The Risk Authority: Turning Up the Volume of Traditional Risk Management Practices

Jeffrey F. Driver, CEO Propelled by shifting demographics and sweeping social and economic changes, U.S. healthcare has never before experienced such an exciting period of growth and development. Science, technology and new innovations are helping people lead longer and healthier lives in ways that our predecessors only dreamed of. Yet, the demands on healthcare systems are undeniably significant. Furthermore, medical negligence and malpractice cases are increasing at an alarming rate, impacting both patients and healthcare providers. A 2013 study carried out by researchers at John Hopkins University found that over the past 25 years, there have been more than 350,000 claims for medical negligence. In 2012 alone, over $3 billion was spent on U.S. medical malpractice payouts, averaging one payout every 43 minutes.

“Simply maintaining the risk management status quo in the face of new and emerging risks and strategies is a recipe for disaster,” says Jeffrey F. Driver. Unsettled by contemporary risk management system’s failures, The Risk Authority Stanford (TRA) is tenaciously striving to develop and implement more efficient and effective risk managing systems both inside and outside the healthcare sector. Through cutting-edge and innovative solutions, the risk-consulting firm is dedicated to transforming their client’s risk management practices into powerful assets.

Improving Standard Risk Processes

“We’re an industry greatly in need of structured methodology, technology upgrades, and technology related risk evaluation,” states Driver, CEO of TRA. “Now more than ever, IT related risk needs modern assessment and solutions.” For example, thousands of medical equipment items that haven’t been traditionally within the scope of IT now have to be reconsidered. As personal and wearable technology evolves, diagnostic, therapeutic and monitoring equipment is now connected to medical records in new, possibly compromising ways.

To respond to these and other emerging risks, institutions need to embrace fresh approaches that improve the quality of their technologies and services. TRA’s Stanford Transformative Assessment of Risk (STAR) is a process that helps organizations strengthen their risk managing techniques. “The STAR methodology is a proven process that establishes a risk program’s baseline, identifies areas for improvement, and provides a roadmap for change in the form of an extensive “Authorite Scorecard” for benchmarking and tracking progress,” elaborates Driver. The STAR module enables healthcare organizations to pay close attention to warning signals and red flags, working to prevent losses before they happen.

TRA also provides a systematic way to address risk within organizations by leveraging the International Organization for Standardization’s risk management framework (ISO 31000), which offers a consistent approach to identify, assess, evaluate, mitigate, and monitor risk. “In order to supplement and enhance each aspect of this approach, TRA has infused the framework with decision analysis, a process that helps quantify cost and benefit variables,” explains Driver. “We call this fusion Value-Driven Enterprise Risk Management (VDERM), which supports us with critical analytical tools and probabilistic models.” Using evidence-based insight, VDERM provides tools for quantifying value creation in addition to value protection, helping clients to capitalize on upside risk opportunities and maximize return on investment.
A large academic medical center asked TRA to evaluate the costs and benefits of introducing a Safe Patient Handling (SPH) program. The VDERM process allowed TRA to quantify all decisions for implementing the program, including determining its design, justifying costs, and balancing investments in other programs. Traditional valuation methods only cover cost and benefits that have been verified by extensive studies, but by using probabilistic models that give evidence-based insight where uncertainty exists, VDERM adds significant value to the clients’ risk management programs. “We were able to identify that for our client’s SPH program, change in employee turnover is the single biggest driver of uncertainty in program value. For example, suppose that investing $100,000 in communicating the benefits of the SPH program to employees could drive reduction in turnover from a base estimate of 2 percent to a 10 percent reduction. From one of the analytic outputs generated using VDERM, we were able to see that would increase total program value by around $1 million—a 10-to-1 return,” explains Driver.

Advanced Risk Management Strategies: From Patient Care to Making Patients Whole

The team at TRA believes that while it’s essential for healthcare providers to focus on both the upside and downside of risk, it’s also an imperative to provide the best possible patient care and when that care does not meet expectations, to compensate patients and otherwise make them whole. TRA’s aim is to help patients understand their treatment and care by addressing complex medical concerns in a comprehensive, compassionate, and confidential way. “Based on open communication, accountability transparency, and integrity, PEARL (Process for Early Assessment and Resolution of Loss) is our communication and resolution program,” remarks Driver. Rather than waiting for a claim or a lawsuit, TRA proposes engaging patients and families to find an early resolution. PEARL addresses the emotional impact of unanticipated events while reducing overall expenses. PEARL also acts as an alternative approach to medical liability processes while providing insights that trigger corrective actions, safety improvements, and ultimately high quality patient care.

