Selected Podcast
What Are the Unique Risks to an Academic Medical Center
Health care risk management is a very diverse field and when you meet one risk manager, you meet one risk manager. One size does not fit all. This podcast series will look to discuss risks inherent to a variety of areas in health care. The fourth of the series will explore the unique challenges of health care risk management for those who manage and mitigate risks in a large academic medical center.
Featuring:
Katie completed the Charles Warren Fairbanks Fellowship in Clinical Ethics in 2011-2012, and she continues as a volunteer member of the IU Health clinical ethics consultation service and co-chairs the committee. She has previously served as an Adjunct Lecturer in the Department of Community and Health Systems at the Indiana University School of Nursing, teaching Applied Health Care Ethics to second-degree nursing students.
Katie served on the ASHRM Advocacy Task Force for four years and chaired the committee for two of the terms. She will serve on the ASHRM board starting in 2022.
Katie earned a Master’s Degree in Nursing and Health Systems Leadership from the University of Indianapolis in May 2015. She received a Bachelor’s Degree from Ferris State University in Big Rapids, Michigan, in 1997.
Katherine Du Fresne, RN, MSN, CPHRM
Katie is the Executive Director of Clinical Risk Management at Indiana University Health. She has been a registered nurse for over 20 years, having gained her clinical experience in inpatient hematology/oncology nursing. In 2003 Katie began working in healthcare risk management and in 2008 she earned the Certified Professional in Healthcare Risk Management designation.Katie completed the Charles Warren Fairbanks Fellowship in Clinical Ethics in 2011-2012, and she continues as a volunteer member of the IU Health clinical ethics consultation service and co-chairs the committee. She has previously served as an Adjunct Lecturer in the Department of Community and Health Systems at the Indiana University School of Nursing, teaching Applied Health Care Ethics to second-degree nursing students.
Katie served on the ASHRM Advocacy Task Force for four years and chaired the committee for two of the terms. She will serve on the ASHRM board starting in 2022.
Katie earned a Master’s Degree in Nursing and Health Systems Leadership from the University of Indianapolis in May 2015. She received a Bachelor’s Degree from Ferris State University in Big Rapids, Michigan, in 1997.
Transcription:
Prakash Chandran (Host): Welcome to the ASHRM podcast, made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted health care through enterprise risk management. You can visit ashram.org/membership to learn more and to become an ASHRM member. My name is Prakash Chandran. Healthcare risk management is a very diverse field, but when it comes to risk managers, one size does not fit all. The needs and circumstances of the various fields in the healthcare industry all have their own multifaceted characteristics that require a deep understanding in order to effectively mitigate risk.
Today, we'll look to hone into the unique challenges of healthcare risk management in large academic medical centers. Here to educate us is Katherine Du Fresne, certified professional in healthcare risk management and the Executive Director of Clinical Risk Management at Indiana University Health. Katie, thank you so much for joining me today.
I really appreciate your time. So, you're the Executive Director of Clinical Risk Management at Indiana University Health. How did you come to work at an academic medical center and what are some of the things that set AMCs apart from other healthcare centers?
Katherine Du Fresne, RN, MSN, CPHRM (Guest): Wow. Interesting story actually, when I started out my career as a nurse, I did not actually work at an academic medical center. I worked at a smaller hospital in Northern Indiana. And it was my experience as a young nurse that any time we had a patient that was a little too complex you know, had issues that we couldn't handle, we sent them down to Indianapolis, to IU Health. And so I kind of knew early on that was the kind of place where I wanted to take care of patients. And then after taking care of patients in an academic health setting for a while, I then transitioned into risk management. I think that some of the things that set us apart in the academic health setting really are the complexity of the patients that we see. It would be really rare that an academic health center would turn away a patient that needed specialized treatment.
And I think that's very exciting. And then another key difference is that we welcome learners into the setting. That of course poses some interesting challenges. But really it's wonderful overall. We're helping educate the next generation of healthcare professionals.
Host: Yeah, that makes a lot of sense. And just kind of touching a little bit on what you just said around sometimes it can be challenging because you welcome learners. Can you expand on that a little bit more?
Katie: So, obviously learners are not yet experts in their field, so, they definitely need guidance and mentorship. Sometimes they don't know what they don't know. So I, I think it can mean that everyone who works around them needs to be cognizant of that and needs to help them and guide them so that errors aren't made.
They need to be aware of the fact that this is really a high-risk environment that we work in. And you know, we have to work as a team to ensure that care is delivered safely and that all of these new young health professionals are getting the experiences and the opportunities that they need in order to go on and deliver care in many settings.
Host: Yeah. And in the learning setting like that, where there is that need for guidance and mentorship, in order to mitigate risk, is there a formalized process around pairing those learners with someone that's more seasoned? Can you speak to that a little bit?
