Risk Management Advice Research Articles

RM Matters/Workers’ Compensation: Quick Reporting Required With Employee Injuries

Click to increase image sizeClick to decrease image size Additional informationNotes on contributors TDIC’s Risk Management Advice Line is a benefit of CDA membership. If you need to schedule a no-cost consultation with an experienced Risk Management analyst, visit tdicinsurance.com/RMconsult or call 800.733.0633.

RM Matters/Wheelchair to Dental Chair: Safe and Smooth Patient Transfers

"RM Matters/Wheelchair to Dental Chair: Safe and Smooth Patient Transfers." Journal of the California Dental Association, 48(3), pp. 163–164 Additional informationNotes on contributors TDIC’s Risk Management Advice Line is a benefit of CDA membership. If you need to schedule a no-cost consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 800.733.0633.

RM Matters/Keeping Office Payments Safe and Secure

"RM Matters/Keeping Office Payments Safe and Secure." Journal of the California Dental Association, 48(2), pp. 89–90 Additional informationNotes on contributors TDIC’s Risk Management Advice Line is a benefit of CDA membership. If you need to schedule a no-cost consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 800.733.0633.

RM Matters/Working From Home? Considerations for Telecommuting

"RM Matters/Working From Home? Considerations for Telecommuting." Journal of the California Dental Association, 48(1), pp. 37–38 Additional informationNotes on contributors TDIC’s Risk Management Advice Line is a benefit of CDA membership. If you need to schedule a no-cost consultation with an experienced risk management analyst, visit tdicinsurance.com/RMconsult or call 800.733.0633.

What’s the lender liability risk for soil pollution in the People’s Republic of China? An evaluation of China’s new Soil Pollution and Control Law in the light of the USA and UK regimes

On 1 January 2019, following a presidential order confirming its adoption by the Fifth Session of the Standing Committee of the 13th National People’s Congress of the People’s Republic of China (PRC), the Law of the People’s Republic of China on Soil Pollution and Control 2019 (SPC) was introduced into law. Succinctly, the SPC was enacted to deal with the vast amount of soil pollution that currently exists in China. This article’s central thesis is that, following a comparative analysis of the regulatory regimes in the USA and UK, the law creates environment-related risks for lenders. In particular, the article is concerned with the risk of lender liability, that is, where the lender itself is made directly liable for the costs of soil pollution remediation. In light of the USA and UK regimes, risk management advice is provided for obviating any prospective lender liability that may be forthcoming from the SPC. As with the regulations in other countries, it appears that the degree of ‘control’ that lenders exercise over their clients must be limited to mitigate the possible transference of any direct liability under the PRC’s principles of property rights law.

A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study

BackgroundNHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40–74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients’ responses.MethodsRIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12–18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources).DiscussionThis study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed.Trial registrationISRCTN ISRCTN10443908. Registered 7th February 2017.

Mycotoxin co-exposures in infants and young children consuming household- and industrially-processed complementary foods in Nigeria and risk management advice

This study compared mycotoxin levels in 53 household-formulated and 84 industrially-processed complementary foods, assessed co-exposure patterns from consumption of the contaminated foods by infants and young children (IYC) in two Nigerian states, and evaluated the influence of awareness and adopted processing practices at the household levels on toxin levels in the foods. About 42 and 93% of the industrial- and household-processed foods, respectively, were contaminated by mycotoxins. Aflatoxins, alternariol, citrinin and dihydrocitrinone levels were significantly higher in household-formulated foods while fumonisins were similarly higher in the industrially-processed foods. Of the household-formulated items, Tom bran contained higher aflatoxin levels leading to higher exposure (median: 641 ng/kg bw per day) and health risk (β-coefficient: 51.4; p = 0.01) in the IYC. Family cereal and ogi contained the highest levels of fumonisins in the industrial and household food categories, respectively, with the highest exposure estimated for IYC who consumed family cereal (median: 18 μg/kg bw per day). Aflatoxin exposures were higher in children aged 12–24 months compared to those below 12 months of age. About 69 and 75% of IYC who consumed family cereal and Tom bran, respectively, were co-exposed to mycotoxins resulting in commensurate risks of co-exposures. Overall, 47% of the IYC were co-exposed to 2–4 mycotoxins (aflatoxins, citrinin, fumonisins and ochratoxin A) with eight different co-exposure combinations. Only 33% of the respondents were aware of mycotoxins. Length of grain storage influenced food aflatoxin levels. Adequate risk management advice to concerned stakeholders for mycotoxin control in complementary foods in Nigeria is offered herein.

