1. Introduction
What is the goal or the idea behind risk management one of their focus is to reduce the financial risk other areas that may seem not important is the regulation. One of the principal issues facing health care risk management is governmental regulation. Over the last few decades, there has been a growing public demand for accountability in health care delivery. The consequent tightening of governmental regulation has led to a greater allocation of an organization's resources to regulatory compliance. Some states, including New York, enacted stringent incident reporting requirements for hospitals, requiring additional staff to investigate and prepare such reports. Additionally, competition among hospitals has also fostered a greater concern over the community's perception of quality of care. Many hospitals have had to compete harder for patients as inpatient lengths of stay decrease and more procedures are performed on an outpatient basis. Risk management in the health care

In the past risk management and quality improvement job was separate in the health care organization. Even though, the job function may have been different the goal was the same. Managing risks is the quality of services provided & the safety of patients, their careers & visitors. To manage risks to staff & subsequent risks to service quality. To manage risk of failing to meet national & local priority targets to manage risks to the efficiency of services. To manage risks to the reputation of the hospital Risk management aims to identify the major sources of risks to hospital, staff & visitors. Develop regular statistical & qualitative risk management reports Establish mechanisms to maintain & develop structures & processes for a cohesive approach to the management of clinical & non clinical risk. Conduct operational reviews of departments to identify deficiencies & potential areas for improvement. Risk management plan aims Recognition & acknowledgement of risks to patient safety & medical/health errors with a focus on improving processes & systems. Initiation of actions that reduce these risks Reporting the findings & action taken to improve processes & systems. Minimizing of individual blame or retribution for involvement in a medical health care errors. Organizational learning about medical health care errors. Sharing of acknowledgment to effect behavioral changes to minimize risk to patients. Risk management objectives
There have been a great confusion among health care professional, about the deference’s between patient safety and risk management. Patient safety is one of the most important aspect in the healthcare environment. Keeping patient safe is one the issue doctors, nurses, and every other healthcare professionals worried about every day. When it comes to errors it is one thing that make executive not been able to go sleep at night. According to the Institute of Medicine the issue of medical error is recognized as a very serious U.S. healthcare concern in terms of avoidable patient death and injury, achieving efficacious treatment, and in controlling the costs. The prevention of medical errors may seem to be a relatively simple task and with recent awareness, some improvements have been accomplished. However, the search for reasonable, acceptable, and more effective remedies and countermeasures continue with force. Attention to medical errors escalated over eight years ago with the release of a study from the Institute of Medicine (IOM), To Err is Human, which found that between 44,000 and 98,000 Americans die each year in U.S. hospitals due to preventable medical errors. Hospital errors rank between the fifth and eighth leading cause of death, killing more Americans than breast cancer, traffic accidents, or AIDS. Serious medication errors occur in the cases of 5 to 10 percent of patients admitted to hospitals. These numbers may understate the problem because they do not include preventable deaths due to medical treatments outside of hospitals. (Kohn, Corrigan & Donaldson, 1999).Now the question is who will take charge or fight to reduce the possibility that error are reduce to a bare minimum. There are not one answered everyone should be involve started with the patients, physicians, nursing, and so on. All of these people or professional are responsible to make sure patients has the safest environment possible.the health care system has the duty to implement the best practice and also save money that is the benchmarking of management.
Integrating Risk Management, Quality Management, and Patient Safety into the Organization.
An integrated framework is needed that can operate across the entire spectrum of health care from local to national, and a full range of administrative arrangements. Such a framework, integrating safety, quality and risk management, is presented in It includes the conventional medical record and ancillary information about patients, investigations and procedures, a system for logging, managing and monitoring progress when things go wrong, a data repository for collating information from all available sources, and a risk management framework underpinning both proactive and reactive responses. Central to this is a comprehensive universal classification supported by a system for eliciting, capturing, classifying, and analyzing the information needed to improve the safety and quality of health care. Safety is just one of the dimensions of the quality of health care, with access, timeliness, efficacy, efficiency, appropriateness and acceptability. Safety cannot be considered in isolation as resources spent on safety cannot be spent on other aspects of quality. Although some of the activities and information sources in are useful for some of the other aspects of quality, the discussion in this paper will be directed towards safety and things that go wrong.
