RCA and FMEA ( Topic)
Discuss the various tools, and their applications, for risk management as outlined by The Joint Commission and the Hambleton article, including conducting a Root Cause Analysis (RCA) and Failure Mode and Effect Analysis (FMEA). View Patient Safety: At the Heart of All We Do and apply proactive risk management to health care delivery in a hospital, long-term care, or ambulatory settings.
Required Text
Nash, D. B., & Goldfarb, N. I. (2006). The quality solution: The stakeholder’s guide to improving health care. Sudbury, MA: Jones & Bartlett Publishers.
Required Articles
American Academy of Family Physicians. (2013). Quality Improvement. Retrieved from http://www.aafp.org/online/en/home/practicemgt/quality.html
Bagian, J. P. (2005). Patient safety: What is really at issue? Frontiers of Health Services Management, 22(1), 3-16. Retrieved from the ProQuest database.
Brehm, J., Ruddick, P., & Lundquist, T. (2003). The culture of safety. Health Management Technology, 24(7), 41. Retrieved from the ProQuest database.
Centers for Medicare and Medicaid Services. (2008). Center for Medicaid and State Operations. Retrieved from http://www.cms.hhs.gov/SMDL/downloads/SMD073108.pdf
Charmel, P. A., & Frampton, S. B. (2008). Building the business case for patient-centered care. Healthcare Financial Management, 62(3), 80-85. Retrieved from the ProQuest database.
CMS proposes quality improvements for hospital outpatient and ASCs for 2009. (2008). Healthcare Purchasing News, 32(8), 6. Retrieved from the ProQuest database.
Grazier, K. L. (2008). Interview with Lucian Leape, MD, HFACHE, Adjunct Professor of Health Policy, Department of Health Policy and Management, Harvard School of Public Health. Journal of Healthcare Management, 53(2), 73-77. Retrieved from the ProQuest database.
Hambleton, M. (2005). Applying root cause analysis and failure ode and effect analysis to our compliance programs. Journal of Health Care Compliance, 7(2), 5-12. Retrieved from the ProQuest database.
Harvard School of Public Health. (n.d.). Lucian Leape. Retrieved from http://www.hsph.harvard.edu/faculty/lucian-leape/
Hofmann. P.B. (2008, May). The executive’s role in malpractice cases. Healthcare Executive, 23(3), 58-59. Retrieved from the ProQuest database.
Hunt, K. G. (2007). Patient safety tops priorities of health care risk managers. Business Insurance, 41(43), 4, 6. Retrieved from the ProQuest database.
Jones. D. S. (2007). Combining disciplines: Making the connection between compliance, risk, and quality management. Journal of Health Care Compliance, 9(3), 5-12. Retrieved from the ProQuest database.
Kobs, A. (1999). “Closet” incidents. Nursing Management, 30(3), 48-9. Retrieved from the ProQuest database.
Leape, L. (1998). The fallacies of failure. Hospitals & Health Networks, 72(14), 14. Retrieved from the ProQuest database.
Lefevre, F. V., Waters, T. M., & Budetti, P. B. (2000). A survey of physician training programs in risk management and communication skills for malpractice prevention. The Journal of Law, Medicine & Ethics, 28(3), 258-266. Retrieved from the ProQuest database.
Mages, M.E. (2006). Quality-driven healthcare. Healthcare Executive, 21(4), 60-62. Retrieved from the ProQuest database.
Merry, M. D. and Crago, M. G. (2001). The past, present and future of health care quality. Retrieved from http://www.tuvamerica.com/services/medical/articles/merry.pdf
Moore, I. N., Pichert, J. W., Hickson, G. B., Federspiel, C., & Blackford J. U. (2006). Rethinking peer review: Detecting and addressing medical malpractice claims risk. Vanderbilt Law Review, 59(4), 1175-1206. Retrieved from the ProQuest database.
National Patient Safety Foundation. (n.d.). Lucian Leape Institute at NPSF. Retrieved from (http://www.npsf.org/about-us/lucian-leape-institute-at-npsf/American Health Information Management Association. http://www.ahima.org)
Olden, P. C., & McCaughrin, W. C. (2007). Designing healthcare organizations to reduce medical errors and enhance patient safety. Hospital Topics, 85(4), 4-9. Retrieved from the ProQuest database.
Reason, J. (2000). Human error: Models and management. Western Journal of Medicine, 172(6), 393-396. Retrieved from the Research Library database.
Reid, R. D. (2005). FMEA-Something old, something new. Quality Progress, 38(5), 90-93. Retrieved from the ProQuest database.
Schutz, A. L., Counte, M. A., & Meurer, S. (2007). Development of a patient safety culture measurement tool for ambulatory health care settings: analysis of content validity. Health Care Management Science, 10(2), 139-49. Retrieved from the ProQuest database.
U.S. Department of Health & Human Services. (n.d.). < target="_new"a href="http://guideline.gov/">National guideline clearinghouse. Retrieved from http://guideline.gov/
van der Velden, J.W. & Sirot, E. J. (2007). Effective risk management tools. Drug Information Journal, 41(1), 63-68. Retrieved from the ProQuest database.
Wagonhurst, C. L., Anderson, J. A., & Lacktman, N. M. (2007, December). The quality of care Cerberus: payments, public reporting, and enforcement. The Health Lawyer, 20(2), 1, 3-9. Retrieved from the ProQuest database.
Weiss, G. G. (2008). Reduce liability risk when treating . . .young patients. Medical Economics, 85(1), 30-31, 34-37. Retrieved from the ProQuest database.
Required Websites
Agency for Healthcare Research and Quality (AHRQ). (http://www.ahrq.gov)
American Medical Informatics Association. (http://www.amia.org/)
American Society for Healthcare Risk Management (ASHRM). ( http://www.ashrm.org)
Health Care Communities. (http://www.healthcarecommunities.org/)
Health Care Incentives Improvement Institute. (http://www.hci3.org/)
Health Information Management Systems Society. (http://www.himss.org/ASP/index.asp)
Institute for Healthcare Improvement. (http://www.ihi.org/Pages/default.aspx)
Institute of Medicine (IOM). (http://www.iom.edu/)
Joint Commission. (http://www.jointcommission.org/)
Leapfrog Group. (http://www.leapfroggroup.org)
National Quality Forum (NQF). (http://www.qualityforum.org)
Six Sigma. (http://www.sixsigma-lean-healthcare.com/)
U.S. Department of Health & Human Services (HHS). (http://www.hhs.gov/ocr/hipaa/)
U.S. Department of Health & Human Services. Clinical practice guidelines archive. (http://www.ahrq.gov/clinic/cpgarchv.htm)
U.S. Department of Health & Human Services. Healthcare innovations exchange. (http://www.innovations.ahrq.gov/)
UCLA Health System Risk Management. (http://risk.mednet.ucla.edu/)
VA National Center for Patient Safety. (http://www.patientsafety.gov/)
Required Multimedia
JohnsHopkinsMedicine. (2013, May 17). Patient safety: At the heart of all we do. John Hopkins Bayview Medical Center [Video file]. Retrieved from http://www.youtube.com/watch?v=Ljq32a1hjFQ