Services

ERC Risk Solutions, LLC (ERC) provides leading edge support services and education. Services are designed to meet the needs of healthcare delivery organizations, physician groups and practices as well as risk control/insurance organizations. Through partnership with ERC, you will have access to top industry experts and premier educational experiences.

Our services strengthen operational functions, claims, risk patient safety and quality management programs. Our methodology includes enterprise risk management as a foundational approach with the use of highly skilled staff, national experts and evidence based/peer review techniques, methods and tools that can be leveraged to enhance your organization's strategy for safety improvements and risk mitigation success.

ERC Risk Solutions offers a broad range of assessment services. This includes: needs assessment/trend identification/claims analysis, identification and vetting of assessment partners and medical experts, identification of key team members for the assessments and logistics for site reviews. Clients have demonstrated significant improvements based on feedback from assessments and quantitative measurement.
What makes us different? Our unique process for risk assessments is related to the proprietary indicators created based on national claims trends and best practice standards known to decrease patient harm and reduce the likelihood of adverse outcomes. These are referred to as the critical indicators and are used to measure performance and improvement over time.

Description of the risk assessment process:

  • Telephone consultation, pre-visit questionnaire, document review, staff competency evaluation
  • Claims and incident data analyses, national benchmark/standards of care research
  • Onsite visit, including:
    • Tour of facility
    • Interviews of key personnel and providers
    • Observation of service delivery and patient care
    • Review of medical records, adverse event/near miss data, and pertinent claim history
    • Exit interview for client leadership to present an overview of findings
  • Report completion
  • Follow up telephone conference with leadership to review findings, answer questions and discuss barriers

The assessment report includes:

  • Executive summary of overall findings with priority areas defined
  • Outline of areas reviewed
  • Findings and recommendations
  • Opportunities for improvement
  • Rationale and references, where applicable
  • Action plan

Available assessments include:

*Indicates assessments applicable to hospitals/facilities and ambulatory care settings.

Clinical/Environment of Care Assessments

  • Ambulatory Surgical Centers
  • Bariatric Programs
  • Behavioral Health/Substance Abuse
  • Cardiology
  • Emergency Medicine/Urgent Care/Clinic
  • GI/Digestive Health
  • Long Term Care/Geriatrics
  • Medical Records/Documentation*
  • Obstetrics/Perinatal
  • Perioperative
  • Physician Office Practice*
  • Radiology/Interventional

Programs/Service Line Assessments

  • Alarm Management/ Medical Device Safety
  • Billing and Reimbursement Audit*
  • Hand-offs/Transitions of Care*
  • Hospitalist Program
  • Infection Prevention (OSHA)*
  • Infusion Services
  • IT – Cyber Security*
  • Laborist Program
  • Medical/AHP Staff Credentialing*
  • Medication Use and Safety/Radiation Dose Review
  • Nursing Services
  • Patient Complaint Management/Service Excellence*
  • Peer Review Process*
  • Quality Program*
  • Readmissions
  • Rehabilitation
  • Research Programs*
  • Stroke Care/Neurosciences
  • Supply Chain Risks
  • Telemedicine Services*
  • Violence Prevention*
  • Other identified area of need

Experts in claims and risk management assist you with analyzing contributing factors that give rise to claims. Defense weaknesses and lessons for patient safety are gathered in a tracking document to ensure risk identification and action. This is monitored over time to identify repeat issues and overall effectiveness of risk reduction.

A formal program is offered for claims management, risk management and/or patient safety staff. This program is tailored to the level of expertise of the staff member from novice to advanced. Foundational principles are taught along with the most advanced including the concepts of Enterprise Risk Management. The mentor program is tailored to the specific needs.

Coaching/Mentoring Program

The collaborative experience is a way for ERC clients to share best practices, network, and learn from one another. ERC partners with top experts in the risk and patient safety industry in order to bring the most current and cutting edge knowledge to our members. Selection of a collaborative focus area is done with the organizations risk manager/leadership input, claim trends, and national data. Previous focus areas have included: ED, OB, perioperative, radiology, medication safety, and information technology security.

Examples of select collaboratives and associated outcomes:

Emergency Department

This collaborative included a multidisciplinary approach involving a gap analysis, risk profiling with comparison to benchmarks, on-line education, team training and communication with proactive auditing of high-risk clinical areas.
Example Outcome: The hospitals and physician groups who participated in the ED collaborative showed a significant ROI through a 30% decrease in claims with financial savings, a decrease in patient harm and improvements in patient experience/satisfaction leading to improvements in value reimbursement.

Shoulder Dystocia Simulation and Team Training

This collaborative included environment of care review, use of a high fidelity pelvic simulator with recorded simulation sessions for team review and learning, and creation and use of team communication tools created for scenario based role play.
Example Outcome: Reduction in Shoulder Dystocia claims to zero for all collaborative participants for two-year post intervention.

