Advancing Health Care Risk Management CPHRM Release Date

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, mediation is a form of alternative dispute resolution designed to facilitate voluntary settlement between parties. In mediation, a neutral third party assists disputing parties in communicating, clarifying issues, and exploring mutually acceptable resolutions. The mediator does not impose a binding decision but guides negotiation toward compromise and reconciliation.

Arbitration differs in that the neutral arbitrator typically renders a decision that may be binding, depending on the agreement between parties. Jury trials and bench trials involve formal court proceedings where a judge or jury determines liability and damages based on legal standards and evidence. These processes are adversarial and result in judicial determinations rather than negotiated compromise.

Claims and litigation objectives emphasize cost containment, early resolution, and reduction of adversarial conflict when appropriate. Mediation can reduce defense expenses, shorten case duration, and preserve professional relationships. It also provides greater confidentiality and flexibility than courtroom litigation.

Therefore, the intervention specifically intended to promote reconciliation, settlement, or compromise between parties is mediation.

Wrong-site surgery is a high-severity, preventable event. Joint Commission analyses repeatedly identifycommunication failuresas a leading root cause—breakdowns in scheduling, consent/site verification, handoffs, and intraoperative confirmation. Risk management objectives therefore emphasize standardized verification systems: correct patient/procedure/site documentation, pre-op verification, surgical site marking, and a robust time-out performed with full team engagement. Communication failures can include ambiguous documentation, incorrect or incomplete handoff information, and hierarchy barriers that prevent speaking up. Improving communication reduces reliance on memory and individual vigilance and increases system reliability. In addition, organizations must audit compliance, address workarounds, and strengthen team empowerment so any member can stop the line if a mismatch is detected.

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, a standard loss run is a report generated by an insurer or third-party administrator summarizing claims activity for a specific period. Loss runs are critical tools in risk financing, underwriting review, actuarial analysis, and budgeting for self-insured retentions.

Essential elements of a standard loss run include the date of loss, indemnity payments, and expense payments. Indemnity reflects amounts paid or reserved for compensation to claimants, while expense represents allocated loss adjustment expenses such as defense costs, expert witness fees, and investigation costs. These data elements allow the organization to evaluate financial exposure, trends in claim development, and adequacy of reserves.

While frequency and severity are important analytical concepts derived from loss data, they are not typically listed as standalone fields within the basic loss run report. Legal analysis, case law references, and root cause analyses are not standard components of loss run documentation.

Risk financing objectives emphasize accurate tracking of financial exposure and informed forecasting. Therefore, date, expense, and indemnity are essential elements of a standard loss run report.

According to Health Care Risk Management standards supported by ASHRM and the American Hospital Association Certification Center, determining coverage requires careful review of the applicable insurance policies and policy structure. Because the alleged negligence occurred 10 years earlier, the risk manager must first review both the current policy and the policy in effect at the time of the delivery. Coverage depends on the specific policy terms, limits, endorsements, and retroactive dates applicable during the relevant policy period.

It is also critical to determine whether the policy is written on an occurrence or claims-made basis. Under an occurrence policy, coverage is triggered by the date of the incident, regardless of when the claim is filed. Under a claims-made policy, coverage depends on when the claim was reported and whether appropriate tail or extended reporting coverage exists.

Identifying co-defendants’ coverage may be relevant to contribution or indemnification but does not determine the hospital’s own coverage. Discussion with defense counsel may assist in strategy but should follow preliminary internal coverage analysis.

Risk financing objectives emphasize accurate policy review and understanding of trigger mechanisms before executive discussions. Therefore, reviewing the relevant policies and determining policy type are essential first steps.