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

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 e-mail address and password at: www.ecri.org Have not activated your profile yet? E-mail us at: Clinical_RM_Program@ecri.org. 45-year history, 450 person staff AHRQ Evidence-Based Practice Center Federally designated Patient Safety Organization

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

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

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

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

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

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

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

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

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.

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.

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

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

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

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 http://www.aafp.org/online/en/home/publications/journals/fpm/fpmtoolbox.html

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)

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

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

You Don’t Need to Reinvent the Wheel HRSA resources Health Center Policy Manual Program Assistance Letter (PAL) 2015-03

You Don’t Need to Reinvent the Wheel Other Resources: AHRQ TeamSTEPPS: http://teamstepps.ahrq.gov AMA Continuing Education: http://www.ama-assn.org/ama/pub/education-careers/continuing-medical-education.page OSHA Training Programs and Resources: https://www.osha.gov/dte/index.html WHO Patient Safety Curriculum Guide: http://www.who.int/patientsafety/education/curriculum/en

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

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

Staff Training Completion Tracking Tool

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

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 2002-22

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)

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

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

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)

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

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

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

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

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

Thank You Additional Questions? clinical_RM_program@ecri.org 610-825-6000, ext. 5200