Medical Records and the Law

424 CHAPTER 12: RISK MANAGEMENT AND QUALITY MANAGEMENTto the analysis of data. Quality management generally approaches theidentification and analysis of patient care problems and issues from thestandpoint of what should occur in, and what goals should be met by,the healthcare organization. Risk management, on the other hand,tends to approach these tasks from the perspective of what should notoccur in, and what risks need to be avoided by, that organization. Accordingly,quality management monitors patient care on an ongoingbasis, and aims to improve quality of care and prevent adverse outcomes,but risk management focuses on risk identification, protectingthe organization’s financial and personnel assets, and investigating specificincidents that may have resulted in liability for the organization.Because the sources of data relied on by each of these disciplines aresubstantially similar, the data may be obtained in a more cost-effectivemanner if coordinated properly. 2In its accreditation manuals, the Joint Commission requires thathealthcare organizations demonstrate integration of quality managementand risk management functions by showing an appropriate sharingof information between established quality management and riskmanagement committees, and a coordinated approach to resolvingidentified problems. For example, information obtained through themonitoring and evaluation process conducted in relation to policiesand procedures on hospital safety must be shared by quality managementand risk management committees, although each committee ultimatelyreviews such information and conducts further investigationfrom their different perspectives.Risk ManagementRisk management can be described as a four-step process designed toidentify, evaluate, and resolve the actual and possible sources of loss.1. Risk identification is the process of identifying activities that havethe potential to expose the organization to the risk of liability or financialloss. Risk management committees and risk managers relyon many data sources to identify risks, including incident reports2See Joint Commission on Accreditation of Healthcare Organizations, 2005 Hospital AccreditationManual, Standards PI.1.10, PI.3.10.