Biomedical subjects
Publications and source records attributed to W McKerrow.
Risk management is worthwhile, and should be given high priority by health professionals. There is a direct payoff for practitioners. The past decade has witnessed organizational trappings of risk management. However, until practitioners appreciate the personal payoff of risk management, and that treatment will be more effective at the same time, more lip service than results will be the norm.
Effective communication with patients results in better treatment outcomes, and may be the best tool in managing risk. Providers must appreciate the barriers to effective communication, identify what and how information is to be communicated, and develop the necessary skills.
Quality improvement and patient-centered care hold great promise for effective health care delivery. The corporate group must show the way, by demonstrating visionary, strategic planning and enabling skills. The development of direct care and infrastructure quality teams require trust and nurturing. Criticism of management is to be expected. The corporate group must walk a fine line by creating a vision and establishing the necessary strategic processes. Operational aspects must be delegated to quality teams, which must acquire skills of problem identification and the analytical processes for their resolution.
The increasing complexity of hospitals and the emergence of corporate responsibility calls for greater trust amongst the Board, Administration and Medical Staff. Physicians will play a more important role in the hospital decision-making process. Boards will expect the medical staff organization to better define and monitor processes for physician credentialling, evaluation, peer review and discipline. Because these issues are complex and sensitive, only the organized medical staff can appropriately address them. Clarification of roles and responsibilities of the President of the Medical Staff, the Chief of Staff and the medically qualified administrative officer is crucial in the development of appropriate relationships and processes.
An assessment of risk management systems for patients on Warrants of the Lieutenant Governor in the provincial psychiatric hospitals was conducted. The assessment revealed that, to date, with some exceptions, the system has coped reasonably well. However, with a present count of over 400, and the ever increasing number of patients on warrants, there is a pressing need to improve the overall coordination of the system. The numbers, types and location of beds required to serve the system must be reviewed. Staff needs and training must be addressed. Increased numbers of coordinated research studies and improved information systems are required. System-wide policies and procedures for releasing information to policy, employers and home operators are necessary. As well, there must be a consistent approach in dealing with potential abuse of alcohol and non-prescribed drugs. Systems for authorizing and documenting patient privileges can be improved in some hospitals. A set of guidelines for interpreting terms and conditions of warrants is necessary. Lastly, information for staff treating patients on warrants should be developed and distributed.
Risk management is defined as the systematic process of identifying, evaluating and addressing potential and actual risk. Although introduced to the hospital industry nearly a decade ago, it status in Canadian hospitals remains uncertain, a position that is in sharp contrast to the American situation. Chiefly as a result of the medical malpractice crisis and associated circumstances in the mid-1970s, risk management has emerged as an integral element in the operational activities of American hospitals. The process is a mechanism for self-protection in co-operative, self-insurance arrangements and to secure commercial premium adjustments. Many trends have been recognized in canada that would suggest a predisposition toward the proliferation of risk management programs. These indicators include an increase in the number and size of claims against hospitals and physicians, a reduction in the availability of commercial health care insurance, and an increase in alternative insurance arrangements. Despite these indicators, movement toward risk management by Canadian hospitals has been minimal. A prime reason appears to be lack of financial incentives to stimulate the development of risk management programs. There is also an absence of specific accreditation standards pertaining to such programs. The case in support of risk management for Canadian hospitals continues to grow. The basic assumptions associated with a program are board, medical and staff support; a concerted effort to recognize and reduce potentially litigious situations and occurrences; and an ability to adapt. The initial steps to develop a risk management program include assessing current risk control activities and implementing structural elements. As well, a program must address its relationship to Quality Assurance activities in the hospital.
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During 1968-77, 572 consecutive children with one or more positive urine cultures who were referred by their family doctors to one paediatric surgical outpatient clinic were investigated and prospectively recorded. An abnormality requiring treatment was found in 45%. The yield of positive findings and need for operation were greater in those referred after one infection than in those with recurrent infection. Among those under 2 years old 90% had an abnormality. One third of children with vesicoureteric reflux showed renal scarring at the time of first attendance. The results of medical and surgical treatment over five to 15 years of follow up were analysed. They emphasised the importance of culturing the urine whenever there may be urinary infection in a child and of investigating immediately those with a positive urine culture.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.