What Could
Go Wrong

Anything and everything, according to risk consultants.

Photography: Yoshihiro Makino

Illustrations: Zach Roszczewski

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Most of us walk through life blind to the hazards around every corner. Little things, like an uneven sidewalk or an unsteady bookshelf, don’t usually register as potential catastrophes. And it’s probably good they don’t, or we might never leave the house.

But what if it were your job to predict the worst—to search your environment for anything that could go wrong? That’s the role of a risk consultant. Here, move through three distinct locations as a risk consultant would, systematically sniffing out disasters before they happen.

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Part 3: Operating Rooms

Hundreds of thousands of patients die each year in hospitals as a result of preventable harm. Journal of Patient Safety estimates this figure to be between 210,000 and 440,000. Of course, hospital administrators, physicians, and other practitioners strive to provide quality care and limit clinical errors, but health care carries inherent risks. This is especially true in operating rooms, where distractions and interruptions can lead to serious mistakes or omissions.

The list of variables that contribute to error during surgery is long. And no matter how skilled a surgeon may be, he or she can't manage all of those factors alone. It takes a combined effort from the surgeon, anesthesiologist, nurses, and technicians to operate safely. But the team needs support from beyond the walls of the procedure suite, too. Risk consultants who specialize in health care can play a critical role by examining clinical processes, observing workflows, suggesting ways to integrate risk-control strategies, and identifying areas for improvement.

Whatever the procedure, an operating room is a complex and fast-paced environment, which is why there's no better setting to illustrate how a risk consultant's proactive, strategic actions can help surgical teams focus on their work and increase patient safety.

Operating Rooms

Risk Assessment

When beginning work within a hospital system, a risk consultant's primary role is to look at the whole clinical environment and carefully identify areas of potential concern. This starts with a review of written policies and procedures. Next, the consultant observes doctors, nurses, and other staff in action, methodically looking for evidence of accountability and a culture of safety and respect.

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Operating Rooms

Risk Assessment

Interviews with key staff members also play a major role in the assessment, focusing on workflows and risk mitigation measures such as how—and how quickly—critical updates are given to patients.

According to one study, health-care providers commonly withhold information from patients about medical mistakes and tend to disclose clinical missteps only when pressed. Risk consultants can provide guidance to the surgical staff on how to acknowledge mistakes, which helps repair patient relationships and promote greater transparency and safety.

Interviews with key staff members also play a major role in the assessment, focusing on workflows and risk mitigation measures such as how-and how quickly-critical updates are given to patients.

According to one study, health-care providers commonly withhold information from patients about medical mistakes and tend to disclose clinical missteps only when pressed. Risk consultants can provide guidance to the surgical staff on how to acknowledge mistakes, which helps repair patient relationships and promote greater transparency and safety.

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Operating Rooms

Patient Selection

One of the most important questions that should come up before entering the operating room: Is the patient an appropriate candidate for this procedure? The benefits of a particular surgery may be a point of debate—as is the case for meniscus surgery, which research shows is usually no more effective than physical therapy for many patients. Risk consultants help doctors and patients communicate effectively to make the right call.

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Operating Rooms

Safety Functions

It seems simple, but checklists go a long way—specifically, standardized safety checklists designed to help staff identify and resolve problems during the three critical stages of surgery: before anesthesia, before skin incision, and before patients leave the operating room.

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Operating Rooms

Safety Functions

These checklists facilitate communication on high-risk issues, including anesthesia safety; equipment readiness; known allergies to medications and latex; positioning of the patient's body; and surgical tool counts. One of the most widely recognized checklists for operating-room safety is from World Health Organization.

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Operating Rooms

Safety Functions

Other checkpoints and protocols help keep the team in sync, like “time-outs,” which occur immediately before the start of a procedure. At that moment, the team pauses all activity to confirm the key details about the patient and the operation.

Other checkpoints and protocols help keep the team in sync, like “time-outs,” which occur immediately before the start of a procedure. At that moment, the team pauses all activity to confirm the key details about the patient and the operation.

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Operating Rooms

Safety Functions

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Operating Rooms

Safety Functions

There are also patient transfer protocols so no important information is left out when a patient is moved between, say, the pre-operation staff and the surgical team, or the surgical team and the postanesthesia care unit.

