The New Risk Management

In my first post, I alluded to the fact that exposure to unexpected, unfortunate patient outcomes and litigation creates a certain array of special occupational risks for those of us engaged in the healing arts.  One of my primary purposes in creating this blog, in fact, is to give us a place to come together to engage in a conversation which I believe has the power to function as a whole new kind of risk management.

What comes to mind for you when you read the words “risk management”? Personally, I think of a handful of wonderful professionals I've known over the years. 

Good risk managers aim to minimize legal and financial risks to the institution as a whole. Their willingness to tackle certain day-to-day realities of life in a hospital supports the rest of us on the front end by helping to steer the ship, and on the back end when storms arise, which occasionally, they will.

Great risk managers, however, have yet another aim; they strive to protect the well-being of a hospital's most important asset --  the people. They fuel a supportive, growth-oriented environment where openness and communication reign. Their responses, particularly when called in to confront unexpected events, can make a real difference for the rest of us.

Even so, I believe that a broad, largely hidden landscape of risks to frontline healers remains, one which we have only begun to learn how to identify and navigate.

It's not that these risks are anything new. Believe it or not, Hippocrates wrote nearly 2500 years ago that “opportunity (is) fleeting, experience treacherous, judgment difficult." It seems to me that any physician who would choose the word "treacherous" to describe clinical experience must have known as intimately as you and I the challenges of a life in healing.

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"...experience (is) treacherous, judgment difficult."

 

                                                - Hippocrates

By contrast, not all healthcare risk managers have first-hand clinical experience. With backgrounds ranging from law to finance, nursing to business, for them, hands-on experience can sometimes be in short supply. 

This is not necessarily a bad arrangement.  In fact, our relationship with risk managers, health lawyers, and malpractice defense lawyers reminds me a bit of what goes on in the delivery room.

Having witnessed several births well before I gave birth myself, I know with certainty that observing childbirth is not the same as doing. Regardless of skill, knowledge, or years of experience, an OB/GYN or midwife who has not given birth can not know how it feels. That doesn't change the fact that the OB or midwife's experience is awfully helpful when push comes to, well, “Push!

Our relationship with risk managers and defense lawyers is a lot like that. Their counsel and support is valuable beyond measure, but to manage some kinds of risks, we who have clinical experience will have to take courage and lead.

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What, then, is this mysterious hidden landscape of risk in clinical practice? What occupational hazards do we face when our patients encounter unexpected, sad outcomes? And how are those risks magnified if we worry that we might somehow have prevented that outcome?

For many of us, the specter of malpractice litigation looms largest on that risk horizon. However, I have learned that other less visible risks to our well-being may actually have a much more lasting impact, far beyond the time frame of a lawsuit. What are they?

Here are what I would call the Big Five:

  1. Early Retirement

  2. Premature Limitation of the Scope of One's Practice

  3. Burnout

  4. Post-Traumatic Stress Disorder

  5. Depression and Suicide

 

Does that list strike you as exaggerated? It is not. The whirlwind of a patient's unexpected outcome and professional litigation has the potential to affect our health, our professional longevity, and our ability to do what we do well and to love doing it along the way.

Further, when these outcomes occur, they reverberate, impacting on our working relationships, families, patients, and trainees. If you ask me, these are the most pressing risks we need to manage, and I'd like to see us finding better ways to do it. I call this "The New Risk Management."

There is a huge opportunity for growth in the experience of an unexpected patient loss or litigation and expanding our repertoire of responses to it, if we choose to claim it. The magnitude of its impact on us is not random. It directly reflects the deep power and boundless meaning inherent in the work we've chosen.

Whether we knew it or not, when we chose such powerful work, we set out on a hero's journey, opening ourselves up to confronting this distinct set of challenges. Handed down to us in sacred trust by other generations, we accepted this challenge just as surely as the knowledge, the pleasures, and the privileges of healing. The time to embrace this piece of our work is now. Next time, we'll begin to explore these ideas, starting with a look at the Big Five. I hope you'll subscribe to the blog and join me.