 In-service program attendance17412 Chemical and Material Safety Data Sheet (MSDS) reviews 831062 Balancing Acts

17 Has your clinic RMP resulted in any of the following? AnswerResponse% We do not have a risk management program.5251% We had one or more incident(s) for which we were appropriately prepared. 2222% Our legal department and/or administration has utilized clinic's documentation. 1717% We have not seen a positive or negative impact from having a risk management program. 1212% We had one or more incident(s) for which we were unprepared. 22% Balancing Acts

18 With a clear understanding of risk management, CDs can integrate appropriate aspects of it into their clinics routine protocols. Balancing Acts

19 How does RM affect my clinic? Risk management refers to strategies that reduce and minimize the possibility of a loss. 1 Its very clear for healthcare: e.g., bloodborne pathogens = use gloves and ePHI = HIPAA compliance tools But for us theres more: Student: safety; FERPA; credentialing Faculty: safety; credentialing Staff: safety; training Accreditation 1 Risk Management and Medical Liability, American Academy of Family Physicians, AAFP Reprint No. 281, retrieved 3.31.14 from: Affects on clinic

20 How does RM affect my clinic? Need – the who, what, where, when and why Commitment of time and resources Academic benefits Harm reduction Teaching tool Affects on clinic

21 What incidents have you recorded? AnswerResponse%AnswerResponse% None; we did not record any risk management incidents 3635% Infection control (e.g., not cleaning materials, reusing speculae, not using gloves, etc.) 88% Client/patient chart documents (e.g., missing data, misfiled charts, breach of privacy) 3635% Asthma and/or respiratory allergy problems 77% Public safety (e.g., falls in clinic, assault, threats, etc.) 2323%Lockdown, university wide55% Externship contracts issues (e.g., sending student to site with expired or no contract) 1717% Abuse (e.g., elder, emotional, physical, sexual) 55% Credentialing documentation (e.g., expired license, certification, liability insurance) 1414%Other55% Privacy (e.g., breach of HIPAA and privacy rules) 1414% Food allergies (e.g., reaction to food exposure) 44% Fire safety (e.g., any type of fire incident) 1212% Chemical (e.g., expiration, spills, etc.) 33% Patient satisfaction (e.g., unresolved complaint) 99%Lockdown, in clinic only22% Other: Workmans comp; altered mental status; falls Affects on clinic

22 University clinic RMP Is it not as important as: Clinical duties and service? Teaching? Research? Affects on clinic

23 What drives risk management? Charge of the risk management committee must be a comprehensive one University administration looks to avoid adverse events thus reducing harm and liabilities Financial Students Clients Faculty Staff Physical plant Affects on clinic

24 Key elements of an RMP include Risk Management Program Education Awareness Action Key elements of RMP

25 Knowledge of these tools assists university clinic managers in the initiation of an RMP in a fairly effortless, and [somewhat] less time-consuming manner. Key elements of RMP

26 Education Education about risk management helps reduce harm to clients, students, faculty and staff. Educating students about risk management philosophy and how it is conducted adds to the pedagogical element of clinical education. Key elements of RMP

27 Awareness Individuals walking into clinic know the risks, measures and how to avoid them. Awareness of the risks takes place on multiple levels and interactions: Environment Environment to people People to people Key elements of RMP

28 Action RMP takes charge to secure harm reduction Protocols Drills Audits Inspections Reinforces the commitment by the university clinic to reducing the risks Key elements of RMP

29 What do we wish to impart on our students, faculty and staff? The elements creating a unique risk management program in the university clinic setting: Pedagogical aspects of client/patient care Measures that reduce risks for clients, students, staff and faculty who attend clinic Environmental monitoring Key elements of RMP

30 The other elements that make it work Governance Risk Assessment Compliance Key elements of RMP

31 Governance Directive from administration that a task needs to be performed Ensures that the directive was completed Managing risks of safety and liability to clients, students, faculty and staff are the goals Governance will often lend financial support to the RMP [if they bring it up first!] Key elements of RMP