ERC Risk Solutions provides access to a proprietary risk identification and classification system built on in-depth clinical and legal review of medical professional liability claims. Organizations may use the taxonomy and coding process to benchmark and identify lessons to assist the organization in reducing patient harm and legal loss. Reports are provided that outline aggregate information of lessons related to patterns of harm events, contributing factors as well as litigation lessons. Data is analyzed for frequency and pattern of harm events as well as litigation weaknesses that is then used for future client benefit. ERC can provide the organization with individual data analysis reports. Benchmarking comparisons may also include national databases that provide comparisons related to frequency, severity and contributing factors.

An analysis of the current culture is conducted related to the concepts of just culture-shared accountability. Board, leadership and management education is provided. The term “just culture” refers to a values-supportive system of shared accountability where organizations are accountable for the systems they have designed and for responding to the behaviors of their employees in a fair and just manner. Employees, in turn, are accountable for the quality of their choices and for reporting both their errors and system vulnerabilities. Just culture training is designed to help change an organization’s culture by placing more focus on risk, system design, and the management of behavioral choices versus determining blame. In this model, errors and outcomes are the outputs to be monitored; system design and behavioral choices are the inputs to be managed.

Enterprise risk management (ERM) is a strategic business discipline that supports the achievement of an organization’s objectives by addressing the full spectrum of its risks and managing the combined impact of those risks as an interrelated risk portfolio.
A mature ERM program enables an organization to:

  • Measure ERM value, based on priorities
  • Create a shared language and vision
  • Tackle inadequately addressed uncertainties and opportunities
  • Streamline processes and resolve business inefficiencies
  • Build a repeatable and scalable process for better decision making
  • Reduce costs by understanding a risk’s root cause rather than simply treating the symptoms

ERC Risk Solutions team members have advanced skill in ERM and can guide your organization by:

  • Conducting a review of the ERM program/structure with a focus on the primary domains:
    • Legal/regulatory
    • Information technology
    • Clinical/patient safety
    • Operations
    • Hazard/environmental
    • Finance
    • Strategy
    • Human capital
  • Development of risk inventory and risk register
  • Use of diagnostic tools-heat map
  • Guiding in the formal creation of the ERM framework and committee process
  • Support for decision facilitation and decision analytics
  • Guiding on the method to calculate TCOR (total cost of risk)
  • Providing education to staff, leadership and the Board
  • Assisting with implementing ERM
  • Incorporating the concepts of value creation and value protection

HIRING SUPPORT

ERC Risk Solutions can provide support in the hiring process for both risk management and patient safety staff. With over 30 years of experience in the recruitment, skill assessment and cultural fit evaluation process we can help you find and fill these critical positions. This service includes interviewing, skill testing and level of expertise ranking for the role. A verbal debrief and written summary is provided and will include onboarding support strategies and recommendations for any candidate that is selected by the organization.

INTERIM OR OUTSOURCED STAFFING SUPPORT

ERC Risk Solutions can offer interim staffing support to assist with risk management/patient safety vacancies or for long term staffing arrangements. This is a customized service based on the client’s needs and staff availability.

STAFFING MODEL AND SKILLS ASSESSMENT

At any time during the employment process or even with tenured staff an organization may be in a position to evaluate or re-evaluate the staffing model, roles and functions in risk mitigation, patient safety or quality. Our assessment services aid the organization in ensuring the staffing model as well as staff placement and job duties ensure success for the organization. Through this assessment process, organizations will be armed with national data on staffing models that have proven to be effective in proactive risk avoidance and mitigation. Organizations may use this data in conjunction with the skills assessment to leverage the addition of staff or reorganization of staff to best suit the organizational goals and objectives.

HUMAN CAPITAL – ORGANIZATIONAL EFFECTIVENESS CONSULTING

You can build strong leaders and teams by developing strategies and training in your organization that build successful, engaged employees at all levels of the organization. ERC can help you:

  • Develop strategic plans
  • Hire the right team members to carry out your plans
  • Drive organizational change to meet strategic objectives
  • Develop and train people to achieve new levels of productivity, performance and innovation
  • HR compliance consulting – HR audits, employee handbooks and policy development/training

ELECTRONIC MEDICAL RECORD EVALUATION

Experts will assist you with evaluating new or existing EMR systems to ensure maximum usability and efficiency. EMR usage is now the standard, and litigation involving the EMR and design shortcomings continues to evolve. This evaluation will result in the participant benefiting from the lessons learned from litigation involving the EMR as well as human factors issues with user interface with the EMR.

ERC will assess the organization’s current process and readiness and provide training related to early resolution including:

  • Leadership’s buy-in of early resolution and communication/optimal resolution process (CANDOR)
  • Identification of adverse events and response time related to harm events including an evaluation of the standard of care
  • Disclosure communication following adverse events
  • Care for the caregiver process following adverse events
  • Methods for investigation and prevention of adverse events
    ERC can collaborate with the client on all harm events where early resolution is a viable option for a defined period of time.

As an add-on service to an assessment, ERC can assist leaders with implementation of the action plan, updating of the risk profile and measuring progress. We utilize a team-based approach with the organization’s team in the lead. Our facilitators are physicians, human factor engineers, risk/safety experts, nurses and administrators. A lead facilitator will set expectations for the team and organization regarding commitment and support to ensure the best opportunity for success. Goals will be identified and frequent meetings (virtual and in-person) will allow the team to identify barriers, needed resources and milestones to achievement. The facilitator is in frequent contact with organizational champions to ensure barriers and resources are addressed. The facilitator will provide examples of how to implement actions and tools to support the process as needed.

