Health Services and Risk Management (Research Paper Sample)

The report on the roles and responsibilities of a “healthcare risk and compliance manager” is divided into nine sections, with each covering varied information. The first section is the introduction part which has covered the brief background of the report and focus of the paper. The second section is on the definition of risk management and the process and activities involved. Thirdly, is on the definition of HIPAA and how it is applied in healthcare risk management. The other section has covered how social media is used in healthcare staff recruitment by outlining how healthcare facilities have taken advantage of the developing social media platforms in their recruitment approaches. The next part is on grading and ranking and how it works in healthcare, where the report has outlined some of the roles ranking and grading have played. The sixth part of the report is on predictive analysis and how it is used in healthcare risk management. The next part of the report explores ethical guidelines for healthcare managers and various ethical issues in daily healthcare practices. The other section of the report is on safety and security in healthcare institutions and how they are assured where; it has discussed some of the measures employed by the institutions to enhance safety and security. Lastly, the conclusion part has summarized the main points of the report.
* Introduction
For the healthcare facility to operates and thrive in the industry, it should adhere and comply with the risk management rules and regulations. Thus, as a healthcare risk and compliance manager, the main objective is to ensure the facility adheres to these policies and guidelines by ensuring all the stakeholders in the institution follow them in their practice. In order to ensure staff adheres to these guidelines and compliance, the manager should understand various elements such as risk management and processes and activities involved. Also, the manager should understand more about HIPAA and its application in risk management. Besides, with technological advancements, the manager should understand the roles of social media in some organizational practices such as recruitment. The other key area that the manager should explore is the safety and security issue in the healthcare institution and explore grading and ranking in the healthcare and how it works. Additionally, the manager should be aware of ethical guidelines for healthcare managers and ethical issues in healthcare practices. Objectively, the report will focus on the above elements that are part of the responsibilities and roles of the healthcare risk and compliance manager.
* Risk Management and Risk Management Process and Activities
Risk management is an organized effort by the organization to identify, assess, and reduces risks to various parties in the healthcare organization (Kavaler &Alexander, 2014). It helps identify the potential risks likely to affect the healthcare organization in the future and to come up and implement some measures that help in their mitigation and prevent their occurrence. The employed measures help reduce the risks of such events or occurrences on patients, visitors, or staff working in the facility.
Various processes and activities are involved in risk management. Firstly, risk identification involves the continuous collection of information for use in search of various liabilities risks that are likely to occur and cause harm to various stakeholders in the healthcare organization. Some of the risks likely to occur in the future include property risks where facilities properties are affected by such uncertainties, causality liability risks, and employee benefits risks where employees may demand more benefits in the future compared to the current benefits they are receiving, resulting in inconveniences. The second process is the analysis of the identified risks, which will involve comparing the risks to several factors such as experience and current exposure, which will help assess the impacts of the risk in case of its occurrence. The analysis of the risks process will also involve checking on the past damages the risk caused to the organization where it occurred and comparing such magnitude among various organizations (Kavaler &Alexander, 2014). The process will also analyze the likelihood or frequency of its occurrences and identify whether it is likely to reoccur again in the future for proper preparations.
Thirdly, after conducting the risk analysis process, various risk control measures are identified which could work better to prevent such risks. The potential liability of the risks is categorized into bodily injury; whose impacts affect the bodies of stakeholders in the facility. The other categories of potential liability are liability loss, property loss, and consequential losses, which affect healthcare facilities differently. Some of the measures that can be employed to minimize different categories of the risks include risk acceptance, exposure avoidance, loss reduction, loss prevention, exposure segregation, and contractual transfer, depending on the category of the identified risk. This process is essential as it helps select the best approach as different techniques work differently depending on the nature of the identified risk. Also, the methods have different ways of controlling the risks, thus assessing the various application treatment techniques. The last process in risk management is financing, which involves allocating resources in the implementation of the risk control measures. Some of the activities involved in this process include self-insurance, commercial insurance, and budgetary funds (Kavaler &Alexander, 2014). Financing in risk management depends on various factors, such as the category of the risk and the intended risk control or treatment method.
* HIPAA and Its Application to Healthcare Risk Management
Health Insurance Portability and Accountability Act (HIPAA) legislation in the United States provides data privacy and security provisions for safeguarding medical information. The law was enacted and signed into law by President Bill Clinton on August 21st, 1996. The main purpose of HIPAA is to provide continuous healthcare insurance coverage for workers who lose or change their job and reduce the cost of healthcare by standardizing the electronic transmission of administrative and financial transactions. Also, it helps in combating the abuse, fraud, and waste in healthcare insurance and healthcare delivery (Cohen & Mello, 2018). Additionally, it helps in the improvement of long-term care services and health insurance. HIPAA has five components: HIPAA Health Insurance Reform, which prohibits groups of health plans from denying coverage to individuals with specific diseases and pretexting conditions and setting lifetime coverage limits. The second section is HIPAA Administrative Simplification which directs the U.S. Department of Health and Human Services (HHS) to establish national standards for processing electronic healthcare transactions. Also, it requires healthcare organizations to implement secure electronic access to health data and comply with HHS's privacy regulations. Next, the section is HIPAA Tax-Related Health provisions which provide for the tax-related guidelines for medical care (Cohen & Mello, 2018). The next section of HIPAA is Application and Enforcement of Group Health Plan Requirements which defines the health insurance reform, including provisions for individuals with pre-existing conditions and those seeking continued coverage. The last section is Revenue Offsets which includes a provision on company-owned life insurance and the treatment of those who lose their U.S. citizenship for income tax purposes.
* Use of Social Media in Healthcare Staff Recruitment
Technological advancement has revolutionized many activities, operations, and how various organizations do things. Healthcare has not been exempted from such changes as the facilities have embraced technologies in many of their activities. One such area that has benefited from the technology is recruitment and hiring processes by the healthcare facilities, which have started to employ social media tools in the recruitment process. With the technology advancements, different social media platforms such as Facebook, Twitter, Instagram, LinkedIn, among many others, have been developed. Many healthcare facilities have taken advantage of these social media platforms to create their pages. They have created a virtual community of clients with whom they share information by posting on these platforms (McRobert et al., 2018). For example, many healthcare facilities have official Twitter and Facebook pages that they use to share information with the public members. If these facilities wish to hire new employees to fill gaps in the organizations, such information is posted on their social media pages with descriptions of the qualifications for the intended candidates. This approach has helped make the recruitment processes easier, faster, and efficient as such recruitment information usually spread very fast due to the high number of individuals seeking employment opportunities. The social media platforms have many users, making it possible for the organization to reach many potential candidates to fill the existing position in the organization. Besides, with social media recruitment strategy, the healthcare facilities can reach many people from different parts of the world, providing a large pool of human resources with various skills and competencies that meet the required criteria (McRobert et al., 2018). Notably, many healthcare facilities strive to enhance diversity in their human resource by recruiting people from different backgrounds; thus, social media recruitment has made it possible for...