32 Risk Assessment Examines the gravity and control of various hazards exposing those entering the sphere of the university clinic setting: Clients Students Faculty Staff Key elements of RMP

33 Compliance Mechanism by which Governance and Risk Assessment are adhered Individuals appointed as compliance officers are typically the turn to person and held responsible for ensuring the various goals of risk management program have been met Key elements of RMP

34 Steps to creating a RM committee 1. Committee mission 2. Committee members Clinical educators Faculty Students Staff 3. Frequency of meetings 4. Generating specific goals and directives Create a committee

35 Steps in running the committee: 1. Elect/Assign committee chair (with every fiber of your being, resist taking command of this role) 2. Allow the new leader to define and delineate the centers risks Classify if the risks are in the purview of the committee or some higher authority 3. Allow the new leader to assign responsibilities to complete tasks 4. Allow the new leader to design activities which will ensure compliance Create a committee

36 Leadership: Clinic director assumes these roles: Advisor: function as an advising member/participant Mentor: allow other faculty members or staff to serve as leader, because: CD is released from duty Advocate for professional development of a peer Create a committee

37 CD guides through important issues (may be overlooked with the less experienced eye): Abuse: elder, emotional, physical, sexual Chemical/Environmental Documentation and credentials Hazardous waste Infection control Privacy Proper identification Supervision Training Transferring patients Create a committee

38 Review issues from these perspectives: Environment Patient care Pedagogy Important issues

39 What areas of RM does committee consider? Compliance to Privacy Policy1192% Client/patient documentation (e.g., charts, notes, raw data, etc.)1083% Fire safety plans1083% Patient privacy (HIPAA)1083% Public safety plan (emergency preparedness)1083% Credentialing documentation (e.g., license, certification, liability insurance, etc.) 975% Infection control protocols975% Chemicals (e.g., cleaning solutions)758% Equipment calibration758% Patient satisfaction758% Abuse issues (e.g., elder, emotional, physical, sexual)650% Externship contracts650% Transfer for patients (e.g., walker to stationary chair, wheelchair to washroom, etc.) 542% Asthma and respiratory allergies433% Food allergies325% Other00% Important issues

40 Identifying risk areas is critical: Privacy and security Infection control Safety Allergens Important issues

41 Assessing Risk in 5 Steps 2 Step 1: Identify the hazards (what can go wrong?) Step 2: Decide who might be harmed and how (what can go wrong? who is exposed to the hazard?) Step 3: Evaluate the risks (how bad? how often?) and decide on the precautions (is there a need for further action?) Step 4: Record your findings, proposed action and identify who will lead on what action. Record the date of implementation. Step 5: Review your assessment and update if necessary 2 Health Risk Assessment Made Easy, National Patient Safety Agency (NSPA), 2007, London, UK ( Important issues

42 What metric surveys are conducted? AnswerResponse% Credentialing review (e.g., valid insurance, license renewal, etc.975% Chart audits867% Patient satisfaction survey867% Equipment calibration (e.g., biologic monitoring, electro-acoustic calibrations, etc.) 867% Monitoring of cleaning (e.g., toys, ear probes, counter tops, etc.)867% Externship contract validity758% Fire drills (frequency and attendance)650% Chemical expiration date monitors (e.g., ultrasonic cleaning solutions, ear mold materials, etc.) 325% Other217% Safety drills (frequency and attendance)18% Majority of these tasks are done by different personnel in our department and not conducted as a part of a formal Risk Management Committee; None of the above are completed by myself as coordinator of clinical services, not as part of the risk management team. Important issues

43 About EHR AnswerResponse% We do not maintain electronic health records at this time and have no plans to move towards electronic health records within the next 12 months. 5150% We do not maintain electronic health records at this time but we do plan to move towards electronic health records within the next 12 months. 3534% We currently maintain electronic health records. 1616% AnswerResponse% Documentation and privacy risks remain unaffected.956% Documentation risks have decreased.425% Additional privacy and documentation risks have resulted. 319% EHR and documentation Important issues