COMMON CAUSE ANALYSIS

A common cause analysis is a method whereby serious safety events are reviewed using a common taxonomy for identification of contributing factors. It is the common trends and themes that assist an organization in identifying the actions for prevention. This also assists in evaluating the effectiveness of previous actions based on repeatable events.

CRITICAL EVENT INVESTIGATION

A key component to both patient safety and risk management is the competency and timeliness of conducting critical event investigations. ERC Risk Solutions has a formal training process for investigation and standardized tools and checklists to guide the process for both critical event and catastrophic events. Thorough and timely critical event investigation has demonstrated a greater probability to avoid litigation, to implement early resolution and most importantly to prevent a recurrence of the event.

DUE DILIGENCE—NEW SERVICE/ACQUISITION

Experts will aid in the evaluation of new service options, expanding services or acquisitions. This review aids in helping the organization to understand the potential areas of risk exposure and opportunities to mitigate that risk prior to offering the service or prior to the acquisition. This service utilizes the Enterprise Risk Management methodology by taking an enterprise wide approach to the evaluation.

LITIGATION STRESS SUPPORT

The toll medical malpractice litigation takes on the physician and other health care professionals is the untold story in many medical malpractice cases. ERC will provide physicians with the resources and support they need to understand and cope with the personal and professional stress created by involvement in a medical malpractice case or an adverse outcome that may result or has resulted in litigation.

PROVIDER SUPPORT/WELLNESS PROGRAMS

ERC will assist organizations with developing and implementing a provider support/wellness program. Experts will educate program leaders about their roles and responsibilities, target provider-specific support issues and offer external resources, as necessary.

A gap analysis is conducted of the risk management program to provide an assessment of the structure, process and outcomes of the program in comparison to best practices. This review includes document review, medical records, interviews and a profile score of your program. The profile is a proprietary method of comparing risk management components to national practice standards. The higher the score the more advanced/mature the program is in preventing harm, avoiding risk and mitigating it quickly when it is detected. The components include:

  • Risk identification, analysis, treatment and evaluation
  • Data use and flow of information
  • Patient safety culture and just culture
  • Risk management plan and goals
  • RM department indicators and effectiveness
  • Claims management, prevention, trends
  • Patient experience, complaint management, HCAPS
  • Medical staff risk control
  • Effectiveness of loss control
  • High reliability components
  • RM education plan
  • Proactive clinical indicators/measures/outcomes-high-risk areas
  • P4P measures/outcomes
  • RM skill mix and resource allocation
  • RM investigation process
  • RCA method, outcomes, effectiveness
  • FMEA process
  • Patient safety, performance improvement, quality and RM integration
  • Compliance/regulatory outliers
  • Environmental/worker safety

Quality and Performance Improvement Assessment

This assessment includes a review of the quality program including the following process and components:

Process:

  • Survey feedback
  • Interviews
  • Document review
  • Tracers
  • Committee observation
  • Data analysis and comparative information
  • Abstracting process

Components:

  • Quality plan and indicators
  • Departmental structure
  • Resource allocation and expertise
  • Performance outcomes
  • Improvement methods and effectiveness
  • Regulatory readiness
  • Partnerships/collaborations
  • Evidence-based protocols – effectiveness
  • Quality gains/cost savings
  • Performance tracking/data review/value reporting

State/national quality initiatives/outcomes

Deliverables:

  • Executive summary
  • Assessment report with action plan
  • Implementation plan/support option

Executive Leadership Support

Quality and/or risk management experts will provide coaching and mentoring to enhance outcomes and improve the triple aim goals. Mentoring is provided to:

  • Boards
  • C-suite leaders or teams
  • Medical staff leaders/teams
  • Quality department leaders/staff

The coaching and mentoring process is customized to meet the needs of the client.

Education

Educational offerings are provided and customized based on client request/need:

  • Improvement methods and capability
  • Quality and cost value
  • Data to drive improvement
  • Trigger tools
  • Measuring harm/improvement
  • Evidence-based protocols and outcomes
  • Quality leadership

This unique service is intended for organizations that retain risk or provide insurance to providers, organizations or facilities in the healthcare delivery sector. The ability to evaluate the potential risk one of these entities presents is a skill in high demand. ERC has a team of seasoned healthcare underwriters and risk managers that allow us to extend this level of expertise to other organizations seeking this skill set. Rather than expending the effort and cost of an executive search for this high demand skill set, let us provide it for you as an outsourced service. This service engagement can be in the form of day-to-day operational support, a one time comprehensive review of all risks in the book of business, assistance with loss ratio calculation.

The risk management hotline offers guidance or advice on risk related issues. The hotline is staffed Monday-Friday during business hours by risk management professionals. Consultation that requires research or a written opinion will require an additional fee. 24/7 availability of a risk management expert can be arranged upon request.