There are also patient transfer protocols so no important information is left out when a patient is moved between, say, the pre-operation staff and the surgical team, or the surgical team and the postanesthesia care unit.

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Operating Rooms

Conflict Resolution

Even with safety protocols in place to facilitate good communication, some friction is inevitable within surgical teams; stress levels run high in operating rooms. According to one survey, 26 percent of nurses said that doctors have actually thrown objects at them. If left to fester, sources of conflict can undermine teamwork dynamics and patient safety. Risk consultants assess the quality of communication within organizations and train staff in conflict-resolution approaches.

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Operating Rooms

Safety Functions

Different surgical tools must be passed in specific ways, allowing surgeons to immediately use them without repositioning their grip.

Surgical teams are typically comprised of surgeons, anesthesiologists, nurses, physicians’ assistants and other personnel. Working well together is paramount for the success of the operation.

Surgical nurses preparing the procedure suite for an operation.

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Operating Rooms

Environmental Safety

Efficiency of movement is an important factor in a well—functioning operating room. With that in mind-and though it may seem obvious—one of a risk consultant's highest priorities is to check whether a surgical suite is optimally laid out for patient safety.

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Operating Rooms

Environmental Safety

Are there guidelines for managing foot traffic in and out of an operating room?

Are there guidelines for managing foot traffic in and out of an operating room?

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Operating Rooms

Environmental Safety

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Operating Rooms

Environmental Safety

Is staff movement unimpeded by structures in the room?

Is staff movement unimpeded by structures in the room?

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Operating Rooms

Environmental Safety

Is there a protocol for the swift removal of equipment that's not in use?

Is there a protocol for the swift removal of equipment that's not in use?

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Operating Rooms

Environmental Saftey

These kinds of questions extend to the larger property as well. Many hospitals are transforming their spaces to accommodate more patients, and risk consultants can oversee every step of the renovation and construction process to make sure insurance concerns are addressed, including large issues like clinical infrastructure and smaller ones like signage.

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Operating Rooms

Discharge Readiness

Many hospitals struggle with overcrowding, which can lead to sending surgical patients home earlier. With the length of inpatient stays on the decline (the current average is four and a half days, down from about seven in 1980), hospitals are retooling the discharge planning process with an eye toward increasing patients' understanding of how to better take care of themselves after they leave. Risk consultants help hospitals determine the root causes of readmissions, improve the discharge process, develop after-hospital care plans, and monitor communication with patients and their loved ones.

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This is how a trained risk consultant sees a hospital. Learn more from Chubb risk expert Caroline Clouser.

Q&A with Caroline Clouser,

EVP, Chubb Healthcare

Which hospital risk keeps you up most at night?

A missed or delayed diagnosis related to an infection is certainly one of the more serious risks. These types of incidents can result in catastrophic injuries to patients, which can include loss of limbs—and that can cost millions to resolve. Multimillion-dollar awards and settlements have been recorded related to these cases, so providers must ensure infection control and infection prevention are top priorities to reduce their liability exposures.

What are the risks you immediately look for when you step into a medical facility?

Security is certainly top of mind. Hospitals may be places of healing, but they also have become the scene of an increasing number of violent incidents. Violence against healthcare providers by patients or visitors nearly doubled between 2012 and 2014, according to the Occupational Safety and Health Administration (OSHA). Medical professionals are often the targets of attacks, harassment, intimidation, and other disruptive behavior. Hospitals and healthcare organizations should enact a zero-tolerance policy prohibiting any form of violence, whether physical, verbal, or psychological.

Healthcare organizations should develop a comprehensive violence prevention program that is specific to their organization, analyzes potential safety hazards, and implements strategies to prevent them.

Can patients do anything to ensure they have a safe hospital-going experience?

The most important way a patient can contribute to their safety during a hospitalization is to be their own healthcare advocate. This means taking part in every decision about their healthcare. Patients should not be afraid to raise their hand and ask questions, especially before agreeing to a specific treatment or procedure. Questions like: Can you please explain what my treatment options are and tell me about the risks and benefits of each? This way they fully understand their options and can make a confident, informed decision about their treatment plan.

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