Katie: Absolutely. And at most academic medical centers, we welcome learners of all different types. So, that pairing can be a little bit different depending on the type of professional. But absolutely. We have student nurses who come with not only their clinical instructors from their universities, but also are paired with experienced nurses throughout our facilities so that they can get really quality and in-depth experiences, and learn from those experts right there on the floor, caring for patients. The same thing happens with all types of allied health professionals, as well as medical students, residents, and even fellows. I think academic health centers really offer physician fellowships in specialized areas that they couldn't achieve in other settings.
Host: Now, you touched on this earlier, but I'd love for you to talk a little bit more about some of the risks you would say are unique to an academic health center. I'd also love to understand how your personal experience gives you insight into them.
Katie: I think that's some of the risks that are unique, truly are that we care for lots of different types of complex patients. So, we have specialty services within academic health settings that you don't see everywhere. But even within those settings, there are times that we treat patients that sort of stump everyone. So, you can run the risk of perhaps not having the expertise that you need for that particular patient. And then you are seeking out the information that you need. So, there is a lot of collaboration that has to happen between multiple team members, multiple professionals, different service lines, and communication can be a big risk factor. We don't always communicate perfectly within health care and then we can run the risk of making decisions or delivering care that wasn't exactly right for that patient simply due to a breakdown in communication. So, that's one that I would say. And I think after having been in this field for a number of years, that's one that we see over and over.
We take a lot of steps to help bridge those gaps, and make sure that our communication is as clear, as complete, as concise as possible. But it's one of the things that since healthcare is delivered by humans, we're always struggling with, we never stop working on that.
Host: I can definitely understand how communication is so paramount and I guess this leads me to my next question. You know, what are some of the protocols that have been put in place to mitigate risk not only around communication, but also to address the other events that might occur in an academic medical setting?
Katie: Well, we certainly rely heavily on technology. Technology to ensure that those things that we are ordering for patients that, that is very clear, that there, there are not miscommunications in those processes. Quick, real time communication platforms that are used between clinicians so that they can communicate quickly, but also clearly. So that's another way that we mitigate risk of communication failures.
I would say that one of the things that we have to rely heavily on is truly identifying our risks first off. And we do that through a robust reporting system so that our clinicians can report ideally near misses, but also when mishaps actually do happen and there are communication failures, we're able to collect that data. We're able to analyze those situations, understand better exactly what did happen and then employ strategies to minimize that from happening again in the future.
Host: And I imagine some of what you're talking about or some of the events that happen, trigger this root cause analysis that go into this robust reporting system. Is that correct?
Katie: Yes.
Host: And so, is there a framework for the events that trigger a root cause analysis, or is it anything that happens should be ideally reported in?
Katie: Well, truly anything that happens would be ideally reported. However, after that, here, where I work, we have a team of expert risk managers who review every single event that's reported and they're looking for key things. They look for any time there was patient harm. They look for events that may be considered joint commission or state reportable. They look for near misses that if it hadn't been a near miss, would have resulted in something that could have been catastrophic. And so those experts who are on this team, review those events and then they make determinations as to whether or not a full root cause analysis investigation is warranted.
Host: So moving on, I'd love to learn a little bit more about the types of positive outcomes that you've seen at Indiana University Health since you started in healthcare risk management there.
Katie: Oh, gosh, there've been lots, but I can say, you know, just a few recently, where a risk manager has received an event that's been reported and they've done an investigation and determined that there truly is a technology fix that can absolutely help our care providers eliminate an option for an error. And those are real wins. When we find something where we can put a process in place that can truly eliminate a risk or an error from happening again. We had one recently, which, you know, it seems like such a small thing, but in one of our clinical documentation systems, there was a default that was set. And if that default wasn't overridden by a provider, then incorrect information would go into a patient's medical record. We had an, a risk manager who was able to identify that and then a technology fix could be put in place, so that wasn't going to happen again.
Host: Yeah, it's amazing to hear about this, whether it be a technology implementation or a process implementation, but I imagine sometimes there are challenges in enacting these types of protocols and processes. Is that something that you face and can speak to?
Katie: Absolutely. And I think sometimes, in large health systems, academic health systems, sometimes maybe it is a little bit more difficult to get things done quickly, simply because there are so many people who are impacted. In a really small facility, you know, you might be able to gather the troops and make a change almost immediately, almost in real time.
But when you're talking about a large health system with many, many providers and many, many team members, you sometimes need a little bit more time to make changes and then absolutely like any other industry cost can sometimes be a factor.
Host: Sure. I mean, in terms of overcoming those challenges for anyone that's listening, that might be in a similar situation, trying to implement new technology or new process; do you have any tips or any frameworks that you can share with our audience around how to do this properly?
