In the changing world of Health care it is essential that health care providers adapt to the ongoing changes, viewpoints and tools of other industries, to a more alternative thinking service system that will improve the quality of continuous care throughout the organization. According to Johnson and Sollecito, “ The future of health care is tied directly to improvements in quality and safety and our ability to meet the challenges of adapting new ideas to everyday practices in health care”(2006).

The use of this manual is to help assist new employees to understand the basic concepts of risk and quality management. The aim of this manual is to give a road map for those who will be taking a lead role in health care. As a health care manager it is vital to know some of management roles, functions, and decisions that are very important in the health care system. Managers are expected to know and understand these roles and the basic concepts of Risks and Quality improvements.

The Concept of Risk Management in the Health Care Industry

Before stepping up to the bat cage to take on a manager’s role, you must be equipped with the knowledge of planning, organizing, leading, and controlling. These are four concepts of Risk management, Effective managers have the knowledge to lead they know how these four tools are used to achieve organizational success. Generally we all know and understand risks, we take risk daily. We even do things knowing there can be a risk involved. When we evaluate risks, we also take into consideration the probability of something happening that we do not want, and the consequences if it does. For example: We learned at a young age “for every risk there is a consequence. Were taught that people who steal, the consequence is if caught they will go to jail for theft, in health care this rule still applies. In health care management, Identifying, evaluating, and understanding risks is a very important part of business management. One of the basic concept of understanding risk management is understand that accident do happen, as quoted by many “to Error is human”.

Prevention is the key factor in risks management, when an organization is not appropriately managed the business can suffer from the consequences. As stated earlier Risk management is the process of planning, organizing, leading, and controlling. The key to preventing risk are to avoid any risk possible. Plan a prevention strategy, Organize the what if’s by transferring the responsibility in the event the organization is force to settle from risk related topic or a member of the public is injured on the premises and sues the organization, any financial loss should be transferred to the insurance company. Lead the organization with Risk retention to protect the organization from suffering a loss if an item is not insured by having funds set aside to cover damage or repairs. This can be used whether the risk is intentionally or unintentionally. Control by following policies, standards, and procedures to avoid, or eliminating adverse risks the organization may face.

Quality Improvement

What is Quality Improvement? According to Health Resources and Services Administration (HRSA), Quality improvement (QI) consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. The Agency for Healthcare Research and Quality (Ahrq), states that the U.S. Department of Health and Human Services ensures organizations to make health care safer, with higher quality, and to be more accessible, equitable, and affordable (n.d).

Johnson and Sollecito states that, “Quality improvement involves designing and redesigning systems to meet customers’ needs by testing and implementing ideas from evidence-based strategies, frontline staff, and customers” (2006). The goal to Quality Management is to ensure that products and service meet the customer’s satisfaction. Ross states, Quality is defined as a measure of degree in which goods or service meets establish standards that satisfies the customer. (2016) Quality is judge by two groups; customer satisfaction is the main key factor. The customer should always feel that got their money’s worth without risk or they will take their business elsewhere. Product and service is another key factor, people expect scholar service to be deliver from any business. They can purchase the same product from a different supplier. The Delivery of exceptional customer service is to always make the customer feel important and respected.

Continuous Quality Improvements

Continuous Quality Improvements uses quantitative and qualitative methods to collect data which is helpful in Quality Improvement efforts. Quantitative methods involve the use of numbers and frequencies that result in measurable data. This information is easy to analyze statistic and is helpful to health care professionals. Both methods helps improve effectiveness, efficiency, and safety of service delivery processes and systems, as well as the performance of human resources to deliver products and services (2016).

One of the most significant factors are state by Agency for Health Care Research and Quality (AHRQ) are the following six aims for the health care system, as the six domains of Health Care Quality which includes Safety, Effective, Patient-Centered, Timely, Efficient, and Equitable. Safety is to avoid harm to any patients from the care that is intended to help them. Effectiveness is to provide services based on scientific knowledge that can benefit the individual from underuse and misuse services (n.d). Patient Centered, is to provide care based on patient preferences, needs, and values that ensures the patients values are respected in all clinical decisions. Timeliness reduces wait time that can harmful to the individual due to delays in treatment. Effectiveness, avoids any waste including equipment, supplies, ideas, and energy. Equitable, when care is given “that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status” (n.d).

The Purpose of Risk Management in Healthcare

In the health care industry risk managers are trained to handle multiple issues. As a risk manager you may face issues with handling financing, insurance claims, incident reports, clinical issues, and behavioral health issues, as well as emergency preparedness.

Healthcare managers evaluate risks to reduce injury to staff, their patients, and visitors within the organization. According to “The University of ”, “Risk managers work proactively and reactively to either prevent incident or to minimize the damages following an event” (2007-2016).