Do advisors perceive climate change as an agricultural risk? An in-depth examination of Midwestern U.S. Ag advisors’ views on drought, climate change, and risk management

Through the lens of the Health Belief Model and Protection Motivation Theory, we analyzed interviews of 36 agricultural advisors in Indiana and Nebraska to understand their appraisals of climate change risk, related decision making processes and subsequent risk management advice to producers. Most advisors interviewed accept that weather events are a risk for US Midwestern agriculture; however, they are more concerned about tangible threats such as crop prices. There is not much concern about climate change among agricultural advisors. Management practices that could help producers adapt to climate change were more likely to be recommended by conservation and Extension advisors, while financial and crop advisors focused more upon season-to-season decision making (e.g., hybrid seeds and crop insurance). We contend that the agricultural community should integrate long-term thinking as part of farm decision making processes and that agricultural advisors are in a prime position to influence producers. In the face of increasing extreme weather events, climatologists and advisors should work more closely to reach a shared understanding of the risks posed to agriculture by climate change.

IPrevent®: a tailored, web-based, decision support tool for breast cancer risk assessment and management.

We aimed to develop a user-centered, web-based, decision support tool for breast cancer risk assessment and personalized risk management. Using a novel model choice algorithm, iPrevent® selects one of two validated breast cancer risk estimation models (IBIS or BOADICEA), based on risk factor data entered by the user. Resulting risk estimates are presented in simple language and graphic formats for easy comprehension. iPrevent® then presents risk-adapted, evidence-based, guideline-endorsed management options. Development was an iterative process with regular feedback from multidisciplinary experts and consumers. To verify iPrevent®, risk factor data for 127 cases derived from the Australian Breast Cancer Family Study were entered into iPrevent®, IBIS (v7.02), and BOADICEA (v3.0). Consistency of the model chosen by iPrevent® (i.e., IBIS or BOADICEA) with the programmed iPrevent® model choice algorithm was assessed. Estimated breast cancer risks from iPrevent® were compared with those attained directly from the chosen risk assessment model (IBIS or BOADICEA). Risk management interventions displayed by iPrevent® were assessed for appropriateness. Risk estimation model choice was 100 % consistent with the programmed iPrevent® logic. Discrepant 10-year and residual lifetime risk estimates of >1 % were found for 1 and 4 cases, respectively, none was clinically significant (maximal variation 1.4 %). Risk management interventions suggested by iPrevent® were 100 % appropriate. iPrevent® successfully integrates the IBIS and BOADICEA risk assessment models into a decision support tool that provides evidence-based, risk-adapted risk management advice. This may help to facilitate precision breast cancer prevention discussions between women and their healthcare providers.Electronic supplementary materialThe online version of this article (doi:10.1007/s10549-016-3726-y) contains supplementary material, which is available to authorized users.

Biography, pandemic time and risk: Pregnant women reflecting on their experiences of the 2009 influenza pandemic

During the 2009 H1N1 pandemic, it was identified that women in the third trimester of pregnancy were particularly at risk of serious respiratory distress. At-risk women were advised to seek vaccination, avoid contact with anyone unwell, maintain hygiene routines and stop smoking. We examine this situation of emergent and intense risk produced at the intersection of individual biography and the historical event of a public health emergency. We examine how pregnant women took account of risk, how they negotiated incomplete and at times contradictory advice and shaped courses of action that assisted them to manage the emerging terrain of pandemic threat. Public health risk management advice was endorsed, although choosing vaccination was fraught. Social distancing, too, was seen as a valuable risk moderation strategy. However, time, and specifically the intersection of individual pregnancy timelines with the pandemic's timeline, was also seen as an important risk management resource. The implications of this mix of sanctioned and temporal risk management practices are discussed.

