1. Sanders, Pauline MBA, RN, CCM, CPHRM, LNC

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As a nurse manager, you need to understand the role of the risk manager and embrace positive change on your unit by promoting patient safety through knowledge of your organization's risk activities. Shared learning can occur via a collaborative relationship with your risk management department. Here we suggest seven strategies for collaboration with risk managers that you can incorporate into your practice.

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Hospital risk management

In the hospital setting, risk management activities are the driver of patient safety through the prevention, monitoring, and identification of medical errors. These activities are largely the result of the facility's active occurrence reporting system, which is initiated by a frontline reporter when staff members submit a potential or actual error. Reports may be submitted in paper form or electronically. Most organizations have some type of electronic submission, which is reviewed in real time; however, the specified review period may range anywhere from 24 hours to 7 days. After information is submitted, risk management staff members, with physician oversight, review and investigate the events to determine the urgency of action needed to correct system issues. Action plans are shared with all staff to prevent similar events from occurring.


Occurrence reports may reveal critical events that need immediate attention or there may be numerous similar occurrences (a cluster of events) that reveal problems on a specific unit, with a certain type of patient, or with an organizational system. Critical events require an urgent root cause analysis (RCA) meeting with involved staff and leadership to develop an action plan to correct systemic problems within the facility.


RCA is a process for identifying the basic causal factor(s) underlying variation in performance.1 The Joint Commission recommends several tools to assist with identifying the root cause(s) of events, including, but not limited to, the Change Analysis Worksheet, Fishbone Diagram, Process Flow Chart, and Five Whys.


Depending on the severity of the error, contact may need to be made with the organization's legal counsel. Less critical occurrences require data trending to determine problematic patterns, including near misses, and liability concerns for the organization. These data trends are communicated to the leadership team and medical staff members for their awareness and to obtain shared support for establishing action plans. Near-miss events may be tracked and used by leadership to create teams or task forces to develop strategies to address identified trends.


Collaborative teamwork

Patient safety and the reduction of medical errors require a multidisciplinary, collaborative approach between nurse managers and risk managers to achieve improved outcomes. For example, hold a standing monthly meeting that includes nurse managers, risk staff members, the risk medical director, the CNO, and the patient safety officer to highlight the most frequent occurrences for the past month and discuss the corrective action plans developed for the organization. Ideally, you should cultivate a clinical networking alliance with your risk manager to determine the most beneficial way for both of you to receive meaningful data and work together to create best practice models. Through this collaboration, your two departments will help drive a culture of quality and safety.


Consider these seven strategies for promoting a partnership with your risk management department:


1. Discuss occurrence reports with your risk manager on a frequent basis, which will help develop a working relationship.


2. Monitor your unit's occurrence report trends. Software access is usually a shared system in which you can review reports specific to your unit. It's recommended that unit staff members focus on the top three event categories to make a meaningful impact on the unit.


3. Embrace near misses. Educate your staff members about the opportunities that exist with these reported events. Encourage staff members to report all near misses.


4. Set aside time during each monthly nurse managers' meeting to have a group discussion about risk events that have occurred. The flip side of risk events is an opportunity to improve patient care. These shared events increase awareness and allow your colleagues to take information back to frontline staff.


5. Have charge nurses review occurrence reports. This enables them to understand the unit's vulnerabilities, which may include awareness about critical patients or nurses who may need more support.


6. Provide positive feedback to staff members when they do an outstanding job describing, writing, and detailing an event in the occurrence report. Well-written reports, which provide information on who, what, why, when, where, and how an incident occurred, enable the risk reviewer, medical reviewer, or organization's attorney to understand the issue and are good tools to have for memory refreshers if the event is litigated in the future.


7. Implement a regularly scheduled risk management/nursing management roundtable to brainstorm, share actions from RCAs, and learn from recent events in the organization without compromising Health Insurance Portability and Accountability Act regulations.



For the win

Collaborative conversations to identify potential litigious events can reduce liability and financial outpours for the organization by deciding which cases need legal counsel involvement. Losses may be mitigated by having providers meet with patients and families to discuss events and assure them that actions are being taken to prevent future occurrences. Alternately, when all parties agree that harm has been done, early settlements may occur, which prevents large monetary payouts and eliminates the need to involve opposing counsel or long court battles.


When nurse managers and risk managers work together as change agents for a culture of patient safety, it's a win-win situation. Together you can identify unit vulnerabilities and commit to driving actions to decrease risks. Engaged nurse managers and risk managers equate to quality patient care-our ultimate goal.




1. Croteau RJ. Root Cause Analysis in Healthcare: Tools and Techniques. 4th ed. Oakbrook Terrace, IL: The Joint Commission Resources; 2010. [Context Link]