We have previously identified the need for “an international patient safety reference group to align terminology, tools and classification systems and to promote the rapid dissemination of strategies that prove to be successful “Also needed is the ability to aggregate large amounts of information and compare patterns and trends over time and between individuals, organizations and countries, so that detailed pictures can be obtained of the individually rare but collectively important problems that make up the bulk of the things that go wrong. A platform from which to do this was established with the launch of the World Alliance for Patient Safety in October 2004. Two of its six early initiatives are relevant to this paper, “Developing a patient safety taxonomy” and “Reporting and learning to improve patient safety while it is essential for a classification and reporting and learning systems to be able to stand alone and function locally, we will propose here that the future lies in an integrated approach. Such an approach is shown in the salient features of this figure are referred to below in bold text. Each of these represents an important activity but, as discussion about most is beyond the scope of this paper, a few key references have been provided

Benchmarking in Risk Management
Over the last few years, increasing attention has been directed toward the problems inherent to measuring the quality of healthcare and implementing benchmarking strategies. Besides offering accreditation and certification processes, recent approaches measure the performance of healthcare institutions in order to evaluate their effectiveness, defined as the capacity to provide treatment that modifies and improves the patient’s state of health. This paper, dealing with hospital effectiveness, focuses on research methods for effectiveness analyses within a strategy comparing different healthcare institutions. The paper, after having introduced readers to the principle debates on benchmarking strategies, which depend on the perspective and type of indicators used, focuses on the methodological problems related to performing consistent benchmarking analyses. Particularly, statistical methods suitable for controlling case-mix, analyzing aggregate data, rare events, and continuous outcomes measured with error are examined. Specific challenges of benchmarking strategies, such as the risk of risk adjustment (case-mix fallacy, underreporting, and risk of comparing noncom parable hospitals), selection bias, and possible strategies for the development of consistent benchmarking analyses, are discussed. Finally, to demonstrate the feasibility of the illustrated benchmarking strategies, an application focused on determining regional benchmarks for patient satisfaction (using 2009 Lombardy Region Patient Satisfaction Questionnaire is proposed. Over the last few years, increasing attention has been directed toward the problems inherent to measuring the quality of healthcare. Accreditation and certification procedures have acted as stimulating mechanisms for the discovery of skills and technology specifically designed to improve performance. Total Quality Management and Continuous Quality Improvement are the most widespread and recent approaches to implementing and improving healthcare quality control. Besides offering accreditation and certification processes, recent approaches measure the performance of health structures in order to evaluate National Health Systems. For example, various international Agencies measure the performance of health structures in different countries, considering three main dimensions: effectiveness, efficiency, and customer satisfaction. In this perspective, performance measurement for healthcare providers, structures, or organizations is becoming increasingly important for the improvement of healthcare quality. However, the debate over which types of performance indicator are the most useful for monitoring healthcare quality remains a question of international concern. In a classic formulation, asserted that quality of care includes structure (characteristics of the resources in the healthcare system, including organization and system of care, accessibility of services, licensure, physical attributes, safety and policies procedures, viewed as the capacity to provide high quality care, process measures related to evaluating the process of care, including the management of disease, the existence of preventive care such as screening for disease, accuracy of diagnosis, the appropriateness of therapy, complications, and interpersonal aspects of care, such as service, timeliness, and coordination of care across settings and professional disciplines), and clinical outcomes. A clinical outcome is defined as the “technical result of a diagnostic procedure or specific treatment episode” “result, often long term, on the state of patient well-being, generated by the delivery of a health service”.Specifically, ongoing attention has been placed on the importance of combining structural aspects with measures of outcomes to assess the quality of care. This consideration was taken into account by the Institute of Medicine, which, in 1990, stated that “quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge”. The objectives are to better understand the concept and its evolution in the healthcare sector, to propose an operational definition, and to describe some French and international experiences of benchmarking in the healthcare sector. To this end, we reviewed the literature on this approach's emergence in the industrial sector, its evolution, its fields of application and examples of how it has been used in the healthcare sector. Benchmarking is often thought to consist simply of comparing indicators and is not perceived in its entirety, that is, as a tool based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices. The key feature of benchmarking is its integration within a comprehensive and participatory policy of continuous quality improvement (CQI). Conditions for successful benchmarking focus essentially on careful preparation of the process, monitoring of the relevant indicators, staff involvement and inter organizational visits (Ettorchi-Tardy, Levif & Michel, 2012). Risk Management Strategic Planning for a Changing Health Care Delivery System

