Welcome, everybody. This is the risk management and patient safety podcast presented by Medplace. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations around the country. So please subscribe to the latest news and content. If you find value from this episode, please share it with your colleagues to create meaningful dialogues in this community. Also, if you're interested yourself in participating as a guest, please send us an email at speakers at Medplace.com. So I'm your host, I'm Jared Bailey. I'm the CEO of a Medplace. And I'm excited to introduce to you today our guest, this is Denise Atwood. She's the Chief Risk Officer at district medical group. So and by the way, the opinion shared by Denise here today with all of us are hers. They're not the district medical group's opinions. And with that, welcome Denise.
Denise Atwood 09:22
Thank you Jarrod. Doing well.
Jerrod Bailey 09:25
Nice to see you. So for some of our listeners, that may not you know they may be new to the industry. Can you just explain briefly what is risk management in your eyes? And how did you get into it? Like what's your sort of story coming into risk management.
Denise Atwood 09:47
Risk Management at a high level when we educate new employees at district Medical Group is really about mitigating or decreasing risk to our employees and to the organization. We do that a number of ways through education, training, answering questions, or if there's a particular real time event, providing risk guidance to help decrease those risks, and sometimes even their anxiety when we're, they're going through some type of unexpected event.
Jerrod Bailey 10:21
Great. Okay, good. So you've got some empathy. And you've got a lot of stakeholders involved here, when you know when things go wrong, maybe, and you're thinking about all of them along the way, how did you get into this?
Denise Atwood 10:33
I got into it a little bit by accident, I guess you could say for a number of years, I was a leader in healthcare management. I had gone to law school a little later in life. And then I decided it was time to switch gears. And I thought risk management would be a good fit in healthcare, with my nursing and law background. So I became a risk management consultant, learned about what risk managers do, again, about the educating how to mitigate risks, how to appropriately answer questions, and not interfere or in any way, go against a law or rule or regulation. And they ended up being a wonderful fit. And that's how I got to be the chief risk officer of a healthcare organization.
Jerrod Bailey 11:27
I love it. Well, that's a lot of things to keep in your mind at all times, as you're navigating also very potentially emotional circumstances. I don't know how you do that. It's, it seems like a superpower I have read, I've had the pleasure to meet a lot of risk managers that share that superpower. And it still eludes me, I'm a technology person. And I love that sort of part of things. But how you guys manage what he manages is pretty incredible. Any, any misconceptions about risk management that are out there that you often feel or miss?
Denise Atwood 12:04
Yes, misconceptions could be. We like to call ourselves fixers. But again, once you bring the problem to us, we can help you fix it, whether that's, again, more education, working with the families to do the right thing, or even supporting you through litigation, but we can't make it go away. So once an incident or event has happened, we use that to teach others but the event will still remain and be something to grow and learn through something unanticipated that I didn't expect getting into risk management is really that second hand trauma that can happen to providers, when an incident or a mistake occurs, and how greatly it really affects them, and being able to work with them to continue to do their very best day after day. Because lawsuits may last 2, 3, 4 years. And that's a long time until you may get resolution and you still have to go do your best every day. For the patients that are you're still treating.
Jerrod Bailey 13:18
Yeah, I've heard about the trauma associated with it. And I've talked to doctors who've gone through, and I've talked to doctors that and then mentor doctors that are going through it and other providers. Because and it's important because they're still practicing medicine. And that's a lot of stress. That's a lot of pressure. And we want to see them continue to practice good medicine, even though they're in the midst of something that's very difficult for them to navigate in the patient and everyone involved. So that's great. Well you've been in the industry, a while you've been in long enough to grow yourself in probably change your own perspective, which would be interesting to hear how you've sort of grown in your in your role. But you're also probably now looking ahead and like what is risk management's 2.0? What does that look like 10 years from now? Right? And what do we wish we'd be doing now thinking about now and what's changing today? In over the next few years that others should be thinking about? Questions altogether?
Denise Atwood 14:26
Interesting questions. I was going to say in general and risk I think it draws people who like change and can really succeed in flux and change and emergencies. So something that I've learned is my nursing and trauma background comes in very handy, because I teach my team triage what's coming at us today. Triage it and say which of these 10 priorities are the top two priorities? And then we move from there. So that's something that we learn and do together. Something that we all So did was we create risk procedures, meaning if we encounter something new, we draft a physical paper procedure so that if we come back to that issue or concern or situation, again, we're very consistent in the information we share, provide the risk mitigation, where we're going, I really think in healthcare and other industries, it's transferable to other industries, enterprise risk management, realizing that risk management touches every aspect of your business, finance, strategic planning, human capital, our employees, contracting it, it has a lot of risk, as we know in and unto itself, you coming from an IT background will greatly understand that, but it impacts what we insure, what type of insurance policies we get. So really thinking more globally about enterprise risk management, risk management touches at all.
Jerrod Bailey 16:05
Interesting, well, so how does somebody think about it? Like what sorts of decisions do you make differently when you're thinking about it in that type of scope?
