Terri Nichols

Terri Morris-Nichols is system director of risk management at PeaceHealth, a not-for-profit health care system with 10 hospitals and medical facilities in Alaska, Washington and Oregon. She is a registered nurse with a master's degree in health administration. She can be reached at TNichols@peacehealth.org.

Risk Insider: Terri Nichols

Proactive Prevention

By: | January 26, 2015 • 2 min read
Terri Morris-Nichols is system director of risk management at PeaceHealth, a not-for-profit health care system with 10 hospitals and medical facilities in Alaska, Washington and Oregon. She is a registered nurse with a master's degree in health administration. She can be reached at TNichols@peacehealth.org.
Topics: ERM | Risk Insider

As a nation, we have watched the health care landscape change.  Not only have we seen dramatic events that have shaped our processes and systems, but the appetite for accompanying risks has shifted as well.

When we think about the transition of thought that occurred as a result of the threat related to Ebola, we have seen health care organizations accepting greater risks on behalf of those they care for, and showing greater effort in mitigating risk to those who serve.

We saw organizations holding practice sessions for putting on and taking off personal protective equipment in order to protect their employees.

We saw coordination of communications with key partners to educate patients and the public about the risk to the community.

And, we saw an exponential increase in resources used to be ready for what came next.

How can we optimize resources used along a continuum to mitigate risk and protect patients, employees and the public?

It is interesting that the risk presented itself in some cases before the magnitude of the impact was imaginable. Whoever thought that a ride on the teacups at Disneyland would warrant a rapid response from the health care community due to the ever-increasing number of Measles infections?

We must ask ourselves then, how do we create a culture where risks are identified earlier, and processes and systems put in place with greater ease?  How can we optimize resources used along a continuum to mitigate risk and protect patients, employees and the public?

Of course, you can’t have been in risk management or health care for that matter, without understanding that events or issues are standing at the front door waiting to come in without warning.

However, when we use risk maps or other tools to understand the risks to the organization, we must challenge ourselves to broaden our thinking to include those risks that are on the horizon across the nation and globe.

Why must the risk present itself before we launch good, solid processes to mitigate the impact to our valued team members?

We have the tools, know what the culture should look like, and have amazing partners to begin this broader conversation.  Let’s get started!

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Risk Insider: Terri Nichols

The Information Gap

By: | August 22, 2014 • 2 min read
Terri Morris-Nichols is system director of risk management at PeaceHealth, a not-for-profit health care system with 10 hospitals and medical facilities in Alaska, Washington and Oregon. She is a registered nurse with a master's degree in health administration. She can be reached at TNichols@peacehealth.org.

All too often, we hear antidotes about circumstances where important information was not provided to the risk management team because of the fear of retribution or retaliation.

When that happens, we lose the opportunity to improve the organization’s performance. Particularly in health care, this leads to ineffective feedback for patient safety.

“Compassionate communication” encourages others to share and express their thoughts. It has been described as ensuring we hear the underlying values, needs, and fears of those we communicate with.

With compassionate communication — and the coaching and mentoring that follows — our colleagues will ensure that critical information is provided and that risk management can be seen as a partner.

Organizations that have a highly evolved risk culture have designed opportunities for this open dialogue. Approaching the risk culture with a mind-set linked to valuing and engaging the individual through compassionate communication still provides the necessary parameters around which we can protect the organization and mitigate risk.

A Hurtful Silence

We have heard stories about individuals who isolate after a mistake has been made or when their actions result in an untoward outcome because they believe that opening up to someone is a risk to themselves and their organization.

They silence their opportunities to process their feelings and emotions in exchange for safety from legal ramifications, believing they will be met with blame and criticism for their actions.

Yet, in a culture of compassionate communication, these doors are opened, and leaders can nurture the space between recognition and reporting to inspire, create hope, and engage employees in areas that might have been neglected in the past.

With compassionate communication, the culture is enhanced and enriched.

Each of our employees has the ability to see and report situations that could bring about risk to the organization, so visibility and approachability are crucial.

Using opportunities to seek information — explore what is keeping your employees up at night — and to provide education on a structured schedule demystifies the idea of who is behind the door.

Risk managers also need strong communication and conflict resolution skills.

While many risk managers understand the skills related to negotiation and mediation, we sometimes forget that we are working with human beings who bring their fears and hesitations when thinking about risks in our organizations.

Training risk managers in empathetic approaches, the principles of cooperative power, and sound communication skills will provide an infusion of compassionate communication within the risk culture where it is needed to ensure that the right thing is done on behalf of those served.

I was once told that it takes at least two years to fully develop trust in another individual. Trust at a level where no matter what the decision or action, support can be given indicates a trusting relationship.

Working to develop and solidify strategic relationships with risk management, through our use of empathy and compassion, will contribute to the kind of risk culture that benefits those serving the organization and those being served.

Read all of Terri Nichols’ Risk Insider contributions.

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Risk Insider: Terri Nichols

A Culture of Risk Management

By: | August 11, 2014 • 2 min read
Terri Morris-Nichols is system director of risk management at PeaceHealth, a not-for-profit health care system with 10 hospitals and medical facilities in Alaska, Washington and Oregon. She is a registered nurse with a master's degree in health administration. She can be reached at TNichols@peacehealth.org.

My favorite definition of culture goes something like this: the arts and other manifestations of human intellectual achievement regarded collectively.

We think of culture as the customs, ways of thinking or behaving in a particular society or group. It can be said then that there is an art in the design, implementation, and sustainability of an organization’s risk culture, and that there are ways of thinking and behaving as it relates to how an organization understands its relationship to risk.

It’s about everyone in the organization identifying risks, participating or contributing to mitigation planning, and recognizing the thresholds the organization holds in regard to risk (for example, by risk mapping).

In a risk culture, the impact that each of our employees has as a result of their contributions to the culture cannot be underestimated. The importance of how the risk culture is nurtured and cultivated by all levels of committed leaders is paramount to setting the tone and influencing risk behaviors … behaviors that demonstrate an understanding of the inter-relationship and impacts of risks which in turn creates the culture of risk management.

In health care, think about the team member from housekeeping who sees patients every day who are at risk from some of our practices. What about the phlebotomist who must understand the risks related to restraints when they draw patient samples for testing? How much could we learn from the chaplain who hears our patient’s fears and concerns about their environment while hospitalized?

These team members contribute so much to a risk culture if we have the communication structure necessary to bring ideas and recommendations forward.

All too often, risk management is identified as the place you go when there is a claim or litigation (once related to me as a call to the principal’s office), or when you have in-the-moment crisis management needs.

However, creating an infrastructure of a successful risk culture begins early — at the job candidate interview process — and continues through the employee’s stay with the organization.

I once asked a candidate to describe their comfort with risk taking, and they described how they would take any risk — whatever the cost — to do what was right for those they would serve. Without parameters that are linked to the organization’s mission, values, and structures, this candidate would have put the organization at a level of risk we were not willing to accept.

Orientation — we use a game called “Risk Jeopardy” — is a great place to practice examples of risk taking as it relates to the organization’s policies and individual employees.

Rewarding new employees who bring a concern to risk management can also help establish the infrastructure of the culture.

As leaders are developed to be more aware of the value of risk management (through opportunities such as risk mapping), they will include risk management in strategic processes related to new programs and services, and day-to-day risk sharing opportunities and operational decision-making can become an approach to success.

Read all of Terri Nichols’ Risk Insider contributions.

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