Most of us know that planning is a way of looking toward the future and deciding what the organization will do in the future. Strategic planning is a disciplined effort to produce decisions and actions that guide and shape what the organization is, what it does, and why it does it (Bryson, 1995). Both strategic planning and long range planning cover several years. However, strategic planning requires the organization to examine what it is and the environment in which it is working. Strategic planning also helps the organization to focus its attention on the crucial issues and challenges. It, therefore, helps the organization's leaders decide what to do about those issues and challenges. Each organization needs to decide for itself when the time is right for a strategic plan. It is sometimes easier to describe when the time is not right than when it is. For example, when the roof has blown off the building, an organization should replace it, not start strategic planning. The organization should get its crisis resolved, preferably by acting strategically, and then begin planning. Something less than a "roof-blown-off" crisis, however, usually prompts organizations to begin strategic planning. Some organizations find the loss of a significant funding source or, conversely, the opportunity to obtain a new source of funds, an impetus to plan. Other organizations recognize that their clients are changing and, therefore, they ought to prepare for these changes. And so on. There are as many reasons for starting a strategic planning process as there are profit and nonprofit organizations. What is risk management any way not everyone has the same meaning. It can be define as such Risk management is a process for identifying, assessing, and prioritizing risks of different kinds. Once the risks are identified, the risk manager will create a plan to minimize or eliminate the impact of negative events. A variety of strategies is available, depending on the type of risk and the type of business. There are a number of risk management standards, including those developed by the Project Management Institute, the International Organization for Standardization. Some may ask what does that mean, what is the purpose of risk management. The purpose for risk management was to protected people, and companies for example health care organization from losses that was associated with accident. There were many different type of risks for example, unexpected death, a doctor fail to diagnose or treat a disease, surgical mistake. Most of those were type of risk management had to deal with in the health care organization.
Using Never Events to Reduce Risk and Advance Patient Safety
While it is believed that having reliable information about the occurrence of the most egregious health care errors that cause patient harm will lead to improvements in patient safety, the primary reason for identifying a standardized set of serious reportable events that would be reported on a mandatory basis was to facilitate public accountability for the occurrence of these adverse events in the delivery of health care. Originally, the intention of developing a consensus list of reportable events was to create the core of a national State-based event reporting system that would increase the public accountability of health care. For purposes of this project, public accountability was considered to be the obligation or duty of specific individuals and/or institutions to make information about their actions or performance available to the public or a public agency that has responsibility for oversight and is answerable to the general public. Reporting in this context is a different matter than whether or how the reported information might be disclosed to the public after being reported to the responsible agency. Reporting and disclosure are often misunderstood as being the same. The public expects health care providers to take all appropriate measures to ensure that care is safe, and the public looks to government and other oversight bodies to make sure that such actions are taken. The occurrence of a serious preventable adverse event in health care operating on the wrong patient or wrong body part or transfusing the wrong type of blood into a patient suggests that a flaw exists in the health care organization's efforts to safeguard patients. It is reasonable for the public to expect an oversight body to investigate such occurrences. In many ways, this is analogous to the reporting of airplane crashes, train derailments, and school bus or tractor-trailer truck crashes. When these types of events occur, the public expects that they will be reported to a responsible transportation oversight agency, investigated, and steps taken to eliminate or remedy whatever caused the event to prevent such occurrences from happening in the future. These serious reportable events are health care's equivalent of airplane or other public-transportation crashes. Accountability entails both an obligation of health care providers to report on their performance and of oversight bodies to investigate specified occurrences and to enforce compliance with accepted standards of care for ensuring safety. Both parties have a responsibility to use the information to improve public safety. Having a standardized set of reportable adverse events should facilitate fulfillment of this obligation. What is the goal or the idea behind risk management one of their focus is to reduce the financial risk other areas that may seem not important is the regulation. One of the principal issues facing health care risk management is governmental regulation. Over the last few decades, there has been a growing public demand for accountability in health care delivery. The consequent tightening of governmental regulation has led to a greater allocation of an organization's resources to regulatory compliance. Some states, including New York, enacted stringent incident reporting requirements for hospitals, requiring additional staff to investigate and prepare such reports. Additionally, competition among hospitals has also fostered a greater concern over the community's perception of quality of care. Many hospitals have had to compete harder for patients as inpatient lengths of stay decrease and more procedures are performed on an outpatient basis. (Challan, 1992).