Clinical management of women in BRCAX families: issues and controversies

The role of the familial cancer clinic (FCC) is to provide a cancer risk assessment and appropriate cancer risk management advice, but there are certain groups of patients for whom there are no standard risk management guidelines. One such group is women with a strong family history of breast cancer but BRCA genetic testing has not found a germline mutation. As a family history of breast cancer is the commonest reason for referral to FCCs, this clinical scenario is a frequent challenge to us all. This presentation will provide a summary of the literature surrounding: • Breast cancer risk in BRCAX families • Ovarian cancer risk in BRCAX families • Does the presence of male breast cancer affect the breast and ovarian cancer risks for women in BRCAX families

Apology and Disclosure

Program Description: Following errors and adverse events, the traditional legal and risk management advice to physicians has been to refrain from any disclosure or apology which might be used against the physician legally. Other factors which may inhibit disclosure and apology include a medical culture of perfection and a lack of experience with effective communication techniques. An increasing body of work has shown that the traditional technique of stonewalling is naturally infuriating to patients and is much more likely to lead to lawsuits. In addition, it places physicians in an intolerable position, since the natural human impulse of the caregiver is to apologize for mistakes and then to do everything possible to make things right. A number of non-profit organizations and a few forward-thinking malpractice carriers and institutions are now encouraging prompt, honest disclosure of adverse events, and apology when a genuine error has occurred. Experience to date has been that this more honest process is tremendously relieving to patients and physicians, and that malpractice suits and losses are substantially less when patients are treated honestly. In this miniseminar, three national experts on errors, disclosure, and apology, will discuss the ethical imperative for disclosure and the data that support this approach, both from a patient/provider satisfaction standpoint and a risk reduction standpoint. Doug Wojcieszak, the founder of Sorry Works! will speak about the advantages of disclosure and (when appropriate) apology from a patient perspective. Linda Kenney of Medically Induced Trauma Support Services will speak to how a culture of secrecy around errors harms both patients who are kept in the dark and physicians who aren’t able to be honest with their patients. Rob Hanscom, Vice President of Loss Prevention of Risk Management Foundation (a branch of Harvard’s medical malpractice carrier), will explain why insurance carriers may support thoughtful disclosure and apology policies. A discussion period will cover the issues of what and when to disclose to patients about adverse events, and the difficult question of when an apology is and is not appropriate. We will also present effective techniques for both disclosure and (when appropriate) apology. Educational Objectives: 1) Understand the literature supporting disclosure and apology as the ethically appropriate response to adverse events. 2) Understand the evidence that disclosure and apology reduce the likelihood of litigation. 3) Know strategies to facilitate disclosure and apology after errors and adverse events.

Risk management in clinical practice. Part 11. Oral surgery

Oral surgery is often an unpleasant experience for a patient and if managed inadequately can be a cause for complaint or a claim in negligence. A practitioner can reduce their risk of complaints, claims or even regulatory body investigations by following some straightforward risk management strategies. Effective communication skills deployed throughout the interaction with the patient, especially during the consent process, are a pre-requisite, as is a proper understanding of the law on consent. An honest reflection by the practitioner on their competence to carry out a procedure, considering their skills, the equipment and support available will result in fewer medico-legal cases. In this article, each stage of the patient's journey is discussed and risk management advice offered for a range of procedures that are regularly encountered in general dental practice.