Risk management, goes hand and hand with risk assessments, managers should be knowledgeable of any possible health hazard within the organization. Managers must be able to identify hazards and respond to resolve them quickly, to successfully complete a good risk assessment. Information need to be gathered and analyze, collection of need data should be obtained such as who, what, where. For example: The maintenance person spilled a toxic chemical on the lobby floor full of patients. During the risk assessment the manager needs to know who was in the lobby, what the name of chemical was spilt, and was there any one affected by the chemical, if there was, what steps were taken.

This information is important to the organization and the individuals that may have been affected. Risk managers may also face challenges that should be addressed in a risk assessment plan that include Patient safety, Potential medical errors, Mandatory federal regulations, Legislation, and Existing and future policy that impact the field of healthcare.

“The ” states, “The hazards of not preparing for potential issues can have significant, long-term effects. Neglecting to have comprehensive risk management plans in place can compromise patient care, increase liability risks, and result in financial losses” (2007-2016). A more reliable and sustainable method of improvement would be to use Plan-Do-Study-Act (PDSA) rapid cycle improvements to test many interventions and fully address any issues (Steven. K, ppt). Plan-Do Study-Act (PDSA) cycles, process map, fishbone diagram, and control charts (2006).

Challenges in making risk- and quality-management decisions

Currently in the health care system the advancement in information technology (IT), are a big foundation for both breakthrough in technology and challenges. Telemedicine and the implementation of Electronic Health Records (EHR), Johnson, J. K., & Sollecito state they offer major benefits to quality improvement, especially in measurement, through ensuring consistency and transportability of data. They go on by stating that the challenges at hand need to be overcome as well. Given an example, “we currently face the dilemma of EHR systems that cannot communicate with each other; it is by recognizing this issue and the benefits of fluency that this challenge is being addressed” (2006). In any business new implementation can be risky when it comes to change. Change comes from trying new ideas, if we do not allow change to take place we fail at the hand of fear. A culture of change must be encouraged to be successful (Steven. K, ppt). In order to succeed we must embrace change to overcome our barriers of fears in order to be ready for change, and be able to continue to take on the challenges that come with change. Healthcare is always changing and implementing new systems. There will always be challenges and barriers to overcome in this industry.


This manual is designed to help new managers in the health care management field to understand risk management and the basic concept of quality managements. What challenges and topic risk managers may face in an organization, and the tools need to be successful.

This manual also elaborates on the meaning of Quality improvements and Continuous Quality Improvements efforts, and the purpose of risk management in health care, and prevention. In the amazing world of the health care system, managers should always be ready for changes. With change comes fear risk and challenges. Being prepared with the proper tools need to handle these objectives in the health care industry, can make all the difference in being a successful Manager.

University of Phoenix Material

Risk and Quality Management Tools Matrix

Risk or Quality Management Tool Purpose Advantages Disadvantages
Data Organizations rely on data and collected information to guide their risk- and quality-management decision making. Qualitative and quantitative data can be use The actual performances and goals in collecting data are based solely on facts, not on ones beliefs, conceptions, or executive directives. Specific tools be used for analysis and decision making under analyze key risk- and quality-management tools in the health care industry The likelihood of success with this intervention is low. Measurement is not intended to be used for selection, reward, or punishment
Change In Ideas After selecting the data of change. Change comes from trying new ideas. Culture of change should be encouraged to be successful. New changes should be aimed at short and long term goals. The reliable and sustainable method of improvement in change would be to use Plan-Do-Study-Act (PDSA) for faster cycle of improvements that can test many interventions to fully address the issues. Health care staffs fear of change.
Change In Testing For validation which is needed daily for testing to improve any changes made. Test frequently and on a small scale to learn quickly. Then validate with daily/weekly tests or tracking of for satisfaction scores. A longer process to learn, but does not take long to learn what does not work. One must allow failure to development new ideas. Because the optimal process is not known beforehand.
Implementation Implementing is just following a plan or orders while testing a change Implementation of new technology can has been successful with EHR. This service can continue improving organizations workflows that achieve the individual practice’s In any business new implementation can be risky when it comes to change
Spread To be proven on a small scale before wider testing. Successful quality improvement personnel should not be afraid to fail early and fail small During implementation a widespread change that does not work can harm business operations
People Surveys: to ask people questions in order to gather information about what they think about something Benchmarking: to evaluate or check information by comparison with what is standard  


Agency for health care research and quality. (n.d). Retrieved from https://cahps.ahrq.gov/consumer-reporting/talkingquality/create/sixdomains.html

Ross, Thomas K. Health Care Quality Management. Somerset, US: Jossey-Bass, 2013. ProQuest ebrary. Web. 11 April 2016.

U.S. Department of Health and Human Services. (n.d). Retrieved from http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/index.html

The University of Scranton. (2007-2016). Retrieved from http://elearning.scranton.edu/resource/business-leadership/purpose-of-risk-management-in-healthcare

Johnson, J. K., & Sollecito, W. A. (2006). McLaughlin and Kaluzny’s Continuous Quality Improvement in Health Care (4th ed.). Retrieved from https://phoenix.vitalsource.com/#/books/9781449679606/cfi/10/18!/4/2/26/4/2/32/2@0:0.

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