Denise Atwood 16:16
When you're thinking about it in that scope, or context, something that we've done at district Medical Group, we actually have a plan. It's an enterprise risk management plan. I happen to have a certification for healthcare risk management through ASHRM. And we use the ASHRM plan that has eight domains touches the entire organization, from patients to insurance. And that's what we use as our plan to guide us and to educate both our board and all of our employees what that means and what it looks like. Okay, great.
Jerrod Bailey 16:51
So those listening who aren't aware of that plan or don't have any plan at all, if they join ASHRM, they get access to that type of that type of guidebook, playbook for doing this. And yes, risk management.
Denise Atwood 17:04
Yeah. Even real time education. ASHRM has started doing enterprise risk management, a two day course, which I attended last year.
Jerrod Bailey 17:15
Great. A circle back to ASHRM, because it's an incredible organization that has a lot of organization of risk managers around these different topics. And I know you've got some interesting projects that you're working on, too. Okay, interesting. So, the thinking in terms of the broader scope of enterprise risk management, if you're not thinking about that today, you probably will be thinking about that as a risk manager going over the next few years, and realizing that all of these things do sort of fit together. And they do have dependencies on each other. Okay, great. Well, what else is sort of a change that you're seeing happen? I think we mentioned earlier talking around like disclosures, and in some of the ways that I think conversations are changing. Well, yes, patients tell me about that. So with
Denise Atwood 18:09
disclosures of unanticipated outcomes, and everyday people, that means something happened between a provider and a patient, and it was not expected, it may have been on the consent form, meaning it may have been a known risk. But if that risk happens, what do you disclose? So, we train our providers to have open disclosures, be honest with the patient, our goal is to do the right thing for the patient, and support our providers through that process, because that's a change from a number of years ago for many providers who may have been in practice for some time. So it's educating, it's supporting, and it's bringing a team together that if that provider is not comfortable discussing that unanticipated outcome with a family, we actually bring in their chair, to help with those discussions, and show them what it looks like in practice.
Jerrod Bailey 19:10
Wow. I mean, it's a big cultural change from decades past. And you think what those in the industry have been industry a while and have, we've all started to see that shift, but I don't know, do you? Do you have any advice on how risk managers who want to move towards that type of communication? protocol in style? Like, how do you do that in an organization that hasn't done it before?
Denise Atwood 19:39
That is a really good question. First, I would, since this will be a national podcast, people really need to check their state laws to see if they have what's called I'm sorry, laws or basically laws that say, just because you've gone to the patient and said you're sorry for what happened. does not equate to liability, are you admitting some wrong, that could be used against you and then lawsuit later. So it's really important to know the state law in your area, before developing this type of program. And then who there's other resources, I'm sure ASHRM has information at ECRI. They have a lot of information about these types of programs. And if you're a physician group with, like us that contracts with other facilities, work with those facility legal and risk managers to develop an appropriate program that works for everyone.
Jerrod Bailey 20:40
That's great. Yeah, and it's interesting that you guys do work with other facilities, because you're not necessarily always in the information stream when stuff happens and you need to collaborate together and work together to wrap around the providers involved, and everyone else that can be, can be a lot of moving parts, and it can be different philosophies about that. Right? And how you how you reconcile those. I don't know if you have any advice on that. But it's, it's interesting that it sounds like you're seeing a trend in this direction.
Denise Atwood 21:17
Yes, that takes a particular personality style, ability to mediate style, to bring people together that may have very different ideas about how such matters should be treated. But it really starts with an open discussion. Because I find most people are adverse to change because of fear. Fear of a past lawsuit, fear of a past disclosure to a patient. So having those discussions to overcome those fears, and maybe looking at other established programs that provide training on how these types of disclosures are done.
Jerrod Bailey 22:03
Yeah, it's interesting, I imagine the first time somebody wades into this water of these kind of early disclosures, open discussion type of styles that it can be scary, and they're not all going to go well. Some are going to be amazing. I've heard some stories that bring tears to my eyes about how well, this works. And I know your other stories were what that didn't go well at all. And they came in with an agenda and, and all sorts of other stuff around it. You've got to have, I guess, some intestinal fortitude to get through some of those hard ones. And celebrate the good ones. But is there any advice? There's anyone that can help through situations like this? I mean,
Denise Atwood 22:51
it's really interesting, you brought that up? Because yes, there's the disclosures that we perceive went very well. And those that we perceive are more confrontational, if you will. But many times we find patients and their families just want to be heard, and being heard, maybe I'm angry that this happened, and learning how to take that potentially critical feedback, we do offer support to our providers, through EAP. And actually, because we also employ counselors, we provide counseling to them both before and after, if they need it, to support them through this process, because it may be very hard to sit across from a family who had maybe a family member that was injured, or a patient that themselves was injured in some way. And hear that type of feedback. So we provide support at that level as well.
Jerrod Bailey 23:50
I love that it's one thing that we've been asked by our so our clients or hospitals, and also carriers and others in the sort of ecosystem of risk. And we get asked a lot can we so medical aids provides specialists, nurses and doctors of different specialties to look at cases and up. And we've asked, Can we also provide specialists that have a background in counseling, these providers that are going through this? And so it's something that we're working on right now, and I think it's great, and I think it's great is there's so many organizations that have created that function for their providers, and because it's so hard to go through this type of thing and have these conversations and switches for the first time. Right? And especially if they get contentious, like how do you navigate that? And having somebody that's, that's been down that road that can be a steady hand in that process is great.
