By Traci Haynes
Does the word risk evoke an emotional connotation? Regardless of the inference and based on life experience, the word can carry an emotive element. There are uncertainties in risk, which may be associated with hobbies, tasks, or employment.
Calculated risk is one in which a chance is taken after careful consideration and estimation of the probable outcome. Healthcare organizations employ risk managers to identify and evaluate risks to reduce injury to patients, staff, and visitors within the organization.
The five basic steps of risk management include:
- establish the context
- identify risks
- analyze risk
- evaluate risks
- treat/manage risks
Risks do exist in a medical call center. There are employee risks and patient risks. These can include risks from the physical environment, clinical management, and technology. What can organizations do to help mitigate these risks? Be calculative, carefully considering and estimating probable outcomes. Even doing so will not eliminate total risk.
An excellent resource that covers information on risk is The Art and Science of Telephone Triage: How to Practice Nursing over the Phone. It is a book written by two industry leaders in the field of telehealth nursing practice, Carol Rutenberg, RN-BC, C-TNP, MNSc, and M. Elizabeth Greenberg, RN-BC, C-TNP, PhD. The book also documents the history of telephone triage and its subsequent evolution, real case scenarios, a chapter of FAQs, best practices, and other topics.
Minimizing risk is essential in the medical call center environment. Consider your potential for risk; then analyze, evaluate, and manage it. Also essential is focusing on ways in which the medical call center can support the organization’s risk avoidance. Of utmost importance to every organization is supporting the Institute for Healthcare Improvement’s Triple Aim initiative and optimizing health system performance of better outcomes, lower costs, and improved patient experience.
Hospitals throughout the country are aggressively tackling performance improvement within their own organizations, and evidence shows their efforts are working, helping to reduce risk. The recent addition of a fourth aim emphasizes the importance of improving the experiences of those in the workforce who provide healthcare. The Quadruple Aim focuses not only on better outcomes, lower costs, and improved patient experience, but also on improved clinician experience.
A medical call center’s number one asset is its staff. Employees need to feel recognized for the work they do. Their working environment should encourage respect and foster a sense of belonging and purpose. They should have the ability to influence their work, as well as given opportunities for professional growth.
Let’s drill down a little further on potential risks in a medical call center. Please note this is not an all-inclusive list and not in order of importance. However, it is information to consider.
- Clinical oversight (such as the medical director): approval of clinical content, decision support tools, educational material, medications, orders, etc.
- Job descriptions: title, clear description of work duties, purpose, special skills, and qualifications for the position
- Scope of service: what type and for whom
- State Board of Nursing Nurse Practice Act: Follow standards of practice
- Licensure: state license, Nurse Licensure Compact
- Orientation/Training/Preceptor: defined program with monitoring, feedback, and evaluation
- Policies and procedures: associated with call handling and call scenarios
- Performance monitoring/evaluations: formal approach using call records and/or call recording
- Continuous quality improvement: process to identify issues, implement/monitor corrective action, and evaluate the effectiveness
- Electronic Health Record (EHR): access and by whom
- Computers: hardware/software, latest recommendations, updates, backup, and archiving
- Database: decision support tools and functionality for a standard method of documentation of the encounter, optimizing the intake of information, and supporting a consistent approach to provision of information and directions for care; reporting of outcomes
- Telephone system: supports call handling that may include auto-attendant, call routing, tracking average speed of answer, time in queue, abandonment; real-time monitoring, reports, and recording of calls
- Chat/email/texts/photos: accept and save as part of EHR
- HIPAA compliant: protecting health information
- Outdoor surveillance monitoring
- Lighting: internal measurement, general, task, emergency, external
- Security locks: after-hours or 24/7
- Parking: onsite, offsite, monitored, lighting
- Security personnel: onsite, offsite
- Sound: acoustics, masking, privacy
- Workstation ergonomics: standing/sitting, monitor height/distance, keyboard/mouse position, adjustable chair with height/arm height/back support, headset, and so forth.
- Repetitive stress injuries: most commonly affects injuries to the upper extremities (wrists, elbows, and hands) due to repetitive keyboard activities
Patients and Families
- Medical call center access: 24/7, after-hours, business hours, community service, or provider/payer service
- Reason of call: emergent, urgent, semi-urgent, and non-urgent
- Language and culture: linguistically and culturally appropriate and using an individual’s primary language
- Age-specific or all age groups
- Social determinants of health: influences an individual’s quality of health
- Past medical history: health status prior to encounter and effect on the reason of call/disposition
- Chronic conditions: type, number, affect the reason for call/disposition
- Medications: routine, prn, affect the reason for call/disposition
- Preventive health: affect overall health
- Disabilities: type, affect the reason for call/disposition
- Disposition: collaborative decision, access for care as needed
Traci Haynes, MSN, RN, BA, CEN, CCCTM, is the director of clinical services at LVM Systems, Inc.