1. How to Build a Risk Management Training Program in a Health Center
Lorraine Possanza, DPM, JD, MBE
Cara Wzorek, MA
ECRI Institute

2. About ECRI Institute
Independent, not-for-profit applied research institute focused on patient safety, healthcare quality, risk management
Website and resources for Section 330-funded health centers, free clinics, and FQHC Look Alikes. Log in with address and password at:
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45-year history, 450 person staff
AHRQ Evidence-Based Practice Center
Federally designated Patient Safety Organization

3. Learning Objectives
Recognize why a risk management training program is important
Recall the steps to implement a risk management training program
Identify resources that can be used for staff training
Recognize strategies for ensuring that staff complete trainings
Recall methods for monitoring and maintaining a risk management training program

4. What is Clinical Risk Management
An approach to improving the quality and safety of healthcare that identifies what places patients at risk of harm and takes action to prevent or control the risks

5. Why Risk Management Training Is Important
Improves patient safety
Minimizes errors, system breakdowns, and harm
Minimizes clinical risks and liability losses
Supports regulatory/accreditation compliance and meets requirements for deeming under the Federal Tort Claims Act
When there is an adverse patient outcome the existence of proof of staff training is helpful

6. You’ve Been Put in Charge of Your Health Center’s Training Program…
Where do you start?
Write a plan
What topics will be covered?
Which staff will complete training?
Which training programs will be used?
How many training programs will be required?
Obtain board support and approval for the training program and plan

7. What Topics Will Be Covered?
Basic risk management training
Required for all staff in the health center—from frontline staff to administrators
Specialized training
Based on position or specialty

8. Basic Risk Management Training
Risk identification
Operational assessments
Event reporting system
Risk prevention
Credentialing
System improvement
Risk control

9. Basic Risk Management Training: Scope and Functions
Claims
Management
Risk management spans the entire operation and most functional areas
Everyone should be trained on risk management functions and responsibilities
Note specific areas with a high impact on risk and safety
Event
Reporting
Credentialing
Risk Management
Quality
Improvement
Patient Safety
Patient
Satisfaction

10. Basic Risk Management Training Topics
Culture of safety
Clinical risk management basics
Teamwork strategies
Communication
Event reporting
Privacy and confidentiality
Infection control
Hand hygiene
Environmental cleaning
Standard precautions for bloodborne pathogens

11. Training on Policies, Procedures, Protocols
Triage
Telephone triage
Walk-in patients
No-show appointments
Tracking
Diagnostic test results, referrals, hospitalizations
See resources on Clinical Risk Management Program website.

12. Training on Policies, Procedures, Protocols
Equipment maintenance
Peer review
Credentialing and privileging providers
Including licensed independent
practitioners and other licensed or
certified staff
See resources on Clinical Risk Management Program website.

13. How Do You Determine Important Training Topics?
Safety culture surveys
Employee safety attitudes questionnaire
Patient questionnaires
Patient complaints
Use results to determine priorities for training
Event report reviews
Near-miss report reviews
Claims reviews
Root-cause analysis
Failure mode effects analysis

14. Other Ways to Determine Training Topics
Review medical literature
See Risk & Safety E-news delivered biweekly to Clinical Risk Management Program members
Check accrediting organization standards
Review federal, state, and local laws and regulations
Consult your state Primary Care Association or other counsel

15. Specialized Training
Training will be customized to staff position in the health center
Some examples:
Leadership training for administrators
Training in employee health and safety issues for human resources staff
Training for providers on handling difficult patient conversations
Training in obstetric [OB] topics (e.g., fetal monitoring, shoulder dystocia) for OB staff

16. Training for Providers and Staff
Clinical protocols for selected conditions
Asthma
Diabetes
Influenza
Pneumonia
Strep throat
Coronary heart disease
For more information, see the American Academy of Family Physicians’ Family Practice Management Toolbox at

17. Training for Providers and Staff
Medical record documentation
HIPAA privacy and security requirements
Completeness of documents
Archiving procedures
Using electronic health records
Clinical decision support tools
Documentation tips in an electronic environment
Potential pitfalls (copy and paste errors, alert management)

18. Which Training Programs Will Be Used?
Consider using available programs and resources rather than creating your own training programs from scratch
ECRI Clinical Risk Management Program resources
HRSA BPHC website and informational resources
Other resources