Governance and Board Responsibility to Assure Safety in Health Care Organizations
To understand the complexities of governance in healthcare organizations, one needs to be aware of the changes that are currently taking place in the healthcare industry. Pointer and Orlikoff, in their book Board Work: Governing Health Care Organizations, wrote that providing and financing healthcare services are going through a revolutionary change driven by healthcare customers and purchasers who they are, how they want to pay, and what they are demanding. Managed care has become a central philosophy for the healthcare services delivery in the United States. In response, healthcare organizations are undertaking proportionate transformations to survive. The organizations are beginning to shift focus from process to outcome and significantly redesign the services they provide. Vertically and horizontally integrated healthcare organizations, capable of providing a full range of services, are being created. The transformation processes affect the organizations' vision, missions, goals, strategies, structure, and key competencies and capacities. Regardless of the exact design healthcare organizations assume to address these revolutionary changes, the quality of their governance has become a necessity to them numerous practitioner-oriented publications have expressed concern that the contributions and performance of many healthcare boards are less than optimal. According to Anthony and Young, in many nonprofit organizations the line of leadership responsibility is f unclear. Unlike for-profit organizations, nonprofit groups have no shareholders, trustees are seldom paid for their services, and trustees often are appointed for financial or political reasons rather than their capability to exercise sound judgment regarding the organization's management. In some institutions, a widely quoted maxim states that the purpose of a board is only to hire a president and then support him or her. Furthermore, performance of some healthcare boards has been under severe strain; disputes over the quality of governance are increasingly overflowing from board rooms into courtrooms. Peregrine and Schwartz noted that allegations of breach of fiduciary duty were at the core of the state attorney general challenges to proposed closures of several hospitals in New York City and West Palm Beach. “Board negligence is frequently alleged in 'imprudent investment' actions brought by attorney generals against failed nonprofit investment practices” (p. 23). Kazemek, Knecht, and Westfall stated that in many of the cases where high-profile health systems and hospitals have been on to the boards of trustees exercise considerable power. They can audit the performance of an organization, hire and fire executives, and make major strategic decisions. If the potential power of the board is misused or not used at all, the trustees do not contribute to organizational effectiveness and, therefore, do not serve the stakeholders. The board's membership composition is a critical determinant of the types of power a board will have and how the board will exercise that power. Research has suggested three types of power that are particularly pertinent with respect to boards: personal, expert, and position. Personal power is based on the personality of the individual; it is independent of an individual's formal position or authority. Expert power is based on the individual's knowledge and information. Position power is based on the individual's formal position and is usually spelled out in the organization's bylaws and operating procedures. A number of studies have indicated that trustees' power, particularly the readiness to use that power, is strongly associated with the positions held beyond their board participation. Specifically, outside directors with no business ties to the organization or its executives are more willing to exercise their power than inside directors, particularly discussing matters that involve questioning the performance and challenging the decisions of senior management. Therefore, at present, boards prefer to appoint outsiders independent of the CEO and other senior management.
Carver and Carver stated that the board speaks authoritatively only when it passes a formal motion at a properly constituted meeting. Any other statements by individual board members have no authority. The board speaks exclusively with one voice. In other words, the one voice principle helps to distinguish what the board has said from what it has not said. This principle requires all board members to respect board decisions. Furthermore, board decisions can be changed only by the board and never by individual board members. Hence, board practices must demonstrate that the board, not individual trustees, has authority. As governance scholar Howe suggested, the board of a nonprofit organization is responsible for the effectiveness and welfare of the whole organization; therefore, the board must ensure strategic planning. It is advantageous for boards to create a standing or ad hoc committee to make plans for planning. In other words, this committee is to make recommendations on how, when, and where planning should take place. The executive staff members often play a pivotal role making sure that the planning team has all necessary information and ultimately implementing the plan. As the result of the strategic planning process, the planning team devises a modification or reaffirmation of the mission statement and the vision that will drive the system or hospital. Kazemek et al. (5) stated that this type of strategic thinking involves a complete analysis of the current state of affairs as well as understanding of all the available options and the likely ramifications of various strategies’ verge of financial collapse or declared bankruptcy, their boards were major contributors to their problems.