44 Environmental issues Chemical Fire safety Public safety Structural Important issues

45 Environment issues Write down RM tasks important to environmental issues Chemical Carbon Monoxide Cleaning solutions Allergens MSDS sheets Gloves Insect/rodent droppings Important issues Fire Safety Exit signs Fire extinguishers Fire drills Flammable materials Fire hazards - closets Fire hazards – hoarding Public Safety Locking doors Adequate exits Signs to contact security Safety drills Toys as weapons IT security

46 Patient/Client care issues Write down RM tasks important to client issues Important issues Patient Care Abuse Documentation Food allergies Asthma triggers Infection control Patient Care Privacy Transferring patients Falls Safe use of wheel chairs and walkers

47 Student issues Abuse Documentation Food allergies and asthma triggers Infection control Privacy Safe use of wheel chair and walkers Transferring patients Falls All of the above, and, Clinical knowledge and skill Credentialing (e.g., liability insurance) Important issues

48 Supervision issues Abuse Documentation Food allergies and asthma triggers Infection control Privacy Falls Safe use of wheel chair and walkers Transferring patients Clinical knowledge and skill Credentialing (e.g., liability insurance) Same as students and: FERPA Important issues

49 Pedagogy Not necessarily a risk (but just in case, you can get rider on your liability insurance) Student involvement is a critical component of this program as it enables them to learn about issues often left to learn at externship or real-world experiences Pedagogy

50 RM as teaching tool AnswerResponse% Risk management is embedded in at least one course in our curriculum. 6362% We discuss risk management subjects during student meetings outside regular classes. 3838% We require students to attend risk management program activities. 3535% Risk management is not embedded in any form in our curriculum. 1919% Other88% Students have the option to attend risk management program activities. 22% Orientation are required and include risk management information; Students sign confidentiality agreements that incorporate HIPAA regulations; Only HIPAA - BBP training; risk management issues are addressed in student orientation and student meetings; on--line training; HIPAA in-service training is conducted yearly at student orientation Pedagogy

51 How do you confirm your students knowledge of RM issues? AnswerResponse% Students' knowledge is confirmed via assessment tool. 5251% Students knowledge is not confirmed via assessment tool. 4040% Students perform self-evaluation of risk management knowledge. 77% Other 66% There are multiple assessment tools; Assessment is done via multiple class exams and vis web-based certificate course; Certificates given for above; Some items confirmed via assessment Pedagogy

52 Risk Management Program Activities Document risk management activities thus ensuring the mission of the committee is accomplished Activities are: Active Passive Combined Doing so crosschecks for compliance RMP activities

53 Active Activities Risk Management Day Audits Drills Inspections RMP activities

54 Educational activities in your RMP: AnswerResponse% Fire drills5050% Signage4646% In-service programs4040% Safety/evacuation drills3535% Web-page information3131% We offer no activities2020% Educational brochures1616% Other1010% Approved Continuing Education (CE) events99% Risk Management Day (i.e., a designated time of activities dedicated to risk management awareness) 88% Computer based learning modules; Department Clinical Staff, Faculty and Practicum Students take web-based HIPAA certificate course; Safety manual on Blackboard for Students; HIPAA training provided by the UH General Counsel Office; E-mail updates; Orientation sessions; Formal course on Moodle that University administers; Addressed in professional issues courses RMP activities

55 Passive Activities Educational brochures Signs Webpage updates RMP activities



58 Tools to help you National Institutes of Health (NIH) Listserve: OCR-Privacy listserve Lots of other information Department of Health and Human Services Security Risk Assessment Tool Download iPad App (search for HSS SRA) Windows tool: professionals/security-risk-assessment NIH: Patient Safety and Quality NHS – National Health Service (UK) 5 Tools to help

59 What can go wrong, will! What can go wrong, will


61 What can go wrong, will! What can go wrong, will




65 Conclusion A clinic director is responsible for so many areas of her or his facilitys function, inclusive of safety and risk. Managing risk through committee will inevitably ease the directors various work tasks, improve quality of care for clients, reduce financial and safety risks, while teaching students management, organization and clinical skills not often discussed in the classroom. Conclusion


67 Risk Management Resources:

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