Banking, insurance

Selecting an Agent or Broker Perhaps as important as the question of which insurance coverages a bank should purchase is the decision made by the bank in selecting the agent or broker and insurer to meet its insurance and loss protection needs. Bankers are well aware of the Bank Secrecy Act handbook Know Your Customer rules, designed to mitigate the potential of the bank being defrauded in check fraud and money laundering schemes. The Office of the Comptroller of the Currency (OCC) acknowledges that firm Know Your Customer policies are a bank's most effective weapon against being used unwittingly to launder money. While the OCC is not involved in the process of assisting a bank in selecting an agent or broker or insurer, the value of knowing the parties the bank is dealing with in this arena is of critical importance as well. Fortunately, many commonsense criteria apply to the decision process associated with Knowing Your Agent or Broker and Insurer. The bank should examine a potential agent or broker with certain characteristics in mind. Their integrity should be unquestioned, while knowledge of the banking business is a prerequisite. At the same time, they must be experienced specifically in insurance coverage for banks; therefore they need access to the specialized financial services insurance markets. These are specialists focused to meet the loss protection needs of financial institutions. Last but certainly not least is how responsive the agent or broker to the needs of the insured. What type of customer service can the bank expect? Selecting an Insurer Similarly, when selecting an insurer, price is only one component of the decision making process. Many of the same attributes required of the agent or broker, may also be applied to the insurer as well. Of equal or greater importance, banks need to consider whether the insurer specializes in products for financial institutions, and can meet all of the bank's bonding, property and casualty insurance, and loss protection needs. Issues a bank may wish to consider in analyzing how a potential insurer may successfully meet its specific needs include the following: Does the insurer have a track record of underwriting and claims handling partnership with financial service firms with positive results? Does the insurer provide value-added services, such as educational materials for bank employees and directors, including loss control or risk management advice? Is there local representation that includes underwriting, and claims settling authority? How timely and responsive is the company's underwriting service? What's their turnaround time on quotations? What's their reputation for timely and responsive, and, most importantly, fair claims handling service? What do you really know about the insurer? What's their financial condition? Do they have a stable, consistent presence in the marketplace? By the same token, do they have underwriters who are experienced with a long-term presence and understanding of the financial services arena? Is the integrity of the company unquestioned? You need to be confident that confidential information that is disclosed to the underwriter will be kept in confidence. Where your operations are multistate, is the underwriter able to deliver the same coverage and service in every state you need? Are they licensed to write business in your state? An unlicensed insurer is not subject to the jurisdiction of your state insurance department, and no protection is afforded under the state guarantee fund. What to Insure Traditional banking exposures to loss are well documented and covered by basic insurance programs. Fire, theft, slip and fall, robbery, extortion demand, shareholder suits against board of directors are commonplace exposures to the financial services firm. Today's banker also needs to be cognizant of new exposures resulting from extraordinary events, new business opportunities, changes in law and regulations, and advancements in technology. …

OMIC workshop: Documentation of ophthalmic care

Eye surgeons have requested risk management advice about documentation of ophthalmic care in course evaluations and needs assessments. A complete, legible medical record serves many purposes. First, it promotes patient safety and continuity of care by providing a comprehensive account of the diagnosis and treatment of the patient’s ophthalmic condition. In the event of a claim or lawsuit, the documentation in the medical record becomes evidence that can be used to defend, or possibly assail, the ophthalmologist’s care.

Issues of cause and control in patient accounts of Type 2 diabetes

Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as 'Up to me' and 'Down to them') are a valuable resource for patients, equally they may be deployed in a selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals.

Cataract surgery: reducing risk through better practice

PurposeA guideline to the practice of cataract surgery was produced in 2004 by the Royal College of Ophthalmologists. This complemented a guideline to best practice produced in 2000 by the NHS Executive. This paper reviews the guidance given by these documents and examines their clinical governance and risk management advice and usefulness.Design/methodology/approachThe guideline is critiqued in terms of its usefulness to clinicians and health‐care managers. Recent research on the consenting process for cataract surgery is used as a benchmark of best practice and compared with the guideline's recommended methods. The medico‐legal caseload experience of The Medical Protection Society (the authors' institution) is used to discuss areas of concern relating to risk management in cataract surgery of interest to clinicians and managers.FindingsThe guideline is felt to be a useful, well‐produced and recommended resource for clinicians and managers with clinical governance responsibilities for cataract surgery services. There was felt to be scope to improve some of the guidance on reporting adverse events following cataract surgery to patients.Practical implicationsThis paper will help to inform the gaining of consent for cataract surgery in the light of the latest research in this area, and help train staff in this task.Originality/valueThis paper will be of value to clinicians and managers with responsibility for cataract surgical services. It should help to inform how they set up, review and audit their practice in this area and be useful for staff training. It highlights areas of the guideline which may be of relevance to those without time to read the whole guideline.

The HEATOX Project

HEATOX is the acronym for a European Union-funded project entitled Heat-Generated Food Toxicants: Identification, Characterization, and Risk Minimization. Acrylamide will be the main experimental focus, but identification of unknown toxicants in heated carbohydrate-rich foods will also be attempted. The project includes research on formation chemistry, food technology, analytical methods, hazard characterization, and exposure assessment. The results will finally be used in risk assessment and risk management advice.