Katie: I think that I would say strong partnerships and clear communication between the risk management team and the senior leadership. When there are trusted relationships in place and that risk manager can identify an issue or an event that could be duplicated, but we've got some ideas on how to mitigate that risk. And as long as those trusted relationships exist between the risk manager and the senior leadership, I think you really see things happen.
Host: Well, Katie this has been a really informative conversation. Is there anything else that you'd like to share before we close here today?
Katie: I think I would like to say that when there are processes and changes that are identified that can improve patient safety, keep our patients safer, and then they're actually implemented; that's just a huge win and so satisfying, and really, I think what drives most people in the risk management field.
Host: Well Katie, that is the perfect place to end. Thank you so much for your time today.
Katie: Thank you.
Host: That was Katie Du Fresne, certified professional in healthcare risk management and the Executive Director of Clinical Risk Management at Indiana University Health. The ASHRAM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashram.org/membership to learn more and to become an ASHRAM member.
I'm Prakash Chandran. Thanks so much for listening and we'll talk next time.
Prakash Chandran (Host): Welcome to the ASHRM podcast, made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted health care through enterprise risk management. You can visit ashram.org/membership to learn more and to become an ASHRM member. My name is Prakash Chandran. Healthcare risk management is a very diverse field, but when it comes to risk managers, one size does not fit all. The needs and circumstances of the various fields in the healthcare industry all have their own multifaceted characteristics that require a deep understanding in order to effectively mitigate risk.
Today, we'll look to hone into the unique challenges of healthcare risk management in large academic medical centers. Here to educate us is Katherine Du Fresne, certified professional in healthcare risk management and the Executive Director of Clinical Risk Management at Indiana University Health. Katie, thank you so much for joining me today.
I really appreciate your time. So, you're the Executive Director of Clinical Risk Management at Indiana University Health. How did you come to work at an academic medical center and what are some of the things that set AMCs apart from other healthcare centers?
Katherine Du Fresne, RN, MSN, CPHRM (Guest): Wow. Interesting story actually, when I started out my career as a nurse, I did not actually work at an academic medical center. I worked at a smaller hospital in Northern Indiana. And it was my experience as a young nurse that any time we had a patient that was a little too complex you know, had issues that we couldn't handle, we sent them down to Indianapolis, to IU Health. And so I kind of knew early on that was the kind of place where I wanted to take care of patients. And then after taking care of patients in an academic health setting for a while, I then transitioned into risk management. I think that some of the things that set us apart in the academic health setting really are the complexity of the patients that we see. It would be really rare that an academic health center would turn away a patient that needed specialized treatment.
And I think that's very exciting. And then another key difference is that we welcome learners into the setting. That of course poses some interesting challenges. But really it's wonderful overall. We're helping educate the next generation of healthcare professionals.
Host: Yeah, that makes a lot of sense. And just kind of touching a little bit on what you just said around sometimes it can be challenging because you welcome learners. Can you expand on that a little bit more?
Katie: So, obviously learners are not yet experts in their field, so, they definitely need guidance and mentorship. Sometimes they don't know what they don't know. So I, I think it can mean that everyone who works around them needs to be cognizant of that and needs to help them and guide them so that errors aren't made.
They need to be aware of the fact that this is really a high-risk environment that we work in. And you know, we have to work as a team to ensure that care is delivered safely and that all of these new young health professionals are getting the experiences and the opportunities that they need in order to go on and deliver care in many settings.
Host: Yeah. And in the learning setting like that, where there is that need for guidance and mentorship, in order to mitigate risk, is there a formalized process around pairing those learners with someone that's more seasoned? Can you speak to that a little bit?
Katie: Absolutely. And at most academic medical centers, we welcome learners of all different types. So, that pairing can be a little bit different depending on the type of professional. But absolutely. We have student nurses who come with not only their clinical instructors from their universities, but also are paired with experienced nurses throughout our facilities so that they can get really quality and in-depth experiences, and learn from those experts right there on the floor, caring for patients. The same thing happens with all types of allied health professionals, as well as medical students, residents, and even fellows. I think academic health centers really offer physician fellowships in specialized areas that they couldn't achieve in other settings.
Host: Now, you touched on this earlier, but I'd love for you to talk a little bit more about some of the risks you would say are unique to an academic health center. I'd also love to understand how your personal experience gives you insight into them.
Katie: I think that's some of the risks that are unique, truly are that we care for lots of different types of complex patients. So, we have specialty services within academic health settings that you don't see everywhere. But even within those settings, there are times that we treat patients that sort of stump everyone. So, you can run the risk of perhaps not having the expertise that you need for that particular patient. And then you are seeking out the information that you need. So, there is a lot of collaboration that has to happen between multiple team members, multiple professionals, different service lines, and communication can be a big risk factor. We don't always communicate perfectly within health care and then we can run the risk of making decisions or delivering care that wasn't exactly right for that patient simply due to a breakdown in communication. So, that's one that I would say. And I think after having been in this field for a number of years, that's one that we see over and over.
