Risk Management in Health Care Institutions: A Strategic Approach, 2nd ed.
Florence Kavaler and Allen D. Spiegel Jones and Bartlett, www.jbpub.com, 2003, $60.95, 444 pages, ISBN 0763723142
Audience: Risk and quality managers, safety managers, healthcare managers, CEO’s, administrators
Key Words: Risk management, ethics, legal/statutory issues, legislative issues, quality assessment, performance improvement, safety and security

Risk management constantly evolves because the changes in technology, medications, liability and regulatory issues, and other concerns mandate this evolution. Rare, yet catastrophic, events like September 11 can also have an impact on it. Written like a textbook, Risk Management in Health Care Institutions: A Strategic Approach provides its readers with an overview of risk management processes both past and present. It also gives a glimpse of its future. The book’s main purpose is to assist risk managers in organizing and developing an up-to-date risk management program by evaluating the components of the process.

The book is divided into three sections. Section 1 presents a late 1980s/early 1990s introduction to risk management. It then provides an overview of the dynamics, regulatory environment, employer risks, patient/consumer communications, and financing activities that are the essence of a risk management program. Section 2 deals with general risk management strategies and discusses quality management/improvement and evaluation, ethical issues, and safety and security for healthcare institutions. Section 3 covers specific strategies for handling medical malpractice, reducing liability, and managing risk in psychiatry, long-term care, home healthcare and highrisk areas, such as emergency medicine, obstetrics, neonatology, surgery, anesthesia, managed care, and integrated healthcare delivery systems. Also included in the chapters are actual case studies that emphasize the integration of various components, such as medical malpractice, quality improvement activities, and peer review, into the risk management program.

The basic definition of risk management for any business is, at rock bottom, the protection of an institution’s financial assets. This book will be particularly useful to the beginning and intermediate risk manager for use as a guide and quick information resource to ensure that risk management is integrated into the strategic plan, mission, long-term objectives, budget, policies, and procedures of any healthcare institution.

Reviewed by Linda Brandt-Comer

Legal, Ethical, and Political Issues in Nursing, 2nd ed.
Tonia Dandry Aiken, Ed. F.A. Davis, www.fadavis.com, 2004, $34.95, 458 pages, ISBN 0803605714
Audience: Nurses, healthcare administrators, nurse educators
Key Words: Legal/statutory issues, legislative issues, public policy, ethics, informed consent, practice guidelines, professional liability, risk management

Legal, Ethical, and Political Issues in Nursing is a comprehensive reference for all disciplines within the nursing profession in the United States. This well-organized text contains five major parts: nursing practice, nursing and the law, nursing ethics, liability in professional practice, and professional issues. Each chapter is broken down into key components containing concepts, thoughts, objectives, and introductory sections, thereby allowing the reader to quickly locate information. The case study components enhance understanding by presenting actual examples and outcomes. The current edition includes topics relating to risk and conflict management as well as an in-depth discussion regarding ethical and disclosure issues.

The chapters covering liability—a topic of great interest in healthcare—answers questions from the perspective of multiple stakeholders. For example, the chapter on facility liability and employment issues details rights and responsibilities of both employers and employees. Beyond the factual information, there is a section in the text that can be useful in the preparation of medical malpractice lawsuits and the litigation process, as well as mediation and arbitration. After reading this, the healthcare professional will be better informed and prepared in dealing with legal issues.

Educators will find this a useful tool for the classroom. An instructor’s guide and discussion questions are contained on a CD-ROM and included with the text. Extensive references and resources including Web sites, expanded tables, appendixes, and actual sample documents complete this excellent legal guide for nurses. Legal, Ethical, and Political Issues in Nursing is an invaluable tool that should be on every nurse’s bookshelf.

Reviewed by Colleen J. Hewes, DC MSN RN

Reaching the Tipping Point: Measuring and Reporting Quality Using the NQF-Endorsed Hospital Care Measures
The National Quality Forum, www.qualityforum .org, 2003, $14.75, 44 pages, Document Number NQFWP2-03
Key Words: Performance improvement, performance measurement, quality tools, administration and management

The National Quality Forum (NQF) was established in 1999 to address the serious and systemic problems that the American healthcare system faces by facilitating initiatives to solve them. The NQF is a public-private partnership whose membership represents four major healthcare stakeholder categories, or councils (consumers; purchasers; providers and health plans; and research and quality improvement organizations), each of which has an equal voice in setting standards for improving healthcare quality. This report is a result of a February 2003 meeting held to produce two specific outcomes: (a) an initial set of hospital care performance measures that would address all six quality improvement aims set forth in 2001 by the Institute of Medicine (IOM) and (b) a comprehensive framework for improving, updating, and implementing the initial set of 39 measures. These measures relate to acute coronary syndrome, heart failure, patient safety, pediatric conditions, pneumonia, pregnancy/childbirth/ neonatal conditions, smoking cessation, and surgical complications and were established through the NQF Consensus Development Process (CDP) in March 2001. Since the CDP confers a special legal status to these measures as “voluntary consensus standards,” it allows them to be more readily adopted for use by Medicare and other federal healthcare programs. Thus, they are well-positioned to become the national standard for hospital care performance measurement and reporting standards.

The report is not innovative. Rather, its purpose is to offer a solution to the lack of national standardization in performance measurement and reporting strategies. Currently, healthcare providers must respond to a multitude of entities, each requiring data collection and performance measures that use different methodologies and specifications. The need for providers to customize measurement and reporting efforts to meet these often similar but technically unique requirements results in confusion, duplication of effort, redundancy, and ineffective use of limited resources.