Now whenever there are no constant change things will remain as business as usual. Good change will require people to be flexible able to adopt with new ideas especially with new technology. Delivery of safe, effective, patient-centered, timely, efficient, and equitable care in a contemporary health care setting requires successful strategic integration of the various departments, programs, and procedures of the particular health care system. To achieve this goal in any health care system, the evaluation of the health system must take place. Evaluating the health care system can bring about needed change that can benefit the system while increasing the effectiveness of health care delivery for the patient, institution, and community. Evaluating health care systems includes analyzing the degrees of effectiveness, efficiency, and equity the system provides (Aday, Begley, Lairson, & Balkrishnan, 2004). Effectiveness describes the improvement of health in patients or populations the health care system serves. Administrative procedures, risk management programs, and epidemiological focuses contribute to the total system effectiveness. Efficiency depends on the health system’s available resources and the methods by which the resources are put to use. In the health care economist’s view, health care is the output attainable by production and allocative efficiency (Aday et al., 2004). Optimum production and allocative efficiency is present when strong administrative policies and procedures, practical risk management programs, and ongoing quality improvement measures and evaluations are in place. In addition, marketing functions are important in attracting patients to receive the products and services the system has to offer from production. Attending to the concerns that can make a health care system better for the population it serves can help make the system more viable in the market by producing satisfied and possibly, healthier patients. Equity involves the degree to which health disparities exist and the methods by which the health system addresses the disparities. One of the entities risk manager have to deal with on a day-today bases is Joint Commission is an essential part of a hospital process. It is the accredited organization in the United States that define risk management in the health care organization. Their responsibly is the administrative activities that deal with evaluation, and reduce the injury a patients, staff, and visitors in the health care organization. In every hospital a surgery has a potential for an undesirable outcome. Sometime a risk manager may have all kind of medical preventions things will happen. With a little bit of common sense can prevent bad result of accident, for example a slippery floor in a high traffic area can an accident.
Now after a potential even like that is there a plan that is designed or implement to avoid any risk. Some people may think that just because a company has a risk management in place, that they have the recipes. Healthcare risk managers have an important role to play in helping their organizations achieve the goal of “Getting to Zero “serious safety events. But no amount of effort will bring us closer to zero if the hard work of risk managers is wasted on interventions that are not effective. And, as with the discipline of healthcare quality improvement, and patient safety more broadly, the status quo for healthcare risk management is that we simply don’t know enough about what works and what doesn’t. (Youngberg, 2011) sometime a good plan from the risk manager may prevent many things on the hand other may been created also, for example the introduction to electronic medical record. Provider who were not afraid to technology did not know what to say, because this technology made their job easier. Now on the hand risk managers did not know what plan to put together who to call, because there were so much invasion to patient privacy it was out of control. Privacy is a fairly complex idea, particularly when you mix in advertising-supported media as it has developed in the past 50 years. The purpose of advertising is to make consumers aware of products and services. At its best, advertising supplies needed information to solve problems people actually have. At its worst, it is used to create demand by inventing a problem and providing a solution. In any case, we've grown to accept advertising as the cost of receiving free television and radio or discounted newspapers and magazines. (Zelnick, 1999). Risk managers could not have been happier with the creation of Health Insurance Portability and Accountability Act. That was created for people to have access to quality health care coverage (like the Obama care), and also to protected the privacy of patient information in the health organization. Inclusion every day risk managers make decision, that impact patients and their families. A single error can cause a damage that is irreversible to patient life. If that was not enough to deal with they have to deal with the risk of health information security breaches, privacy violation, and noncompliance internal fraud. Risk management in its purest form is typically a hybrid function bridging a number of disciplines to reduce the incidence of organizational loss. Activities can be proactive, attempting to prevent or mitigate a loss or reactive – in other words, damage control. I’m confident that most healthcare organizations would agree that they have a risk management program, but is it proactive or reactive? Proactive risk management may avoid some losses and expenses that could otherwise impact your bottom line. Now in the end what is the government role when it come Legislative and Regulatory Issues Impacting Risk Management and Patient Safety. Compliance risk management is critical to the success of regulatory compliance operations. A robust risk management program allows health care organizations to identify weaknesses in internal controls and systems, and minimize financial and other losses by reducing exposure to potential overpayments, civil or criminal penalties, and administrative sanctions, such as program exclusions. Strategic Management’s strong team of experts have assisted hundreds of organizations with regulatory compliance and program integrity advisory services, such as assessing and evaluating compliance with high-risk areas. The focus of Strategic Management’s Risk Management services is on regulatory compliance risks and areas that may give rise to potential liability. The objective is always to integrate compliance risk management into the overall business strategy of the organization. Compliance risk management is a continuous, dynamic process of gathering, analyzing and updating information to ensure ongoing compliance with government rules and regulations. Compliance risk management begins with identifying, analyzing, and prioritizing regulatory risks associated with the daily operations, and continues with the implementation, monitoring, auditing, and routine reporting of control strategies.