We take a lot of steps to help bridge those gaps, and make sure that our communication is as clear, as complete, as concise as possible. But it's one of the things that since healthcare is delivered by humans, we're always struggling with, we never stop working on that.
Host: I can definitely understand how communication is so paramount and I guess this leads me to my next question. You know, what are some of the protocols that have been put in place to mitigate risk not only around communication, but also to address the other events that might occur in an academic medical setting?
Katie: Well, we certainly rely heavily on technology. Technology to ensure that those things that we are ordering for patients that, that is very clear, that there, there are not miscommunications in those processes. Quick, real time communication platforms that are used between clinicians so that they can communicate quickly, but also clearly. So that's another way that we mitigate risk of communication failures.
I would say that one of the things that we have to rely heavily on is truly identifying our risks first off. And we do that through a robust reporting system so that our clinicians can report ideally near misses, but also when mishaps actually do happen and there are communication failures, we're able to collect that data. We're able to analyze those situations, understand better exactly what did happen and then employ strategies to minimize that from happening again in the future.
Host: And I imagine some of what you're talking about or some of the events that happen, trigger this root cause analysis that go into this robust reporting system. Is that correct?
Katie: Yes.
Host: And so, is there a framework for the events that trigger a root cause analysis, or is it anything that happens should be ideally reported in?
Katie: Well, truly anything that happens would be ideally reported. However, after that, here, where I work, we have a team of expert risk managers who review every single event that's reported and they're looking for key things. They look for any time there was patient harm. They look for events that may be considered joint commission or state reportable. They look for near misses that if it hadn't been a near miss, would have resulted in something that could have been catastrophic. And so those experts who are on this team, review those events and then they make determinations as to whether or not a full root cause analysis investigation is warranted.
Host: So moving on, I'd love to learn a little bit more about the types of positive outcomes that you've seen at Indiana University Health since you started in healthcare risk management there.
Katie: Oh, gosh, there've been lots, but I can say, you know, just a few recently, where a risk manager has received an event that's been reported and they've done an investigation and determined that there truly is a technology fix that can absolutely help our care providers eliminate an option for an error. And those are real wins. When we find something where we can put a process in place that can truly eliminate a risk or an error from happening again. We had one recently, which, you know, it seems like such a small thing, but in one of our clinical documentation systems, there was a default that was set. And if that default wasn't overridden by a provider, then incorrect information would go into a patient's medical record. We had an, a risk manager who was able to identify that and then a technology fix could be put in place, so that wasn't going to happen again.
Host: Yeah, it's amazing to hear about this, whether it be a technology implementation or a process implementation, but I imagine sometimes there are challenges in enacting these types of protocols and processes. Is that something that you face and can speak to?
Katie: Absolutely. And I think sometimes, in large health systems, academic health systems, sometimes maybe it is a little bit more difficult to get things done quickly, simply because there are so many people who are impacted. In a really small facility, you know, you might be able to gather the troops and make a change almost immediately, almost in real time.
But when you're talking about a large health system with many, many providers and many, many team members, you sometimes need a little bit more time to make changes and then absolutely like any other industry cost can sometimes be a factor.
Host: Sure. I mean, in terms of overcoming those challenges for anyone that's listening, that might be in a similar situation, trying to implement new technology or new process; do you have any tips or any frameworks that you can share with our audience around how to do this properly?
Katie: I think that I would say strong partnerships and clear communication between the risk management team and the senior leadership. When there are trusted relationships in place and that risk manager can identify an issue or an event that could be duplicated, but we've got some ideas on how to mitigate that risk. And as long as those trusted relationships exist between the risk manager and the senior leadership, I think you really see things happen.
Host: Well, Katie this has been a really informative conversation. Is there anything else that you'd like to share before we close here today?
Katie: I think I would like to say that when there are processes and changes that are identified that can improve patient safety, keep our patients safer, and then they're actually implemented; that's just a huge win and so satisfying, and really, I think what drives most people in the risk management field.
Host: Well Katie, that is the perfect place to end. Thank you so much for your time today.
Katie: Thank you.
Host: That was Katie Du Fresne, certified professional in healthcare risk management and the Executive Director of Clinical Risk Management at Indiana University Health. The ASHRAM podcast was made possible by the American Society for Healthcare Risk Management to support efforts to advance safe and trusted healthcare through enterprise risk management. You can visit ashram.org/membership to learn more and to become an ASHRAM member.
I'm Prakash Chandran. Thanks so much for listening and we'll talk next time.