Denise Atwood 24:47
Yes, we also have peer to peer support, and that's through a RISE program. It's a formal program through Johns Hopkins. They trained our staff for peer-to-peer support, and it's resilience in stressful events, we allow our employees to use it for both work related and non-work related, like maybe a divorce or child custody event. So you have peer to peer, non-clinical, but therapeutic support as well.
Jerrod Bailey 25:15
Fantastic. one thing I hear a lot is a lot of times the, the patient or the family they're angry, but a lot of times, they just want to know, how can this experience help others avoid this situation in the future? And that's it. And you can take that quote that question seriously, or you can blow it off. But I've heard some really amazing responses, that question of how simple things, in the delivery of care protocols, were changed as a result of that. And in the relief that gave the family knowing that they could help just avoid that, that unfortunate outcome that nobody was intending on but to help avoid that in the future.
Denise Atwood 26:02
Yes, and risk managers should take that unsolicited solicited feedback from patients and families, it's the best way to understand how we're being perceived that we do our job, and that's delivering the best healthcare we can.
Jerrod Bailey 26:18
And seeing that information, go back into the quality departments in the in the medical staff and really being integrated back into things it's really great. I've seen some really great examples of health coordinate organizations that do a great job of feeding back the learnings back into the to what they're doing and creating a new best practice. That's really nice. Love it? Well, so you've got a lot of peers around the country, that some of them are on an island make feel alone, some of them have some great like ASHRM chapters around them that they plug into your thinking of your own or not thinking you've started your own kind of organization, specifically, the collaborative, just like organizing people, what is the Arizona risk management collaborative, like what prompted the collaborative.
Denise Atwood 27:17
So myself and another risk manager, Maritza, we were talking about ways to do things better and bring together organizations that defend against medical malpractice lawsuits. And we thought, what a better way to do that than to reach out, see if our peers would come together, those from healthcare organizations, hospital organizations, even an insurer to see what we could do better to learn about what it takes to defend and do better in the space.
Jerrod Bailey 27:51
I love that. So, the purpose is, is to bring all these different constituents together and learn from each other.
Denise Atwood 27:59
Yes, together and get better together and be loosely grouped together. There's no one person that is the president of the collaborative, it's truly a team effort and a collaborative with group input.
Jerrod Bailey 28:15
I love that in so like, what are the mechanics? Or do you guys get is there do you get together in some way? Or do you do how do you how do you collaborate? How do you talk to each other? We do we originally plan on doing that to kicking some of the stuff off.
Denise Atwood 28:35
Sure. Maritza and I thought originally people would maybe we could get them together one time a year. And we thought that would be amazing. But after the first meeting, the collaborative the team think was, let's meet quarterly. So we just had our second quarterly meeting this morning. And we take up the entire two hours, and participants staying engaged about risk and legal matters, things that are on their mind, and we share collectively. So for example, today at the quarter two meeting, we got volunteers, or the second meeting, we got volunteers for quarter two, three and four. So that we divvy up the work the agenda that presenting throughout the team and it's not just relying on one or two people
Jerrod Bailey 29:26
to one or two heroes and their heroic efforts. Yes, everything happened. Yeah. Like getting a lot of different people together. They're all busy in their different lanes and exchanging information if it's not sustainable if it's on one or two person shoulders, so for anyone who would love to see a little bit more togetherness in their in a local community. Hopefully this gives them a little bit of inspiration on what they might start themselves into the analog of the LRMC if you will If people need one, if somebody is in Arizona and lessons, which is where I happen to be where you and I are both based, right? So I do work actually my place does work nationally, but we're based largely here in Arizona, so it's nice to your backyard. But if anybody local is listening to this, how do they get involved?
Denise Atwood 30:18
Sure, they could email me at Denise_Atwood@DMGAZ.org.
Jerrod Bailey 30:30
Perfect. And I'll see if I can put that in the in the show notes as well, in case they are listening to this and didn't quite get that get that down. But this is great. Denise, is there anything else that you want to give us any parting words on
Denise Atwood 30:45
If you're interested in risk management, it is an excellent field, try to find a mentor to help you navigate some of these areas of risk. But I have found great people that mentored me through this process. And it is a wonderful profession. I really love what I do.
Jerrod Bailey 31:03
Fantastic. Well, thank you for doing what you do. And thank you for bringing together others so that we can all get better together. I think that that resonates with me that we can learn from each other and we can move forward and grow and discover what the risk management platform of 10 years from now really will be and how we've worked together to improve that. And what we do in between now and then. So Denise It was a pleasure to have you thanks for making the time. Don't be a stranger love to have you on again. And let us know you know how things are going with the air and see as we continue to track what you guys are doing and thanks again for joining us.
Denise Atwood 31:49
Thank you. All right, we'll talk soon. Okay, bye bye.