At the conclusion of this meeting, it was decided that the “tipping point” that would make the NQF-endorsed measure set the single healthcare industry standard for measuring hospital care would depend on the four crucial components of (a) achieving standardization of the measures, (b) data collection and submission, (c) rewarding high-quality performance, and (d) public reporting. According to the NQF, the ideal hospital would base its success on the formula of C + L + D = Q? That is, by creating a Culture of caring and quality with patient involvement + Leadership on the part of administrative and medical staff + Data (feedback, benchmarked, standardized) = Q? (Quantum leaps of quality).

This report is important to those quality improvement professionals and healthcare administrators interested in knowing what developments to healthcare improvement and reporting are being proposed that will have an impact on their organizations. It will help inform those who need to know what to prepare for and how, why, and by whom the new standards are being developed. With the release of the initial set of NQF voluntary consensus standards for hospital care performance measurement, all healthcare stakeholders are now responsible for taking the first steps to reach a “tipping point” for embracing a single national standard for hospital measurement and reporting.

Reviewed by Patricia A. Cholewka, EdD MPA RN BC CPHQ

Maximize Patient Safety with Advanced Root Cause Analysis
Catherine Corbett, Craig Clapper, Kerry M. Johnson, with Richard A. Sheff HCPro, 2004, www.hcmarketplace.com, $99, 202 pages, ISBN 1-57839-348-5
Audience: Healthcare leaders, quality improvement professionals
Key Words: Accreditation best practices, collaboration, communication, outcomes, patient safety, process improvement, quality of care, quality tools, sentinel event

The primary goal of Maximize Patient Safety with Advanced Root Cause Analysis is to help healthcare organizations truly meet the JCAHO requirement for “thorough and credible” root cause analyses of each sentinel event. The premise of the text is that most healthcare organizations do a very rudimentary job of looking at sentinel events. The authors propose that the process outlined in this book will assist organizations in identifying not only root causes but also root solutions to prevent recurrences of problems. Coauthored by partners from Performance Improvement International and a consultant from HCPro, Inc., this text provides a truly useful manual for going beyond traditional healthcare root cause analysis.

The preface outlines an excellent introduction to root cause analysis and details not only what is lacking in traditional healthcare root cause analysis (RCA) but also some first steps that can be taken to more effectively implement this process. Chapter 1 explains why the authors feel that management should “own” the process and demonstrate where the RCA system should fit into the performance management system. Chapter 2 provides an overview of the RCA process, outlining a six-step process for doing effective RCA in healthcare.

The next six chapters detail the six process steps presented in Chapter 2: Investigate the Occurrence, Collect and Process Data, Identify Failure Modes, Construct the Failure Scenario, Develop Root Solutions, and Monitor for Effectiveness. These six steps will be familiar to those who have done RCA or failure mode and effects analysis (FMEA), but many of the suggestions for performing these steps may be new to less experienced practitioners.

The remaining chapters of the book are perhaps the most useful, particularly for the experienced professional. The authors provide tools that enable an organization to evaluate its RCA program. In terms of prevention of adverse events, the more interesting discussion moves the reader beyond single-event root cause analysis to examine common cause. The idea behind moving to common cause analysis is that this type of program is as effective in reducing event rates as traditional single-event RCAwhile using only 10% of the resources. Finally, the appendix offers a wide range of data collection and analysis tools that would be useful in an organization’s RCA process.

This book is an impressive collection of theory and tools that would benefit new or experienced quality professionals. The subject matter is timely from a regulatory and patient safety perspective. This is a text that both healthcare leaders and quality professionals should read and keep as a reference.

Reviewed by Eileen Johnson, MSN BC RN CPHQ

The Healthcare Industry: A Primer for Board Members
Dennis D. Pointer, Stephen J. Williams Jossey-Bass, www.josseybass.com, 2003, $35, 135 pages, ISBN 0-7879-6721-1
Audience: New or tenured board members
Key Words: Governing board/body, healthcare delivery

Merriam-Webster defines primer as “2: a small introductory book on a subject.” The authors have succeeded in writing a primer targeting new and long-tenured board members. The book provides a snapshot of the various aspects of healthcare including financing, personnel, and hospital systems.

The vast majority of topics necessary for a basic understanding of the healthcare industry are provided in this text, although at times it is written in a manner that is too simplistic. A glossary of terms is provided as well as recommendations for learning more about a topic. For example, the primer provides little on the issues of governance so the authors suggest Board Work by Dennis Pointer and James Orlikoff, 1999.

The authors do not explore current, relevant issues that healthcare organizations face today— issues that often find their way to the governing board. These include cultural and communication issues resulting from the recruitment and hiring of foreign trained personnel; costs of agency nurses issues surrounding the hiring of private-duty nurses; and effects of rising malpractice premiums on physicians. Most surprising, patient safety and rural healthcare have become foremost issues in healthcare today, and yet nothing is written on either of these significant topics. Board members who are not experienced in navigating the healthcare system as a patient or patient advocate may find this text useful.

Reviewed by Mary Savitsky, BS CMSC CPHQ

JHQ welcomes the opportunity to review various media that could potentially be of benefit to healthcare quality professionals and the people they serve. Reviews are published in every issue of JHQ. To have your product reviewed by a healthcare quality expert, please send a nonreturnable copy to:

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