Risk Insider: Marilyn Rivers

The Paralysis of the Political Season

By: | August 31, 2015 • 3 min read
Marilyn Rivers is director of risk and safety for the City of Saratoga Springs. She chairs the PRIMA Institute for the Public Risk Management Association and is chairperson of the RIMS Standards and Practice Council. She was named Public Risk Manager of the Year by PRIMA in 2007. She can be reached at [email protected]

It’s political high season – those few months before the primaries and the elections when candidates across the country vie for a headline or a moment on the news.

Candidate commercials are rampant during the dinner hour and rhetoric is at an all time high. There appears to be an inordinate amount of interest as to whether hair is real, what a candidate ate for lunch and how many babies can get kissed within range of the camera.

A colleague of mine likens politics to putting lipstick on a pig to make it sexy.

Public risk professionals and those that insure them are battening down the hatches, measuring their resources and preparing for the inconceivable shot across the bow. Inevitably there will be that one case file you’ve worked hard to contain that beckons like a shiny bauble for a political sound bite and unwanted attention from a candidate who wouldn’t know the truth if it hit them square in the forehead.

The political sound bite from a candidate, who should know better, often sends ripples within a governance structure and sends its insurer into anaphylactic shock.

What better way to call attention to your candidacy than by preying on the unknown because the issue is sexy and the press eager to get the scoop. The political sound bite from a candidate, who should know better, often sends ripples within a governance structure and sends its insurer into anaphylactic shock.

Have you ever polled a public risk professional during election season? Many will comment that they have working populations split between apathy, undermining, open warfare or a weary acceptance that not a lot is going to get done while the rhetoric flies.

A paralysis seems to envelop ordinary tasks and strategic goals. Incumbents and prospective candidates often spar over the most trivial of issues that somehow made their way into the workplace causing concern, strife or heated arguments.

Public governance requires stamina and endurance regardless of the political season’s veiled threats and promises. Let’s be clear folks. Public employees, regardless of the season, have a responsibility to ensure governments run, offices are open for business, licenses and permits are issued, and the public is served.

Making that happen amidst the carnival sideshow, the empty promises and the campy atmosphere of “it’s a mess out there that needs a-changing” is a true testament to the public servants who keep the peace, clean the streets and manage the processes to ensure our economy is successful.

It’s a thankless job with no pictures or press or glory.

Although we believe we’ve seen and heard it all, we need to find solace and humor in the ridiculous lack of reality the political season brings.

As the potential onslaught looms, find strength in knowing your risk programming and your partnerships can withstand the potential threat of words.  Gather your troops and shout “Ooh Rah” like a Marine as loud as your voice will carry. There are no knights in shining armor, only jesters who beg the attention of the crowd.

Public risk management is more than an issue. It’s a legacy that will more than withstand the test of time.

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Risk Insider: Martin Frappolli

Grab Some Risk While You Can

By: | August 31, 2015 • 3 min read
Martin J. Frappolli, CPCU, FIDM, AIC, is Senior Director of Knowledge Resources at The Institutes, and editor of the organization's new “Managing Cyber Risk” textbook. He can be reached at [email protected]

Because many of us in the risk management business make thoughtful and prudent decisions in life, you may be among those people who choose a vehicle for pragmatic purposes.  You may consider size, safety, and fuel economy.

If you’re like me, you might choose that pragmatic car even though it doesn’t quicken your pulse in the way that a red convertible performance coupe might do.  “Someday” you might buy that performance or luxury car.

Well, here is your excuse to act sooner. We’re keenly aware of how each new vehicle has more “smart” features than previous models, taking us closer to the future reality of autonomous cars.

We’re rushing toward a model of streaming transportation – driverless vehicles that arrive when you need them, take you where you need to go, then head off to another purpose for another passenger.

There’s plenty of upside to this – reduced need for parking, removal of the costs of ownership and insurance, reduced congestion, great strides in safety. I take some comfort that by the time I am no longer physically able to drive, I won’t need to.  If I can use a smart phone or whatever devices succeed the smart phone, I can get a ride.

From a risk management perspective, the move to streaming, on-demand autonomous transportation is a clear winner.

From a risk management perspective, the move to streaming, on-demand autonomous transportation is a clear winner. Cars will be safer when the possibility of human error is removed. Car insurance exists, after all, primarily as a means to compensate victims of human error.

Beyond the savings for vehicle repair, the reduction in bodily injury events will be cause to celebrate. Further, much of the capital and resources now devoted to automobile insurance may be freed up for other productive uses.

The flip side, though, is that we’ll pass up on the joy of motoring, the very notion of motor sport. Just as we’ve surrendered the beauty of album art when we moved from vinyl LP to CD to MP3 to streaming music, so too we’ll leave behind the rush of a fast muscle car and the twisty mountain road handled by the finely tuned suspension of a sports car.

You need to manage your own personal appetite for risk. While you may increase your risk of a traffic ticket or even an accident if you aggressively exploit the power of a sports car, you also mitigate the risk because these high-end vehicles typically are built with better braking systems and advanced safety features.

Were you eying that red convertible in the showroom when you bought that SUV?  The time for you to own and drive a car for pleasure is going away. Our future selves will marvel at the old days when multi-ton machines traveled at 70 miles an hour piloted by humans and subject to fatal error.

The question remains about how soon – but the change is coming. Here’s your rationalization to buy that performance car before your only role is that of passenger.

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Sponsored: Lexington Insurance

Managing Patient Safety in a New Health Care World

There are great benefits and challenges associated with improving safety in health care institutions.
By: | August 31, 2015 • 5 min read
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Much like regular screenings, exercise and a healthy diet, patient safety in health care institutions should be thought of as preventive medicine.