19. You Don’t Need to Reinvent the Wheel
Clinical Risk Management Program Training Resources:
E-Learn library of continuing education courses
Optimal Outcomes fetal heart monitoring and intrapartum management course
Education and Training Tools
Archived Webinars
Annual Virtual Conference
Extra! Web Resources

20. You Don’t Need to Reinvent the Wheel
HRSA resources
Health Center Policy Manual
Program Assistance Letter (PAL)

21. You Don’t Need to Reinvent the Wheel
Other Resources:
AHRQ TeamSTEPPS:
AMA Continuing Education:
OSHA Training Programs and Resources:
WHO Patient Safety Curriculum Guide:

22. The Plan
Develop and implement a plan for annual continuing education and risk management training for all staff
Ensure that the plan takes into account staff roles and responsibilities
Set training goals and document/track staff completion
Health centers and free clinics should determine the number of required training programs on an individual basis
Based on size and needs of health center or clinic
Ensure that the board supports and approves the plan or delegates approval authority to authorized leadership

23. How Do You Ensure Staff Complete Trainings?
Set training goals
Create clear expectations
Set schedule for which courses are required and deadlines for completion
Track staff completion
Take attendance at in-person trainings
Request that staff submit certificate of completion (e.g., CME certificate) for online training
Use standardized tool to track completion of both required and optional courses by staff member

24. Staff Training Completion Tracking Tool

25. How Do You Ensure Staff Complete Trainings?
Ensure that staff have time set aside to complete training programs
Plan trainings during lunch hour and provide free lunch
Be creative
Post individual progress toward training programs to create friendly competition among staff
Provide incentives (e.g., gift certificates) for meeting training goals

26. How Do You Ensure Staff Complete Trainings?
Connect with credentialing and privileging
Require that employees submit list of completed trainings as part of credentialing and privileging process
File training records in employee’s credentialing file
For more information, see HRSA Policy Information Notice

27. Make Training a Priority
Encourage administrators/directors to make introductory remarks during training session
Sends the message that training is important
Promotes an overall culture of learning
Seek staff input on which trainings are most useful or meaningful to them
Make it easy for staff to learn about and find training programs (link on website, notice posted in office)

28. Make Training a Priority
Use a variety of training styles (in-person, online programs, simulation or role-play) to maintain interest
Share success stories and improvements made as a result of training

29. Make Sure Learning Is Ongoing
Consider recording and archiving trainings on health center website or employee portal
Provide “refresher” trainings on a regular basis
Be available to employees; ask what additional resources they need
Provide staff with supplementary material they can refer to at any time with questions:
Copies of policies and procedures
Risk management manual

30. The Risk Management Manual
Describes the risk management program
Contains policies and procedures of the program
Risk manager job description
Algorithms
Flow of information to and from the program
Event reporting and management
Committee structure
Integration with other committees and functions (e.g., Quality Improvement, Patient Safety)

31. Benefits of Compiling a Risk Management Manual
Serves as a reference guide
Serves as a training manual for providers and staff
Helpful for orientation/continuing education
Supports commitment to the risk management program

32. Monitoring and Maintaining the Training Program
Review on an annual basis
Make necessary changes based on:
Changes in results from safety culture surveys, event reports, etc.
Changes in policies/procedures
Regulatory/FTCA changes or updates
Health center priorities
Report to the Board of Directors annually
What impact training has had on risk management program

33. Clinical Risk Management Website
Guidance articles
Self-assessment questionnaires
Get Safe! and Practice Alert! assessment checklists
Sample risk management plan
Toolkits
E-news
Sample policies and tools
Education and training tools

34. Selected Resources Guidance
Identifying Risks and Assessing Patient Safety in Physician Practices
Medical Records
Risk Management in Ambulatory Care
Toolkits
Credentialing
Developing Policies and Procedures
Quality Improvement/Quality Assurance
Test Tracking and Follow-Up
Triage

35. Selected Resources (cont.)
Sample Policies and Tools:
Sample Policy Guide: Tracking Hospital and Emergency Department Visits
Safety Attitudes Questionnaire (Ambulatory Version)
Track Patient Hospitalizations and Emergency Department Visits
Tracking Hospitalizations: Patient Card and Procedures

37. Thank You Additional Questions? clinical_RM_program@ecri.org
, ext. 5200