TRA was engaged to solve a complicated case for a client’s hospital, and leveraged PEARL to arrive at a compromising solution. It was a case of medical negligence due to miscommunication between the emergency team, gastroenterology and radiology departments. A pediatric gastroenterologist wrongly inserted a percutaneous gastric tube in a five-month old boy with poor nutritional status and failure to thrive. A reading of the radiological imaging interpreted that the new G tube placement was in the stomach, while in fact the tube was in the colon. It took several hospital visits before the mistake was remedied, resulting in surgical intervention and a longer recovery time.

On behalf of their client, TRA was notified of the misinterpreted radiological read upon its discovery. PEARL was initiated, and as per PEARL protocol, in less than seven days, an internal radiological opinion concluded that the standard of care was not met. A physician member of hospital leadership, along with the PEARL Patient Liaison, met with the family to provide full disclosure and apology, a careful and clear explanation of the complex clinical picture, as well as lessons learned and quality improvement initiatives.

Following that meeting, TRA’s Claims team specialist took over resolution discussions with the family and resolved the claim, informed by TRA’s Decision Analysis Reserve Targeting process (DART). Rather than using guesswork and estimation to establish patient compensation, DART brings consistency and certainty to this ambiguous process by applying decision science and risk management tools to evaluate the uncertainties involved in litigation strategy.
After analyzing the claim through DART and several rounds of negotiation, TRA provided appropriate compensation on behalf of their client, based upon a careful analysis that considered both special and general damages. Through PEARL’s patient-centered approach, which is based upon communication, transparency, justice, and accountability, TRA was successful in reaching a fair resolution for both client and patient.

The Pulse of Healthcare Risk Management

Steered by design thinking, TRA’s risk products have provided benefits to both patients and healthcare providers. Design thinking’s creative approach to problem solving emphasizes the importance of the end user’s needs, and TRA has embraced this focus to develop breakthrough solutions for healthcare risk managers. In addition, TRA has developed a Collaborative for Evidence Based Risk Management that will study, design, and implement evidence-based clinical enterprise risk management systems for the U.S. and U.K.

"We are taking a look into this ocean of data and aiming to separate the grains to sand from the water"

TRA is striving to tackle one of healthcare’s biggest challenges: data collection. Healthcare is inherently a data rich environment, but collecting that information can take years. The greatest challenge is collecting real-time data in a way that is accurate, thorough, and efficient. “There is an undeniable need to get valuable and actionable insights from the data in order to accelerate risk identification in real-time,” says John Littig, Chief Finance and Underwriting Officer of TRA. “We are taking a look into this ocean of data and aiming to separate the grains of sand from the water.”

This coming fall, TRA is rolling out software that will turn this goal into a reality, a program designed by risk managers, for risk managers. Innovence PulseTM is a tool for innovators in the health care space that collects and analyzes empirical data in actual time to monitor results and return on risk investments. The program is built on a foundation of unstructured data sets, including natural language ability and machine learning, and is designed to be used easily and accessibly. “Innovence PulseTM is an on-demand risk management system comprised of a suite of discrete on-line TRA Stanford risk management modules available at the click of a mouse or mobile application,” adds Driver. The initial modules will provide the necessary infrastructure for more advanced modules, which the company will make available to customers over the next few years. In time, the software will grant users the ability to implement and monitor TRA products like PEARL, DART, and VDERM, enabling clients to break into a new, faster, more accurate era of risk management.

Through cutting-edge and innovative solutions, The Risk Authority is dedicated to transforming their client’s risk management practices into powerful assets

“The Risk Authority embraces the change we are all facing in our healthcare system,” says Driver. “It is our goal to help our clients and business partners move through this change; to become more effective and more efficient, and to ultimately improve the health, well-being and lives of the patients and communities we all serve.”

The Risk Authority

Palo Alto, CA

Jeffrey F. Driver, CEO and John Littig, Chief Finance & Underwriting Officer

An innovative healthcare risk consulting firm dedicated to transforming risk management practices with cutting-edge solutions, unrivaled industry expertise and quantifiable results.