“Patient safety aims to relieve the burden of fixing mistakes by taking steps to prevent them from happening in the first place,” said Aileen Killen, head of casualty risk consulting, AIG.

With the right strategies and protocols in place, human error in delivering patient care can, to some degree, be factored out, mitigating the risk of things like falls or medication mistakes. And the outcomes-based reimbursement model enforced by the Affordable Care Act provides extra incentive to improve patients’ overall experience and reduce readmission rates.

Some challenges stand in the way, though, of achieving better safety.

For one thing, increased consolidation in the industry has brought risks associated with integrating disparate safety cultures and ensuring continuity of care if patients are moved to a new doctor. The trend of shifting more care out of main hospitals to ambulatory sites instead also creates concern that those outpatient facilities are not up to the same safety standards as larger organizations.

Finally, advancing technology — while offering great promise to eventually make health care more efficient and error-free — presents significant risks in its implementation while doctors, nurses and other health care professionals learn how to best use it.

Lexington Insurance, a member of AIG, is meeting the demand for more innovative tools to navigate the changing environment with a suite of safety assessment programs that identify problem areas and provide recommendations for improvement.

Assessing Safety Culture

Lex_BrandedContentThe first step in overcoming any challenge is assessing the situation in order to create the best strategy.

“Every health care organization should aim to become a ‘high reliability organization,’ or HRO,” said Brenda Osborne, division executive, health care, Lexington. “It’s a term borrowed from the airline and nuclear power industries, in which any employee has the right to shut down operations if they spot a safety issue.”

Lexington’s Best Practice Assessment tool allows organizations to compare their own protocols against evidence-based best practices and identify weak spots in their safety culture.

“We survey employees and ask if they feel free to speak up to people in authority,” Killen said. “If they can all say yes, you’re on the road to a safety culture. Then we drill down into specific high-risk areas.”

Clients can conduct specific assessments for error-prone areas like the emergency department, obstetrical department and operating room.

We give organizations recommendations on how they can improve in areas where they are deficient, and we can benchmark their performance against the best practice as well as against other institutions that have done the same assessment,” Killen said.

Those benchmark comparisons are key for securing leadership buy-in. Executives often need to see what other institutions are doing in order to feel confident in their decisions to make changes or invest more heavily in patient safety measures.

If another competitive hospital has better staffing ratios, for example, benchmark stats will show that and support the C-suite’s decision to hire more nurses to achieve a similar ratio.

“What it basically does is give the risk management, patient safety and quality improvement staff a roadmap for which areas to focus their activities for improving patient safety and risk management at their organization,” Killen said.

Acquisitions and Physician Employment

Lex_BrandedContentThe flurry of merger and acquisition activity in the health care industry creates new risks for large hospital networks that acquire physicians’ practices. The integration of different patient safety and risk management practices can prove difficult.

“You have to take multiple approaches and mindsets and meld them into one fluid organization,” Osborne said. “That has a big impact on physicians’ ability to treat patients and deal with the appropriate hand-offs.”

“Patient hand-off is one of the biggest safety challenges,” Killen said. “Assigning a patient’s care to a different doctor leaves room for gaps in communication, which is so critical to making the correct diagnosis and keeping a medication schedule.”

Lexington’s Office Practice Assessment tool scores acquired practices on 14 different domains, including risk management and patient safety, communication, infection control and prevention, incident reporting and medication safety, among others. Recommendations are provided for any domain that scores less than a perfect 100 percent.

“We’ve been able to go in and help these growing organizations benchmark each of these acquired physician offices to show where they are at in terms of their safety protocols,” Osborne said. “It helps risk managers know where they need to start.”

Ambulatory Safety

Another major challenge for patient safety is the movement of care away from main hospitals to ambulatory care settings, an area that previously did not concern hospital-based risk managers very much.

“Historically, there has not been a big focus from a patient safety standpoint on outpatient services,” Osborne said. “The office practice assessment that AIG’s been doing for the last two or three years has actually put us out in front. Few other resources out there can assist hospital-based risk managers in dealing with outpatient-type services.”

“Now more people are thinking about safety in ambulatory areas, and we have more knowledge and experience there,” Killen added.

The same office assessment tools that survey physician practices can also be applied to ancillary services like ambulances, blood banks, and outpatient surgery centers, though benchmarking is not yet available for these sites.

Advancing Technology

Lex_BrandedContentAdapting to new technology is an ongoing challenge for health care risk managers.

“Everyone thought electronic health records were going to solve all our patient safety issues, but they’ve come with some unintended and dangerous consequences,” Killen said. Employees may accidentally order medications for or even discharge the wrong patient, for example, if they have multiple records open at once.

The upside to technology advancements, though, is more streamlined documentation and more opportunities for communication between doctors and patients via telemedicine, which is slowly growing in popularity for remote and elderly patients.

“When we’re underwriting, we look at these areas of growth in technology and the many ways it can be applied,” Osborne said. “We consider all the pros and cons.”

Standout Services

Lexington’s dedication to improving safety in health care shines through in their thorough assessment tools, expert recommendations, and attention to insureds’ changing risk management needs.

“Our unique tools help insureds identify risks and minimize potential claims,” Killen said.

“These services are homegrown and developed by a lot of very knowledgeable people over a period of time,” Osborne said. “They’re not available out in the market, and only Lexington insureds have access to them.”

For more information about Lexington Insurance’s risk management services for the health care industry, please visit www.lexingtoninsurance.com.

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This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Lexington Insurance. The editorial staff of Risk & Insurance had no role in its preparation.




Lexington Insurance Company, an AIG Company, is the leading U.S.-based surplus lines insurer.
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